Application form About you Family name (required) Email (required) Date of birth ID number Gender MaleFemale About your spouse Name (spouse) Date of birth (spouse) ID nummer (spouse) Marital status MarriedSingle Current address Telephone / Fax Adittional questions Do you own a lot? YesNo Do you own a hereditary tenure (erfpacht)? YesNo Do you own a house? YesNo Do you have an application at Civil Registy Office (Burgelijke Stand / Kranshi)? YesNo Do you have an application at DOMEINBEHEER? YesNo Gross income per month is between (Ang.) —Please choose an option—1500-25002500-30003000-40004000-55005500 or more How many people does your household consist of: —Please choose an option—1-23-45 or more If you have children in school? YesNo If yes, where do they attend? Who is your employer? What is your function? Comments Verification code
