Tenant Income Declaration Form

Tenant Income Declaration Form
DETAILS OF TENANT APPLYING FOR RENTAL RELIEF
Name
First NameLast Name
Identity Number
Date of Birth
MonthDayYear
1
Nationality
Marital Status
Married State Status
In community of PropertyANCAccrual SystemNone of Them
Phone Number
Please enter a valid phone number.
Email
example@example.com
Rental Property Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Postal Address
Name of the Next Kin
First NameLast Name
Phone Number of Next Kin
Please enter a valid phone number.
DETAILS OF AGENT AND PREMISES UNDER THE LEASE AGREEMENT
Premises Details
ON WHAT GROUNDS ARE YOU APPLYING FOR RELIEF FROM YOUR CURRENT RENTAL OBLIGATION?
I hereby declare that I am unable to meet my rental payment obligations due to the declared National State of Disaster on the following grounds:
RetrenchmentPlaced on Temporary Unpaid LeaveCommission-only earnerSelf-employedOther
What percentage of your income do you expect to lose?
Letter from Employer
Cancelof
3 Months Bank Statements
Cancelof
EMPLOYMENT DETAILS
Current Employer / Previous Employer if Retrenched
First NameLast Name
Employer Phone Number
Please enter a valid phone number.
Employer Email
example@example.com
Employer Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I hereby consent to the Landlord and / or Agent at all times:
1. contacting, requesting and obtaining information from my current/ previous employer to verify my declaration that I am unable to meet my rental payment obligations; or
2. requesting and obtaining financial documents from me which prove that I am no longer able to meet my rental obligations due to the declaration of a National State of Disaster.
NATURE OF RENTAL RELIEF SOUGHT
Due to my inability to meet my rental obligations as declared above, I wish to apply for the following relief (tick appropriate box):
Rental Deferment
DETAILS OF THE NATIONAL STATE OF DISASTER:
Date of Declaration of National State of Disaster: 15 March 2022
Date of Declaration of National Lockdown: 26 March 2022
It is specifically noted that in terms of section 27 (5) of the Disaster Management Act 57 of 2002, a National State of Disaster can be terminated in the following manner:
A National State of Disaster:
1.     lapses 3 (Three) months after it has been declared; or
2.     may be terminated by the Minister by notice in the Gazette before it lapses in terms of paragraph (1): and
3.     may be extended by the Minister by notice in the Gazette for 1 (One) month at a time before it lapses in terms of paragraph (1) or any existing extension in place is due to expire.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty:

Tenant Income Declaration Form

DETAILS OF TENANT APPLYING FOR RENTAL RELIEF

DETAILS OF AGENT AND PREMISES UNDER THE LEASE AGREEMENT

ON WHAT GROUNDS ARE YOU APPLYING FOR RELIEF FROM YOUR CURRENT RENTAL OBLIGATION?

EMPLOYMENT DETAILS

NATURE OF RENTAL RELIEF SOUGHT

DETAILS OF THE NATIONAL STATE OF DISASTER: