Registration date:

Personal data:

surname:*

first name(s):*

Date of birth:

Place of birth:

Address:

Postal code:

City:

Nationality:*

Sex:

male

female

Marital status:

Telephone private:*

Telephone work*:

E-mail address*:

Source of income:

independent entrepreneur

employee

limited time

infinite time

employment agency

Name company:*

Function:

Address:

Postal code/city:

Date of entry:

income p/m

€

gross

netto

You are looking for:

number of rooms:

type of accommodation:

price indication:* €

incl.

excl. utilities

interior:

bare

carpeted

furnished

number of persons:*

pets:

location / other

remarks:

rent starting date:*

till:*