Bollaert, Immo & Verzekeringen BVBA

Bollaert, immo & verzekeringen BVBA Page 1 of 3

Candidate renter for: …………………………………………………………………………………………………… THE CANDIDATE(S) CANDIDATE A CANDIDATE B Surname

First name (second name as well) Date of Birth

Place of Birth

Email address

Telephone number

In possession of good YES/NO YES/NO behaviour?

MARITAL STATUS CANDIDATE A CANDIDATE B o MARRIED o MARRIED Marital status o REGISTERED PARTNERSHIP o REGISTERED PARTNERSHIP o SINGLE o SINGLE Incase you’re married or have a registered partnership: Surname, name (first and second) of your partner

SITUATION OF WORK CANDIDATE A CANDIDATE o FIXED o FIXED o TEMPORARY o TEMPORARY Current job o INTERIM o INTERIM o INDEPENDENT o INDEPENDENT o … o … o Full-time o Full-time o Part-time o Part-time o 4/5 o 4/5 o … o …

Bollaert immo & verzekeringen BVBA Heirweg 98, 9270 Laarne-Kalken 09/367.85.28 & 0478/50.16.72 Ond nr: BE0567947371 [email protected] IBAN: BE45 3930 4615 2689 Marleen De Mulder BIVn° 501060 Sarah Bollaert BIVn° 508171 Monthly net income (add proof that you’ve received your wage of the past 3 months)

Where do you work and what is your function?

Have you had the following past year?: YES/NO YES/NO Debt negotiation YES/NO YES/NO Budget control YES/NO YES/NO Budget negotiation YES/NO YES/NO Collective debt settlement YES/NO YES/NO Paid alimony YES/NO YES/NO Incase it’s yes, how much? …. ….

FAMILY SITUATION CANDIDATE A CANDIDATE B Amount of adults & their age

Amount of children & their age Amount of family members that will be living in the house Pets? Incase you have, which ones?

Do you smoke?

CURRENT RESIDENCE CANDIDATE A CANDIDATE B Current street & number

Current postal address

Current town

Starting rental date of the previous residence Bollaert, immo & verzekeringen BVBA Page 3 of 3

NEW RESIDENCE CANDIDATE A CANDIDATE B From which date onwards would you want to hire the residence? Expected rental period

ADD THE FOLLOWING DOCUMENTS o Salary slip of the past 3 months o Proof that you’ve paid your rent the past 3 months (if applicable)

Undersigned declares that this declaration is filled in truthfully and signed (put your initial on each page). Made at the …………………………………………………………. on ……………………………………………… Signature of the candidate-renter(s):

Bollaert immo & verzekeringen BVBA Heirweg 98, 9270 Laarne-Kalken 09/367.85.28 & 0478/50.16.72 Ond nr: BE0567947371 [email protected] IBAN: BE45 3930 4615 2689 Marleen De Mulder BIVn° 501060 Sarah Bollaert BIVn° 508171