<p> Bollaert, immo & verzekeringen BVBA Page 1 of 3</p><p>Candidate renter for: …………………………………………………………………………………………………… THE CANDIDATE(S) CANDIDATE A CANDIDATE B Surname</p><p>First name (second name as well) Date of Birth</p><p>Place of Birth</p><p>Email address</p><p>Telephone number</p><p>In possession of good YES/NO YES/NO behaviour?</p><p>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 </p><p>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 …</p><p>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)</p><p>Where do you work and what is your function?</p><p>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? …. ….</p><p>FAMILY SITUATION CANDIDATE A CANDIDATE B Amount of adults & their age</p><p>Amount of children & their age Amount of family members that will be living in the house Pets? Incase you have, which ones?</p><p>Do you smoke?</p><p>CURRENT RESIDENCE CANDIDATE A CANDIDATE B Current street & number</p><p>Current postal address</p><p>Current town</p><p>Starting rental date of the previous residence Bollaert, immo & verzekeringen BVBA Page 3 of 3</p><p>NEW RESIDENCE CANDIDATE A CANDIDATE B From which date onwards would you want to hire the residence? Expected rental period</p><p>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)</p><p>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):</p><p>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</p>