Applicants last name :... First names :... Male/female* married/single/divorced* Place of Birth :... Nationality : Present address :...

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1 J.S.M. HILLEGERSBERG VASTGOED B.V. Application form for renting a home PERSONAL DETAILS PROSPECTIVE RESIDENT Hoogstraat 61a 3011 PH Rotterdam Tel Fax Applicants last name : First names : Male/female* married/single/divorced* Place of Birth : Nationality : Present address : Zipcode/residence : (cell) Phone : PERSONAL DETAILS SPOUSE Name spouse : First names : Male/female* married/single/divorced* Place of Birth : Present address : Zip code/residence :... (Cell) Phone :...: FAMILY COMPOSITION/OTHER OCCUPANTS Family size :...adults......children Age children :......year......year.....year....year.....year...year Other occupants :...adults......children Do you play Musical instruments? :yes/no* ifso, what kind?..... Do you have pets? :yes/no* if so, what kind?.... JOB/EMPLOYER/INCOME Occupation applicant :......

2 Applicant employed by : Address : Zip code/residence : (cell) Phone : Net salary :....per Other sources of income :......per Personal loans/liabilities :......per Alimony :......per JOB/EMPLOYER/INCOME SPOUSE Occupation spouse : Spouse employer : Address : Zip code/residence : Net salary :......per Other sources of income : per Personal loans/liabilities :......per Alimony : per DATA CURRENT HOME Current home :rental/owner-occupied/resident* Type of property :detached house / flat* number of rooms... Basic rent per : Service costs :. Owner/administrator* : Address : Zipcode/residence : (cell) Phone : DESIRED PROPERTY DATA Neighborhoods :... Street : Maximum baisic rent :......

3 Desired property with / without elevator * Desired number of rooms : Special needs : GENERAL Reason for this application : Desired move-in date : How did you hear about us? : EMPLOYER S STATEMENT APPLICANT Undersigned declares that...residing at....since.. employedas......he/she is in temporary/permanent employment*. The contract runs untill with constant operation, the contract will/will not* be extended/renewed* Gross annualsalary......

4 Holiday fee. Irregularity fee.. Commission. End of year bonus. Gratuity.. Overtime Net per Is there a loan granted to the employee? No/yes, if so privately or mortgage Date from: term: costs per year: Is wage confiscated? Yes/no Company stamp: employer signature: =================================================================== =============== WERKGEVERSVERKLARING AANVRAGER Ondergetekende......verklaart dat...wonende te.... sinds.. in dienst is als......hij/zij is in tijdelijk/vast dienstverband*. De arbeidsovereenkomst loopt tot en met Bij gelijkblijvend functioneren wordt het contract wel/niet* verlengd. Het contract wordt dan omgezet in bepaalde/onbepaalde* tijd. Bruto jaarloon......

5 Vakantietoeslag. Onregelmatigheidstoeslag.. Provisie. Vaste eindejaarsuitkering. Gratificatie.. Overwerk Netto per maand Is door u een lening aan werknemer verstrekt? onderhands/hypothecair Datum ingang: Looptijd: Jaarlast: Er is wel / geen loonbeslag gelegd Nee/Ja: zo ja, Firmastempel: Handtekening werkgever: ================================================================== ================ EMPLOYER S STATEMENT SPOUSE Undersigned......declares that...residing at... since.. employed as......he/she is in temporary/permanent employment*. The contract runs untill. with constant operation, the contract will/will not* be extended/renewed* Gross annual salary... Holiday fee Irregularity fee Commission End of year bonus

6 Gratuity. Overtime Net per Is there a loan granted to the employee? No/yes, if so privately or mortgage Date from: term: costs per year: Is wage confiscated? Yes/no Company stamp: employer signature: WERKGEVERSVERKLARING PARTNER Ondergetekende......verklaart dat...wonende te.... sinds.. in dienst is als......hij/zij is in tijdelijk/vast dienstverband*. De arbeidsovereenkomst loopt tot en met Bij gelijkblijvend functioneren wordt het contract wel/niet* verlengd. Het contract wordt dan omgezet in bepaalde/onbepaalde* tijd. Bruto jaarloon Vakantietoeslag. Onregelmatigheidstoeslag.. Provisie. Vaste eindejaarsuitkering. Gratificatie.. Overwerk

7 Netto per maand Is door u een lening aan werknemer verstrekt? Nee/Ja: zo ja, onderhands/hypothecair Datum ingang: Looptijd: Jaarlast: Er is wel / geen loonbeslag gelegd Firmastempel: Handtekening werkgever: VERKLARING HUIDIGE EIGENAAR/BEHEERDER (STATEMENT CURRENT OWNER OR ADMINISTRATOR) Ondergetekende, verhuurder van het huidige adres, verklaart hierbij dat Naam huurder: Huidige adres: Ingangsdatum huurovereenkomst:. Het huurbedrag per maand bedraagt: er op dit moment - een betalingsachterstand is O ja O nee - voor deze achterstand een betalingsregeling is getroffen O ja O nee er in de afgelopen 2 jaar - een betalingsachterstand is geweest O ja O nee - een vordering aan derden uit handen is gegeven O ja O nee - één of meer vonnissen zijn geweest in verband met een huurachterstand O ja O nee - sommaties zijn gestuurd i.v.m. woongedrag of overlast O ja O nee - een juridische procedure is geweest i.v.m. overlast O ja O nee - een vonnis is geweest i.v.m. overlast O ja O nee - woonfraude is geconstateerd O ja O nee Als u "ja" heeft ingevuld, graag hieronder toelichting/opmerkingen vermelden.. Naam verhuurder Contactpersoon

8 . Telefoon contactpersoon Handtekening en stempel verhuurder Datum, GENERAL PROVISIONS - The information submitted will be treated strictly private. - This application is considered necessary for 1 year. After this period at the request of applicant, the application can be renewed. - Signing this form does not mean an automatic allocation of a dwelling - An application may be rejected without giving any reason. - Applicants shall add to this form, a copy of: Identification, recent pay slip, annual statement of the entire past year (it may there for be more) and the employment contract Ifself-employed, the applicant needs to add: identification, a form IB60, chamber of commerce and extract data in recent years. - Applicant shall sign a contract, according to the model of the landlord in question. Contracts are entered for a minimum period of 1 of 2 years, with a noticeperiod of 1 or 2 s - By signing this form, the applicant entrusts JSM Hillegersberg Vastgoed BV to mediate. At the conclusion of a lease single brokerage fee of 350,- excl VAT will be charged. In general JSM Hillegersberg Vastgoed BV will perform for you (if at all) following activities: - We collect your information, and introduce you to the landlord (real estate owner) if you meet the requirements. - We take care of and guide you to the viewings. - We set up the lease and take care of all documents related. - We support the signing of the lease and provide you with all related information. - Until the effective date of the lease, we take care of all correspondence between the tenant and landlord (real estate owner). - We will arrange for the collection of the deposit and the first rent payment. - We accompany the transfer of keys - All oral and written communications on any rental of a dwelling shall be deemed to have been made subject, permits and permission from the owner or right holder will be granted. If it appears that no permit or permission is given, then the lease will not have been achieved and will give any statement on our part no rights. Any liability on our part is excluded in this matter.

9 - By signing the lease a deposit is due, often equal to 1 or 2 s. - It is known to the applicant that, information is sought, rent from a recognized agency on solvency and credit worthiness. - If you do not have a permanent employment in some cases it is desirable to have a guarantee from the parents. Consequently, there is an ID and pay slip to be supplied by parents or guardians Signature applicant: Place and date: Forms not fully completed, signed, or where necessary attachments are missing, will not be taken. * delete as appropriate