Application for rental contract

Personalia applicant

Marital status applicant

Employer applicant

Personalia partner

Marital status partner

Employer partner

Current landlord / lessor

The undersigned testifies that B.V. Makelaardij Onroerende Goederen Peter van Bruggen te Heerlen is given the permission to confidentially check the above data on correctness. The applicant further declares to have truthfully filled in the requested fields. Rental will be effective as and when both parties have signed the rental agreement. The applicant declares not to hold B.V. Makelaardij Onroerende Goederen Peter van Bruggen te Heerlen responsible if for whatever reason a rental agreement could not be reached. Undersigned, hereafter to be referred to as "the client", states that B.V. Makelaardij Onroerende Goederen Peter van Bruggen te Heerlen, hereafter to be referred to as "the estate agent", is permitted to act as a mediator to obtain a rental contract on account of a housing accommodation. By co-signatory "the estate agent" accepts the request of "the client".

Signing