CONFIRMATION OF PERSONAL DETAILS Your Details Title First Name(s) Surname Gender Male Female Date of Birth
Initials
RSA Identity Number or Passport Number Residential Address Unit / Flat Number Complex / Flat Name Street Number Street Name Suburb City Postal Code Postal Address (If different to residential address) Box Number Suburb City Postal Code Contact Details Telephone (home) Fax E-mail Address Marital Status (Please tick appropriate box) Single Divorced Married Widowed Marital Contract Type Antenuptual Contract Accrual System Community of Property Tribal Law Telephone (work) Cellphone
Occupation (Please tick appropriate box) Full-time Employed Part-time Employed Self-employed Unemployed Student Minor (under 18 years) Pensioner Housewife Member of Parliament
Gross Income per Annum (Please tick appropriate box) 0 -3 999 4 000 - 7 999 8 000 - 11 999 12 000 - 17 999 18 000 - 23 999 24 000 - 29 999 30 000 - 35 999 36 000 - 47 999 48 000 - 59 999 60 000 - 71 999 72 000 - 83 999 84 000 - 99 999 100 000 - 119 999 120 000 - 149 999 150 000 - 199 999 200 000 - 249 999 250 000
If you are a Tax Payer in South Africa RSA Tax Reference Employer I certify that the above information is true and correct
Signature I ATTACH HERETO THE FOLLOWING SUPPORTING DOCUMENTS: Proof of Identity (Please tick appropriate box) RSA Identity Document Proof of Address Proof of Tax Registration (Please tick appropriate box) Payslip (reflecting your tax no. Passport
Date
SARS Letter of registration
SARS Tax Return
The tenant hereby consents that, 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.