Full Names & Surname*
ID Number*
Cell No*
Office No*
Email Address*
Source of Income* - Monthly Salary Contactor Temp Self Employed Other
Monthly Income (after tax)*
Other Income
Total Loans*
Marital Status* - Single Divorced Married ICOP Married ANC
SA Citizen* - No Yes
I have:* - Broken a lease in the last 2 years Refused to pay rent in the last 2 years Been evicted in the last 5 years Been in arrears in the last 2 years Been under debt review in last 3 years Had judgements in the last 5 years Been declared insolvent Been convicted of a crime Two of the above None of the above
Details on "other" sources of income (if applicable) or circumstances around "I have" above
Current Residential Address*
Status* - Owner Tenant
Period at Address (years)*
Current Rent / Bond amount*
Employer Company Name*
Area *
Length of service (Years)*
Occupation / Position / Title*
Reason for moving*
Preferred Occupation Date*
Preferred Lease Period* - 6 months 1 Year 2 Years Longer
Total Occupants* - 1 2 3
No. of Vehicles* - 0 1 2
No. of Smokers* - 0 1 2
No. of Children - 0 1 2
Please upload a copy of the applicant ID here. The remaining documents can be forwarded later once the application is approved.
The tenant confirms having read the terms and conditions below and hereby consents and authorises the landlord or agent to, at all times: a) contact, request and obtain information from any credit provider (or potential credit provider) or registered credit bureau relevant to an assessment of the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the tenant; b) furnish information concerning the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the tenant to any registered credit bureau or to any credit provider (or potential credit provider) seeking a trade reference regarding the tenant’s dealings with the landlord.* Agree Disagree