PRB Application Form for flat

Step 1 of 2

Personal Information: Compulsory

Name

First Middle Last

Date of Birth

Fathers Name

First Last

Gender

Marital Status

Ethnicity

Home Address

Mobile Contact

TIN

Present Employer

FNPF NO.

Employers Address

Emloyers Phone/ Contact

Position

Year of Service

Weekly Gross Income $

OTHER FAMILY MEMBERS INFORMATION (WHO WILL BE LIVING WITH YOU.)

Name	Date of Birth	Sex	Relationship	Working	Disable Person	Weekly Gross Income	Phone Contact	Actions

There are no Entries.

Applicants Housing History

Present Landlords Name

First Last

Phone Contact

Landlords Address

Why do you want to leave your present address?

Give reasons for applying to Public Rental Board?

Principal Applicant Questionaire

Have you or any of your listed occupants ever been legally sued for debt?

Yes

Have you or any of your listed occupants ever been declared bankrupt?

Yes

Have you or any of your listed occupants ever been convicted of a crime?

Yes

Have you or any of your listed occupants ever been issued with a court eviction order

Yes

Have you or any of your listed occupants ever been charged for damaging property?

Yes

Disclaimer

All Amounts are Subject to Change

	1 Bedroom	2 Bedroom
Deposit	$792.00	$888.00
Advance Rent (1 Month)	$396.00	$444.00
Admin & Application fees	$ 20.00	$ 20.00
Total Payable	$1,208.00	$1,352.00

Income	Food	Water Bill	FEA Bill	Telephone Bill	Education	Medical	Hire Purchase	Loan Repayment	Other - Fare etc	Total Expenses	Deficit/Surplus	Actions

There are no Entries.