| | Property for rent |
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| | Prospective rental client | Other party |
| Surname | | |
| First name | | |
| Street | | |
| Postcode/town | | |
| Date of birth | | |
| Telephone | | |
| Employer | | |
| Profession | | |
| | (married couple's apartment)
|
| Nationality |
| |
| Number of adults Number of children | | |
| Family pets | | |
| Musical instruments | | |
| Have you received notice to quit your present apartment? | | |
Third party liability insurance (incl. damage caused by tenants) | | |
| Insurance on contents of home | | |
| Present landlord/ Telephone | | |
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