L P M G. 239 Paul Kruger Avenue Universitas Bloemfontein / Fax:

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1 L P M G 239 Paul Kruger Avenue Universitas Bloemfontein / Fax: lukisaprop@gmail.com/ lukisaprop@mweb.co.za Website: Tenant Information: Accommodation Booking Form Name and Surname: Student Number: ID Number: (if not a South African Citizen, please provide date of birth): Contact Number: Address: Address of Residential Accommodation and room number applied for: For the Academic year of: Field of Study: Year (1 st, 2 nd, 3 rd, 4 th ) Details of person responsible for rental payment: (ONLY FOR BURSARY STUDENTS) Name of Bursary Institution/ Sponsor: Name and Surname of contact person:

2 ID Number of contact person: Contact Number: Address: Residential Address: Postal address (if different from residential address: Details of person responsible for rental payment: (ONLY FOR CASH PAYMENT STUDENTS) Name and Surname of contact person: ID Number of contact person: Contact Number: Address: Residential Address: Postal address (if different from residential address: Contact details of parents/ guardian: (THIS PART MUST BE FILLED IN SO THAT WE KNOW WHO TO CONTACT IN CASE OF EMERGENCY) Name and Surname Mother: Name and Surname Father: ID Number Mother: ID Number Father: Contact Numbers Mother & Father:

3 Address Mother & Father: Residential Address: Postal address (if different from residential address: Contact details of relative or person not living with you: Name and Surname: Contact Number: Declaration: I declare: 1.1 that prior to the date of occupation, I will familiarise myself with the contents of all student rules and regulations (as contained in the House Rules attached to the lease agreement), as well as all policies and procedures relating to students; 1.2 that for the duration of my studies I commit myself to compliance with all rules, regulations, policies and procedures of LPMG or any authorised body or person may announce or amend from time to time, with said rules, regulations, policies and procedures forming part of my agreement with LPMG, 1.3 that I am completing and signing this declaration and application for admission with the full knowledge and permission of my parent/guardian; 1.4 that all particulars as provided to LPMG are true and correct, failing which my application will be cancelled with immediate and automatic effect; and that I have authorised LPMG and its duly authorised verification agents to forward my personal information, as well as any information that I have provided in support of my application, to the suppliers of verification information for the purpose of verifying my personal credentials and records, 1.5 that the agreement arising from the signing of this application, notwithstanding the place of signing, is deemed to have been concluded in Bloemfontein, provided that this application only becomes a valid and binding agreement upon my official enrolment at my preferred studying institution; 1.6 that I will immediately notify LPMG in writing of any change of address. 1.7 that, in terms of the Promotion of Access to Information Act, Act No 2 of 2000 I herewith grant permission to LPMG to disclose my personal information to third parties, as deemed necessary by LPMG; 1.8 that I will be fully responsible for rental payment if the bursary does not pay. SIGN: 1.9 that I am still liable for payment if the Campus/ University closes due to strikes or anything relating to that. SIGN: 1.10 that I am responsible for getting all bursary documents together and hand it in at Lukisa Property Management and that I will contact the institution to follow up on late payments. SIGN:

4 2. I hereby renounce any possible action against LPMG and indemnify the LPMG from any claim that may arise from the following: 2.1 any loss of or damage to property, movable or immovable, including any consequential damage directly arising from damage to such property; 2.2 any injury, illness or death; 2.3 any event, incident or accident; 2.4 any legal costs or expenses relating to claims or lawsuits arising from the specified incidents; and 2.5 any costs incurred for medical treatment; where such loss, damage, illness, injury, death, event or incident arises from my stay with LPMG during my period of study. 2.6 any liability that may result from furnishing verification information from and to LPMG and its duly authorised verification agents. 3. I accept that I participate in the activities mentioned in paragraph 2 at my own risk and I voluntarily accept all risks associated therewith. 4. Irrespective of any bursary or loan that has been received or is to be received, I hereby accept liability/accountability, as the responsible person, for the prompt and punctual payment of all residence and other fees, of whatever nature, owed to LPMG. (PLEASE ALSO SIGN HERE) 5. I hereby accept and confirm that I will not occupy any residence of LPMG before all minimum claimable fees have been paid. 6. I hereby accept liability/accountability for the payment of all legal fees of LPMG, including attorneys' and client fees, as well as collection fees, if I should fail to honour any of my commitments with respect to payments. 7. If this application is accepted, it will constitute part of the contract with LPMG. THIS APPLICATION MUST BE ACCOMPANIED BY COPY OF TENANT S ID DOCUMENT AS WELL AS A COPY AND PAYSLIP OR BANK STATEMENT (3 MONTHS) OF THE PERSON THAT WILL BE RESPONSIBLE FOR PAYING THE RENT. BURSARY HOLDERS MUST PLEASE SUBMIT A LETTER FROM THE BURSARY TYPED ON A CERTIFIED LETTERHEAD.

5 CONSENT CLAUSE: (Future tenants) Application form and Lease Agreement The tenant hereby consents that, and authorises the landlord or agent to, at all times:- a) contact, request and obtain information from any credit provider (or potential credit provider) or registered credit bureau relevant to an assessment of the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the tenant; b) furnish information concerning the behaviour, profile, payment patterns, indebtedness, whereabouts, and creditworthiness of the tenant to any registered credit bureau or to any credit provider (or potential credit provider) seeking a trade reference regarding the tenant s dealings with the landlord. NOTICE: Invoice / Statement Lukisa Property Management is affiliated to TPN Credit Bureau, a registered credit bureau, all account payment profiles, patterns and behavior is recorded monthly with the credit bureau for the purposes as per the National Credit Act. BANKING DETAILS: Lukisa Property Management Group First National Bank Account Number: Branch Code: Lukisa Property Management Group Standard Bank Brandwag Account Number: Branch Code: IMPORTANT NOTICE: WITH EVERY CASH PAYMENT, AN EXTRA DEPOSIT OF R80.00 MUST BE MADE TO COVER BANKING COSTS INTERNATIONAL PAYMENTS: R PER PAYMENT MADE IF THIS AMOUNT IS NOT PAID, IT WILL BE DEDUCTED FROM THE DEPOSIT

6 Signature Tenant: Date: Signature of Person responsible for payment: Date: Signature Lukisa Property Management Group Date: