SECTION A SECTION B - Daleglen

1 RESIDENTIAL APPLICATION FORMTel: 021 424 1210 Fax: 086 212 9333 IMPORTANT NOTES: For each Applicant/Occupant copies of the following documents should accompany this Application form . (Please tick box)ID DocumentProof of income - ( Payslip or 3 months bank statements)Proof of current residential address - ( copy of lease, cell phone, clothing, bank or credit card account) 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. A R125-00 credit check fee is payable by each adult Applicant once application has been accepted. 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 - ACCOMODATION APPLIED FOR:Flat / House:No:Garage No:Parking Bay No:Occupation Date:Number of adults to occupy the premises:( SECTION B to be completed by First Applicant and SECTION C for every other.)

2 Number of children to occupy the premises:Age of each child:2 - FIRST APPLICANT (For every other occupant a copy of SECTION C should be completed in full)Surname:Mr / Mrs / Ms / OtherFull Names:Identity No:Citizenship:Do you have a clear credit record?Tax number:Marital Status:SingleMarried (Specify)3 - CONTACT DETAILSC urrent Residential Address:Residential Telephone No:Cell No:E-mail Address:Duration at Current Address:yearsmonthsPresent Monthly Rental: RReasons for leaving:Present Landlord:Landlord's Telephone No:Cell No:4 - BANK & FINANCE DETAILSName of Bank:Branch:Bank Account No:Car Registration Number:Make and Model:Amount owing:RMonthly Instalments: RFinancier: SECTION ASECTION BYESNOPage 1 of 4 RESIDENTIAL APPLICATION FORMTel: 021 424 1210 Fax: 086 212 9333 5 - EMPLOYMENT reference & INCOMEName of Employer:Work Address:Contact reference Person:Work Telephone No:Cell No:E-mail Address:Occupation:Period Employed:yearsmonthsMonthly Salary Income:RMaintenance Income (If any):ROther Income.

3 RSpecify6 - REFERENCES OTHER THAN WORK No colleagues or Ex-Landlord ONLY 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: ( Clothing / Credit Card)1 Amount Owing: R2 Amount Owing: R7 - SPOUSE SECOND APPLICANT PERSON SHARING PARTNER(Please select)Surname:Mr / Mrs / Ms / OtherFull Names:Identity No:Citizenship:Do you have a clear credit record?Tax number:Marital Status:SingleMarried (Specify) SECTION CYESNOPage 2 of 4 RESIDENTIAL APPLICATION FORMTel: 021 424 1210 Fax: 086 212 9333 8 - CONTACT DETAILSC urrent Residential Address:Residential Telephone No:Cell No:E-mail Address:Duration at Current Address:yearsmonthsPresent Monthly Rental: RReasons for leaving:Present Landlord:Landlord's Telephone No:Cell No:9 - BANK & FINANCE DETAILSName of Bank:Branch:Bank Account No:Car Registration Number:Make and Model:Amount owing:RMonthly Instalments: RFinancier:10 - EMPLOYMENT REFERENCEName of Employer:Work Address:Contact reference Person:Work Telephone No:Cell No:E-mail Address:Occupation:Period Employed:yearsmonthsMonthly Salary Income:RMaintenance Income (If any):ROther Income.

4 RSpecify11 - REFERENCES OTHER THAN WORK No colleagues or Ex-Landlord ONLY 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 FORMTel: 021 424 1210 Fax: 086 212 9333 11 - REFERENCES OTHER THAN WORK ( )3 Name:Address:Home No:Work No:Cell No:Relationship:Accounts: ( Clothing / Credit Card)1 Amount Owing: R2 Amount Owing: R12 - ACKNOWLEDGEMENT: I/WE HEREBY CONFIRM THAT I/WE HAVE PERSONALLY INSPECTED THE INTERIOR OF THE PREMISES APPLIED FOR AND ACCEPT THECONDITION OF THE SAID PREMISES AS IS. I/We declare that the above information is correct. 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.

5 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 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 :Date:First ApplicantSignature:Date:Second ApplicantHow did you get to know about Daleglen Property Group (Pty) Ltd?

6 NewspaperDaleglen Website GumtreeTo let sign Been tenant beforeOther tenantsFriendsOther referralsOther (Please specify)OFFICE USE ONLY:Rental DetailsDeposit & Feesi013 Flat / Townhouse: Rb919 Deposit - FlatRi014 Garage:Rb919 Deposit - GarageRi014 Parking Bay:Rb919 Deposit - ParkingRi022 Store roomRb919 Deposit - Store room RTOTALRb406 TPN Fees:Rb407 Lease Fees:RTOTALRSECTION DPage 4 of 4