New Customer Registration Form
Date
*
-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Agent/Representative Names
*
First Name
Last Name
Type a question
*
1
2
3
4
5
Customer Details:
Marital Status
*
Please Select
Married
Not Married
Type of Marriage
*
Community of Property
Not In Community of Property
Client Names
*
First Name
Last Name
Citizenship Status
Please Select
Local Citizen
Non Local Citizen
Identity Number
Spousal details
*
First Name
Last Name
Citizenship Status
*
Please Select
Local Citizen
Non Local Citizen
Identity Number
*
Address
*
Physical Address
Postal Address
Village
District
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Other Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Interested Plot Number
*
Plot Size (meter Square)
Listed Property Price
*
Amount to be Paid
*
Remaining Ammount
*
Percentage Amount to be paid
*
Please Select
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Occupation/Business Type
*
How did you hear about us?
*
Please Select
Newspaper
Facebook
Magazine
Other
Suggestions if any for further improvement:
Will you be willing to recommend us?
*
Yes
No
Maybe
Your Identity Documents
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Proof of Payment
Browse Files
Drag and drop files here
Choose a file
Cancel
of
OFFER ACCEPTED AND APPROVED BY (THE PURCHASER)
Completed at
*
On this Day of
*
Purchaser Signature
*
Spouse Signature
*
1.Witness Names
*
First Name
Last Name
1.Witness Signature
*
2.Witness Names
*
First Name
Last Name
2.Witness Signature
*
Declaration of Signature Authenticity
I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law.
SIGN & SUBMIT
For Office Use (FULL TITLE OF PLOT)
Lease number
Zone number (Provisional):
Plot number (Provisional):
Plot Size (meter Square)
Price Per Square Meter
Total Property Price
Total Amount Paid
Total Amount Remaining (Balance)
Should be Empty: