Offer to Purchase

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					                                                                Registration number: 2003/005273/21
                                                                Vat Registration number: 4840207833



HEAD OFFICE                                                    Litigation || Velile Tinto, Nelius van Huyssteen, Danie Swanepoel, Christiaan De Wet,
TINTO HOUSE                                                    Conveyancers || Jacobus Johannes Erasmus, Cynthia du Plessis, Janine
C/O Hans Strijdom & Disselboom RD, Wapadrand,                  Shackleton, Pieter Wolmarans
P O Box 733 Wapadrand, 0050                                    Chief Operating Officer: Henriette Du Plessis
Docex 178, Pretoria                                            Snr Manager Home Loans: Martin Vorster
Tel: (012) 807 3366                                            Executive Consultant: PS Grobler
Fax: (012) 807 0966




OFFER TO PURCHASE                                               AANBOD OM TE KOOP
Which Constitutes an                                            Wat omskakel tot ‘n
AGREEMENT OF SALE                                               KOOPKONTRAK
Upon Acceptance by the Seller                                   Teen aanvaarding deur die Verkoper


I/We                                                            Ek/Ons
………………………………………………………………………                                     …………….…………………………………………………………..
       (Full names & Surname of Natural Person / Name of                (Volle name & Van Natuurlike Persoon/ Naam van
                 Company, Close Corporation, Trust)                            Maatskappy, Beslote Korporasie, Trust)
 ………………………………………………………………………                                    …………….…………………………………………………………..
 (Identity Number of Natural Person / Registration Number of         (Identiteitsnommer van Natuurlike Persoon / Registrasie
           Company, Close Corporation. Trust Number)            nommer van Maatskappy, Beslote Korporasie, Trust Nommer)


Marital Status if Natural Person                                Huwelikstatus indien Natuurlike Persoon
 Single                                                         Ongetroud
 In Community of Property                                       Binne Gemeenskap van goed
 ANC / Ante Nuptial / Out of Community                          HVK / Huweliksvoorwaarde / Buite
 Traditional                                                    Tradisioneel
 Foreign ……………………………………………………………                                Buitelandse Huwelik ……………………………………………
 Other ……………………………………………………………..                                Ander …………………………………………………………….


Capacity if not natural person                                  Hoedanigheid indien nie natuurlike persoon
 Director                                                       Direkteur
 Share Holder                                                   Aandeel Houer
 Member                                                         Lid
 Trustee                                                        Trustee
 Authorized Agent                                               Gemagtigde Agent
Authorized person to sign documents…………………                      Gemagtigde persoon om dokumente te teken
………………………………………………………………………..                                   ………………………………………………………………………
………………………………………………………………………                                     ………………………………………………………………………
(hereinafter referred to as the Purchaser)                      (Hierinlater verwys as die Koper)
                                                               2

Hereby make(s) an offer to purchase the undermentioned         Maak hiermee ‘n aanbod om die ondergenoemde eiendom te
property from                                                  koop van


………………………………………………………………………                                    ………………………………………………………………………...
     (Full names & Surname of Natural Person / Name of                  (Volle name & Van Natuurlike Persoon/ Naam van
                Company, Close Corporation, Trust)                           Maatskappy, Beslote Korporasie, Trust)
 ………………………………………………………………………
 (Identity Number of Natural Person / Registration Number of   ………………………………………………………………………...
           Company, Close Corporation. Trust Number)                 (Identiteitsnommer van Natuurlike Persoon / Registrasie
                                                                   nommer van Maatskappy, Beslote Korporasie, Trust Nommer)
Marital Status if Natural Person
 Single                                                       Huwelikstatus indien Natuurlike Persoon
 In Community of Property                                      Ongetroud
 ANC / Ante Nuptial / Out of Community                         Binne Gemeenskap van goed
 Traditional                                                   HVK / Huweliksvoorwaarde / Buite
 Foreign …………………………………………………………..                              Tradisioneel
 Other ……………………………………………………………..                               Buitelandse Huwelik …………………………………………..
                                                                Ander …………………………………………………………..
Capacity if not natural person                                 Hoedanigheid indien nie natuurlike persoon
 Director                                                      Direkteur
 Share Holder                                                  Aandeel Houer
 Member                                                        Lid
 Trustee                                                       Trustee
 Authorized Agent                                              Gemagtigde Agent
Authorized person to sign documents…………………                     Gemagtigde persoon om dokumente te teken
………………………………………………………………………..                                  ………………………………………………………………………


(hereinafter referred to as the Seller)                        (Hierinlater verwys as die Verkoper)


The property in respect of                                     Synde die eiendom beskryf as
 Sectional Unit                                                Deel Eenheid
Unit / Section Nr                ………………                        Eenheid Nr                    ………………
Exclusive Use Area               ……………..                       Uitsluitlike Gebruiksgebied ……………..
Complex Name …………………………………………………….                             Kompleks …………………………………………………….
Scheme Number …………………………………………………                              Skema Nommer …………………………………………………

                                                                Konvensionele Eiendom
 Conventional Property
                                                               Erf Nr               ………………
Stand / Erf Nr       ………………
                                                               Gedeelte / Restant ……………..
Portion / Remainder ……………..
                                                               Dorpsgebied          ………………………………………………..
Township…………………………………………………………
                                                               Uitbreiding ………………………………………………………….
Extension ………………………………………………………….
                                                               Provinsie            ………………………………………………..
Province …………………………………………………………….
                                                               Groot       ………….         vierkante meter/ hektaar
Extent ……………………square metres / hectares
                                                               Straat Naam           ……………………………………………….
Street Name ……………………………………………………….
(Hereinafter referred to as the Property)                      (Hierinlater verwys as die Eiendom)
                                                                       3
The Conveyancers / Attorneys                                           Transportprokureur / Aktevervaardigers
VELILE TINTO & ASSOCIATES INC                                          VELILE TINTO & ASSOSIATE ING
TEL: (012) 807-3366                                                    TEL: (012) 807-3366
FAX: (012) 807-0966                                                    FAKS: (012) 807-0966
REFERENCE:                                                             VERWYSING:
1. PURCHASE PRICE                                                      1. KOOPSOM
1.1 The purchase price is the sum of:                                  1.1 Die koopsom beloop die bedrag van:
R………………………………………………………………………                                            R………………………………………………………………………
 ……………………………………………………Rand (in words)                                       ………………………………………………….. Rand (in woorde)
payable as follows:                                                    Betaalbaar soos volg:
1.2 on acceptance of this offer by the Seller the Purchaser            1.2 Met aanvaarding van hierdie ooreenkoms deur die
        will make an initial deposit of –                                    Verkoper sal die Koper ‘n deposito maak ten bedrae van –
R………………………………………………………………………                                            R………………………………………………………………………
 ……………………………………………………Rand (in words)                                       ……………………………………………………Rand (in woorde)
Within ……… days on request by the Conveyancers /                       Binne ……… dae op aanvraag van die Aktevervaardiger /
acceptance of this offer.                                              aanvaarding van die kontrak.
The Conveyancer will deposit this sum in an interest bearing           Die Aktevervaardiger sal die gelde op ‘n rente draende trust
trust account. Interest thereon, (until registration), accruing to     rekening belê, tot datum van registrasie, welke rente tot krediet
the Purchaser                                                          van die Koper sal wees
1.3 The balance / full purchase price being:                           1.3    Balans Koopsom / Volle Koopsom synde :
R………………………………………………………………………                                            R………………………………………………………………………
 ……………………………………………………Rand (in words)                                       ………………………………………………….Rand (in woorde)
To be paid to the Seller against registration of this transfer in      Is betaalbaar aan die Verkoper teen registrasie van die
the name of the Purchaser(s)                                           oordrag in die naam van die Koper(s)


2. SUSPENSIVE CONDITION                                                2. OPSKORTENDE VOORWAARDE


2.1          This agreement is subject to the suspensive               2.1 Hierdie kontak is onderhewig aan die opskortende
             condition that the Purchaser obtains approval for the            voorwaarde dat die Koper goedkeuring bekom vir ‘n
             granting of a loan by a Bank / Financial Institution –           verbandlening deur ‘n Finansiele Instansie / Bank –
2.1.1        Such approval will be granted within 14 (fourteen)        2.1.1 Goedkeuring moet bekom word binne 14 (veertien)
             calendar days of acceptance hereof.                       kalender dae op aanvaarding hiervan.

2.1          The     loan    will    be     for   not   less    than
                                                                       2.2        Die      verbandlening       sal      ten      minste
             R…………………………… against registration of a
                                                                                  R…………………………… bedrae, en rangeer as ‘n
             first mortgage bond over the property;
                                                                                  Eerste Verband oor die Eiendom;
2.2          If the Purchaser cannot obtain finance from a
                                                                       2.3        As die Koper nie finansiering kan bekom binne 20
             financial institution within 14 days of date of
                                                                                  dae na aanvaarding van die aanbod nie,by ‘n
             acceptance of this offer, this contract will lapse and
                                                                                  Finansiele Instansie nie, sal hierdie kontrak verval
             be null and void.
                                                                                  en as gekanselleer beskou word;
                                                                     4
2.4. DELIVERY OF GUARANTEES                                          2.4. LEWERING VAN WAARBORGE
The Purchaser will within:                                           The Koper sal binne:
     -     7 (seven) calendar days (bank loan by purchaser                -    7 (seven) kalender dae (verband lening deur die
           and/or existing bond registered over property); or                  Koper en/of bestaande verband oor eiendom); of
     -     14 (fourteen) calendar days (cash offer by purchaser           -    14 (veertien) kalender dae (kontant koop deur Koper
           and no existing bond on property),                                  en geen bestaande verband oor eiendom),
after acceptance of this offer by the Seller, deliver to the         na aanvaardig van hierdie aanbod deur die Verkoper, aan die
Conveyancer a Bank Guarantee. Such guarantee securing                Transport Prokureurs 'n Bank waarborg lewer, welke waarborg
payment of the balance/full purchase price to the Seller on          die balans/volle koopsom sal verseker aan die Verkoper teen
registration.                                                        datum van registrasie.
3. ACKNOWLEDGEMENT BY PURCHASER                                      3. ERKENNINGS DEUR KOPER
The Purchaser acknowledges that the Property is sold:                Die Koper erken dat die eiendom verkoop word:
3.1 to the extent it now lies, voetstoots, without any               3.1 voetstoots, soos dit nou daar is, sonder enige waarborge
     warranties whether expressed or implied and the Seller               hetsy uitdruklik of stilswyend en dat die Verkoper nie
     shall not be liable for any defects whether latent or                aanspreeklik sal wees vir enige gebrek(e), hetsy verborge
     otherwise in the Property nor for any damage suffered by             of andersins, in die eiendom nie en ook nie vir enige
     the Purchaser by reason of such defects; and                         skade wat die Koper as gevolg van sodanige gebreke
                                                                          mag ly nie;
3.2 Subject to the conditions of the Sectional Titles Act No 95      3.2 onderworpe aan die bepalings vandie Wet op Deeltitels
     of 1986 as amended; and                                              No 95 van 1986 soos gewysig; en
3.3 Subject to all conditions and servitudes mentioned or            3.3 onderworpe aan al die voorwaardes en serwitute soos
     referred to in the current and/or prior title deeds of the           tans na verwys indie huidige en/of voorafgaande
     property, as well as in the Sectional Title Plan and any             titelaktes van die eiendom, of in die deelplan en enige
     town planning scheme applicable to the Property;                     dorpsbeplanning-skema van toepassing op die Eiendom;


4. OCCUPATION                                                        4. OKKUPASIE
4.1 Occupation of the Property shall be given to the                 4.1 Okkupasie sal aan Koper gegee, en deur hom geneem
     purchaser on ……………………………… on which date                              word op …………………………………. Indien okkupasie-
     the Purchaser shall take occupation thereof. If the date             en registrasiedatum nie dieselfde is nie, sal die party wat
     of occupation does not coincide with the registration date,          okkupasie het terwyl dit in die naam van die ander party
     the party enjoying occupation of the Property while it is            geregistreer is, maandeliks vooruit okkupasiehuur by die
     registered in the name of the other party, shall pay at the          transportprokureurs     inbetaal    ten    bedrae      van
     transferring Attorney, occupation rental monthly in                  R………………………(………………………………………
     advance            in         the          amount          of        …………………………………………………….…)woorde
     R……………………(…………………………………………                                      4.2 Die verkoper bevestig dat daar geen huurkontrak op die
     ………………………………...……………………….)words                                      eiendom is nie
4.2 It is hereby recorded that the Property is not subject to a
     lease agreement


5. BREACH                                                            5. KONTRAKBREUK
In the event of the Purchaser failing to remedy any breach of        Indien die Koper versuim om enige breuk van die bepalinge
the terms hereof within 7 (seven) days of the date of dispatch,      van die ooreenkoms te herstel binne 7 (sewe) dae na datum
by prepaid registered post or facsimilee, requesting the             van versending van 'n kennisgewing per vooruitbetaalde
Purchaser to rectify such breach, the Seller shall be entitled at    geregistreerde pos of facsimile waarin hy versoek word om
his option and without any prejudice to any other of the rights      sodanige breuk reg te stel, sal die Verkoper na keuse en
in law.                                                              sonder benadeling van sy ander regte, geregtig wees om:


5.1 to cancel this Agreement, reoccupy the property and to           5.1 hierdie ooreenkoms te kanselleer, herbesit van die
                                                                      5
     keep any deposit in terms of Clause 1, as well as other                 Eiendom te neem en om die deposito kragtens Klousule
     amounts paid by the Purchaser as "roukoop" or by way of                 1, asook ander bedrae deur die Koper betaal, te behou
     penalty, or as liquidated damages, or as payment in                     as roukoop of as 'n strafbedrag of as gelikwideerde skade
     respect of the prejudice agreed upon as being suffered by               of as betaling van die ooreengekome nadeel wat die
     the Seller as a result of the Purchaser's breach, over and              Verkoper gely het as gevolg van die Koper se
     above any further damages claimed;                                      kontrakbreuk bo-en behalwe enige verdere eis om
                                                                             skadevergoeding;
5.2 to enforce performance of the terms hereof including              5.2 nakoming       van    hierdie    ooreenkoms     af     te     dwing,
     payment of the full balance of the purchase price and all               insluitende die betaling van die volle balans van die
     other amounts owing in terms hereof, as well as any                     koopsom en alle ander bedrae hierkragtens, en enige
     losses incurred by him.                                                 skade wat hy mag ly


6. PENALTY CLAUSE                                                     6. BOETERENTE
Should there by any delay with the registration of transfer, the      Die party wat verantwoordelik is vir die vertraging van die
party responsible for such delay shall pay penalty interest on        registrasie van transport, sal aanspreeklik wees vir die betaling
the full selling price at a rate of prime % per year for the period   van 'n boete, bereken op die volle koopsom vir die duur van
of the delay                                                          die vertraging teen prima rentekoers per jaar.




7. DOMICILIUM CITANDI ET EXECUTANDI                                   7. DOMICILIUM CITANDI ET EXECUTANDI
All notices intended for the Seller shall be sent to him by           Alle    kennisgewings     gerig     aan   die   Verkoper        sal   per
registered mail to:                                                   geregistreerde pos gestuur word na die volgende adres:
………………………………………………………………………                                           ………………………………………………………………………
………………………………………………………………………                                           ………………………………………………………………………
………………………………………………………………………                                           ……………………………………………………………………….
All notices intended for the Purchaser shall be sent to him by        Alle kennisgewings gerig aan die Koper sal per geregistreerde
registered mail to:                                                   pos gestuur word na die volgende adres:
………………………………………………………………………                                           ………………………………………………………………………
………………………………………………………………………                                           ………………………………………………………………………
……………………………………………………………………….                                          ……………………………………………………………………….


8. ENTIRE CONTRACT                                                    8. VOLLE OOREENKOMS
The parties agree that this Deed of Sale constitutes the entire       Die partye erken hiermee dat hierdie ooreenkoms die hele
contract between them and that there are no other conditions,         kontrak tussen hulle bevat en dat geen ander voorwaardes,
stipulations, warranties or representations whatsoever made,          bedinge, waarborge en/of voorstellings hoegenaamd deur
other than such as may be signed by the parties hereto.               enige van die partye gemaak is, behalwe soos hierin
                                                                      uiteengesit nie.


9. ELECTRICAL CERTIFICATE                                             9. ELEKTRISITEITSERTIFIKAAT
The Seller shall be liable to furnish the Purchaser with an           Die Verkoper sal verantwoordelik wees om die Koper te
Electrical Certificate in respect of the Property at his cost,        voorsien van 'n elektristeitsertifikaat op sy koste, tensy anders
unless otherwise agreed by the parties herein.                        deur die partye ooreengekom
                                                                    6
10. JURISDICTION                                                    10. JURISDIKSIE
The parties consent to the jurisdiction of the Magistrates Court    Die partye stem hiermee toe ingevolge die bepalings van
having jurisdiction over its person in respect of all proceedings   Artikel 45 van Wet 42 van 1944, soos gewysig, tot die
connected with this Agreement, notwithstanding that the value       jurisdiksie van die Landdroshof wat jurisdiksie mag hê
of the matter in dispute might exceed the Court's jurisdiction.     ingevolge Artikel 28 van die gemelde Wet, ten opsigte van
Notwithstanding the afore going, the parties and the Agent          enige    geding    wat       voortspruit   uit   hierdie   ooreenkoms,
shall be entitled to institute all or any proceeding against any    nieteenstaande die feit dat sodanige bedrag andersins die
party connected with this Agreement in any Division of the          jurisdiksie van gemelde Hof te bowe mag gaan nie.
Supreme court of South Africa having jurisdiction.                  Nieteenstaande die voorgaande sal enige van die partye
                                                                    geregtig wees om in sy absolute diskresie regstappe te neem
                                                                    in enige bevoegde Hof wat andersins jurisdiksie mag hê.



11. AGENTS COMMISSION                                               11. AGENTE KOMMISSIE
It is hereby recorded that no/agent's commission will/not be        Die partye plaas op rekord dat hierdie transaksie nie / deur 'n
paid by the Seller. The agent's commission will amount              eiendomsagent bewerkstellig is/nie en dat agentekommissie
R………………………… and will be payable to the following                    deur die Verkopers betaalbaar is/nie.            Die gemelde agente
agency ………………………………………………………                                        kommissie beloop R…………………………………… welke
Which said commission will be paid out on date of registration      bedrag teen registrasie van transport in die naam van die
of this transfer in the name of the Purchaser.                      kopers betaalbaar sal wees aan die Agentskap.


12. PAYMENT OF TRANSFER COST                                        12. BETALING VAN OORDRAGSKOSTE
The registration of transfer shall be proceeded with                Die genomineerde Aktevervaardiger sal na ondertekening
immediately after signature hereof by the nominated                 hiervan dadelik voortgaan met registrasie van oordrag, en die
Conveyancer and the parties agree to sign all the necessary         partye onderneem om onverwyld op versoek die nodige
documents upon request. The Purchaser is liable for payment         dokumente te onderteken. Die koper is aanspreeklik vir die
of all costs pertaining to the registration of transfer and other   betaling van alle kostes wat met die registrasie van oordrag
related costs, which cost shall be payable upon request.            gepaard gaan, welke koste op aanvraag betaalbaar is.


13. RISK AND OWNERSHIP                                              13. RISIKO EN EIENDOMSREG
Possession of the property shall be given to the Purchaser on       Besit van die eiendom word aan die Koper gegee op datum
date of registration of transfer, on which date all benefits and    van registrasie van transport op welke dag alle voordele en
risks with regard to the property shall pass to the Purchaser,      risikos ten opsigte van die eiendom na die Koper oorgaan
including rates and taxes and other imposts levied thereupon.       insluitende die aanspreeklikheid van belastings en heffings.


14. LEVIES / RATES & TAXES & HOME OWNERS                            14.      HEFFINGS        /     UITKLARINGS         &   BELASTINGS&
ASSOCIATIONS                                                        HUISEIENAARS VERENIGING
14.1 Levies and/or rates and taxes and or Home Owners               14.1     Heffings / Uitklarings& Belastings tesame met gelde
         Association Monies are for the account of the –                     verskuldig aan die Huiseienaars Vereniging is vir die
                                                                             rekening van-
14.1.1       Seller up to date of registration                      14.1.1     Verkoper tot en met datum van registrasie;
14.1.2       Purchaser after the date of registration               14.1.2     Koper vanaf datum van registrasie;
14.2 Service fees (incl. water & electricity) are for the account   14.2     Diensfooie (insl. Water & elektrisiteit) is vir die rekening
         of the –                                                            van-
14.2.1       Seller up to the date that the Seller vacates the      14.2.1     Verkoper tot en met datum wat die koper die
             Property                                                          eiendom okkupeer;
14.2.2       Purchaser from the date of occupation by the           14.2.2     Koper vanaf okkupasie datum deur Koper;
             Purchaser
                                                                    7
The seller hereby certifies that they are nor indebted by any       Die Verkoper sertifiseer hiermee dat hy nie agterstallig is met
local authority for the abovementioned. The Seller indemnifies      enige bedrae verskuldig aan die owerhede nie. Die Verkoper
the Purchaser against any claim above entities may make for         indemnifiseer hiermee die Koper van enige eis wat enige
payment of any amount before consenting to issue a clearance        owerheid mag hê voor uitreiking van 'n klaringsertifikaat. In die
certificate. In the event that the above entities refuse to issue   geval wat 'n owerheid weier om 'n 'n klaringsertifikaat uit te
the required certificate, this contract lapses immediately, and     reik, sal hierdie koop as gekanselleer beskou word, en sal die
the Purchaser will be entitled to the immediate reimbursement       Koper geregtig wees om enige/alle eise in te dien, dien effekte
of any expenses or loss suffered flowing from this contract.        vir skadevergoeding en/of uitgawes aangegaan as gevolg van
                                                                    hierdie kontrak.


15. COOLING-OFF CLAUSE                                              15. AFKOELKLOUSULE
The PURCHASER is in terms of the Alienation of Land Act,            Die KOPER is in terme van die Wet op Vervreemding van
Act 68 of 1981 entitled within a period of 5 (FIVE) DAYS from       Grond, Wet 68 van 1981, geregtig om binne 'n periode van 5
date of signature hereof by the PURCHASER, to revoke the            (VYF) DAE vanaf ondertekening hiervan deur die KOPER, die
offer, and in the event of the offer having been accepted by the    aanbod te herroep en indien die aanbod aanvaar is deur die
SELLER, to terminate this agreement by giving the SELLER or         VERKOPER of sy/haar agent skriftelik tot die effek in kennis te
his/her agent written notice to that effect in the manner           stel op die Wyse soos voorgeskryf deur die bogenoemde wet.
prescribed in the said Act.


16. SPECIAL CONDITIONS                                              16. SPESIALE VOORWAARDES

………………………………………………………………………                                         ………………………………………………………………………
………………………………………………………………………                                         ………………………………………………………………………
………………………………………………………………………                                         ………………………………………………………………………
………………………………………………………………………                                         ………………………………………………………………………
………………………………………………………………………                                         ………………………………………………………………………
                                       8

DONE AND SIGNED AT …………………………………. ON THE ………………………………………………………2009


ALDUS GEDOEN EN GETEKEN TE …………….……… OP DIE ……………………….……………….……………..2009


AS WITNESSES:
AS GETUIES:




1. ………………………………………………………………...             …………………………………………………………………




2. ………………………………………………………………...             …………………………………………………………………
                                           (Seller // Verkoper)




THUS DONE AND SIGNED AT ………………………………. ON THE ……………………………………………………2009

ALDUS GEDOEN EN GETEKEN TE ………………………… OP DIE …………………………….…………………..…..2009



AS WITNESSES:
AS GETUIES:




1. ………………………………………………………………...             ………………………………………………………………




2. ………………………………………………………………...             ………………………………………………………………
                                           (Purchaser // Koper)
                                      9
GENERAL INFORMATION                   ALGEMENE INLIGTING
SELLER                                VERKOPER
SURNAME                               VAN
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
FULL NAME                             VOLLE NAME
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
IDENTITY NUMBER                       IDENTITEITSNOMMER
………………………………………………….……………………          ………………………………………………………………………
POSTAL ADDRESS ………………………………………………     POS ADRES
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
RESIDENTIAL ADDRESS ………………………………………   WOON ADRES
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
TELEPHONE NUMBER                      TELEFOON NOMMER
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
BOND HOLDER                           VERBAND HOUER
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
BODY CORPORATE / COUNCIL              BEHEERLIGGAAM / MUNISIPALITEIT
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
TAX REFERENCE NUMBER                  VAT VERWYSINGSNOMMER
………………………………………………………………………...        ………………………………………………………………………...


PURCHASER                             KOPER
SURNAME                               VAN
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
FULL NAME                             VOLLE NAME
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
IDENTITY NUMBER                       IDENTITEITSNOMMER
…………………………………….…………………………………          ………………………………………………………………………
POSTAL ADDRESS ……………………………………………      POS ADRES
………………………………………………………………………           ………………………………………………………………………
………………………………………………………………………           ………………………………………………………………………
RESIDENTIAL ADDRESS ………………………………………   WOON ADRES
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TELEPHONE NUMBER                      TELEFOON NOMMER
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TAX REFERENCE NUMBER                  VAT VERWYSINGSNOMMER
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