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Name*

Gender*

Driving Licence Number

Passport Number

Country of Citizenship

Institution you are Attending

Student ID Number

Home Address

Postal Address

Email*

Home Telephone

Mobile Telephone

Parents Names

Parents Address

Parents Telephone Number

Emergency Contact other than Parents

Referee 1

Referee 2

City Vue: room applied for

Urban Vue: room applied for

Approximate date you would like to move in*

I have read and agree to the terms and conditions of residence

I agree to sign a tenancy agreement

I acknowledge a holding deposit is payable.

I acknowledge a bond is payable.

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