RESIDENTIAL APPLICATION FORM Tel: 021 424 1210

Fax: 021 423 4694

residential@daleglen.co.za

www.daleglen.co.za

IMPORTANT NOTES:

� Copies of ID DOCUMENTS and PROOF OF INCOME (i.e. Payslip) of all Applicants to accompany this application.

� Pets / Animals may NOT under any circumstances be kept in or on the premises.

� Please ensure that the Application Form is completed in full in order to be eligible for consideration.

� Completion of this form does not guarantee that you will be accepted as a Lessee as final acceptance is that of the Lessor.

� Successful applicants are notified within three days. Should you not hear from our office in that time, your application is unsuccessful.

� A R125-00 credit check fee is payable by each Applicant once application has been accepted.

1 - ACCOMODATION APPLIED FOR:

Flat / House: No:

Garage No: Parking Bay No:

Number of persons to occupy the premises (Including children): Occupation Date:

2 - FIRST APPLICANT

Surname: Mr / Mrs / Ms / Other

Full Names:

Identity No: Citizenship:

Do you have a clear credit record? Tax number:

Marital Status: Single Married A.N.C Married I.C.P Other (Specify)

3 - CONTACT DETAILS

Current Residential Address:

Residential Telephone No: Cell No:

E-mail Address:

Duration at Current Address: years months Present Monthly Rental: R

Reasons for leaving:

Present Landlord:

Landlord's Telephone No: Cell No:

4 - BANK & FINANCE DETAILS

Name of Bank: Branch:

Bank Account No:

Car Registration Number: Make and Model:

Amount owing: R Monthly Instalments: R

Financier:

SECTION A

SECTION B

YES NO

Page 1 of 4

RESIDENTIAL APPLICATION FORM Tel: 021 424 1210

Fax: 021 423 4694

residential@daleglen.co.za

www.daleglen.co.za

5 - EMPLOYMENT

Name of Employer:

Work Address:

Contact Reference Person:

Work Telephone No: Cell No:

Work Fax No:

Occupation: Period Employed: years months

Monthly Income: R Maintenance (If Any): R

6 - REFERENCES OTHER THAN WORK

Parents, Family or Friends (Not at the same address)

1 Name:

Address:

Home No: Work No:

Cell No: Relationship:

2 Name:

Address:

Home No: Work No:

Cell No: Relationship:

3 Name:

Address:

Home No: Work No:

Cell No: Relationship:

Accounts: (e.g. Clothing / Credit Card)

1 Amount Owing: R

2 Amount Owing: R

7 - SPOUSE SECOND APPLICANT PERSON SHARING PARTNER (Please select)

Surname: Mr / Mrs / Ms / Other

Full Names:

Identity No: Citizenship:

Do you have a clear credit record? Tax number:

Marital Status: Single Married A.N.C Married I.C.P Other (Specify)

SECTION C

YES NO

Page 2 of 4

RESIDENTIAL APPLICATION FORM Tel: 021 424 1210

Fax: 021 423 4694

residential@daleglen.co.za

www.daleglen.co.za

8 - CONTACT DETAILS

Current Residential Address:

Residential Telephone No: Cell No:

E-mail Address:

Duration at Current Address: years months Present Monthly Rental: R

Reasons for leaving:

Present Landlord:

Landlord's Telephone No: Cell No:

9 - BANK & FINANCE DETAILS

Name of Bank: Branch:

Bank Account No:

Car Registration Number: Make and Model:

Amount owing: R Monthly Instalments: R

Financier:

10 - EMPLOYMENT

Name of Employer:

Work Address:

Contact Reference Person:

Work Telephone No: Cell No:

Work Fax No:

Occupation: Period Employed: years months

Monthly Income: R Maintenance (If Any): R

11 - REFERENCES OTHER THAN WORK

Parents, Family or Friends (Not at the same address)

1 Name:

Address:

Home No: Work No:

Cell No: Relationship:

2 Name:

Address:

Home No: Work No:

Cell No: Relationship:

Page 3 of 4

RESIDENTIAL APPLICATION FORM Tel: 021 424 1210

Fax: 021 423 4694

residential@daleglen.co.za

www.daleglen.co.za

11 - REFERENCES OTHER THAN WORK (continue...)

3 Name:

Address:

Home No: Work No:

Cell No: Relationship:

Accounts: (e.g. Clothing / Credit Card)

1 Amount Owing: R

2 Amount Owing: R

12 - ACKNOWLEDGEMENT:

� I/We declare that the above information is correct.

� I/We hereby confirm that I/we have personally inspected the interior of the premises applied for and accept the condition

of the said premises as is.

� If the application is successful, I/we agree to sign Daleglen Property Group (Pty) Ltd's standard lease agreement and I/we

shall be bound by all terms and conditions thereof.

� No agreement of lease shall be deemed to exist between the Lessor and myself until the lease has been signed by, or on

behalf of, the Lessor.

By submitting this application form, the applicant hereby consents and authorises the landlord and Daleglen Property Group (Pty) Ltd to:

� 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 applicant.

� Furnish information concerning behaviour, profile, payment patterns, indebtedness, whereabouts and creditworthiness

to any registered credit bureau or to any credit provider (Or potential credit provider) seeking a trade reference regarding

the applicant's dealings with the Lessor.

Signature: Date:

First Applicant

Signature: Date:

Second Applicant

How did you get to know about Daleglen Property Group (Pty) Ltd?

Newspaper Daleglen Website Gumtree To let sign Been tenant before Other tenants

Friends Other referals Other (Please specify)

OFFICE USE ONLY:

i013 Rent: R

i014 Garage: R

i014 Parking Bay: R

b919 Rental Deposit: R

b919 Remote Deposit: R Credit check:

b919 Electricity Deposit: R

b406 TPN Fees: R Date approved:

b407 Lease Fees: R

b408 Cancellation fee: R

TOTAL R

SECTION D

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