Japa Estate - Plot Application Form
CONFIDENTIAL: Please complete all required details (Name, Phone, E-mail, Plot Type) and confirm the declaration before submitting.
Plot Details
Form Receipt No.
Plots Required
Payment Plan
Outright Payment
Within 6 Months
Plot Type
*
Residential 300sqm - 2 Bedroom Bungalow Semi Detached
Residential 540sqm - 3 Bedroom Bungalow with BQ
Residential 540sqm - 3 Bedroom Duplex with BQ
Residential 720sqm - 4 Bedroom Bungalow with BQ
Residential 1080sqm - 5 Bedroom Duplex with option of guest chalet
Commercial (Above 200sqm) - Nursery/Primary School
Commercial (Above 200sqm) - Clinic
Commercial (Above 200sqm) - Event Center
Commercial (Above 200sqm) - Sport Complex
Commercial (Above 200sqm) - Hotel
Personal Info
Upload Passport Photograph
Upload Passport Photograph
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of
Name (Surname First)
*
Status
Single
Married
Current Home Address
Phone No.
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ID No.
Next of Kin Info
Next of Kin Name
*
First Name
Last Name
Address
*
Phone No.
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Employment Info
Current Employer
*
Date Employed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Office Phone No.
Please enter a valid phone number.
Format: (000) 000-0000.
Position
*
Annual Salary
Organisation/Institutions/Companies
Organisation Name
Organisation Address
RC Number
Name of Representative 1
Representative 1 Phone No.
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Representative 2
Representative 2 Phone No.
Please enter a valid phone number.
Format: (000) 000-0000.
Declaration
Declaration statement
Full Name
*
First Name
Last Name
I agree to the above declaration
*
I agree
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: