Client Information Form "*" indicates required fieldsClient DetailsLandlord / Owner Type* Individual BusinessRole of person completing this form:*Landlord / OwnerEstate AgentOtherRelation to Landlord / Owner*Name of Landlord / Owner* MrMrsMissMsDrProf.Rev. Title First Last Name of Landlord / Owner (Business Entity)Contact Number of Landlord/Owner*Email of Landlord/Owner* ID Number of Landlord/Owner*Registration Number of Landlord/Owner*Occupation of Landlord/Owner*Residential Address of Landlord/Owner* Street Address Address Line 2 Town/City Postal Code Postal Address of Landlord/Owner* Same as Residential? Address Line 1 Address Line 2 Town/City Postal Code Name of contact person/ landlord’s or owner’s representative:* MrMrsMissMsDrProf.Rev. Title First Last Contact Number of Contact Person / Representative*Email of Contact Person / Representative* Are above details the same for billing?* Yes NoBilling Details (Person to receive monthly invoices)Name & SurnamePhone NumberEmail Preferred method of Correspondence* Email PostRegistered / Physical Address Street Address Address Line 2 Town/City Postal Code Postal Address Same as Residential? Address Line 1 Address Line 2 Town/City Postal Code FICA RequirementsFICA: Upload certified copy of ID and Proof of Address not older than 3 (three) months:* Drop files here or Select filesAccepted file types: pdf, doc, docx, jpg, Max. file size: 64 MB, Max. files: 6. Service RequirementsType of Service* General Residential Property Commercial Property Arrears Rental CollectionDetails of Opposing PartyFul Names / Registered NameRegistration / ID NumberEmail Business / OccupationPhone NumberMobile NumberRegistered/Physical Address Street Address Address Line 2 Town/City Postal Code Postal Address Same as Residential? Address Line 1 Address Line 2 Town/City Postal Code Previous Judgement? Yes NoIs there a second Opposing Party? Yes NoDetails of 2nd Opposing PartyFul Names / Registered NameRegistration / ID NumberEmail Business / OccupationPhone NumberMobile NumberFaxRegistered/Physical Address Street Address Address Line 2 Town/City Postal Code Postal Address Same as Residential? Address Line 1 Address Line 2 Town/City Postal Code Previous Judgement? Yes NoInstructionYou are instructing us to do what is needed to proceed with:* Eviction Rental Collection Disconnection of UtilitiesYou are instructing us to do what is needed to proceed with:* Eviction Rental CollectionDetails of the PropertyThis field is hidden when viewing the formResidential PropertyWas the property bought on auction?* Yes NoIs it an investment property?* Yes NoThis field is hidden when viewing the formDetails of the Property (universal)Is a written Lease Agreement in place?*If yes, please upload the lease agreement below Yes NoDate of initial default*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Claim Amount - Arrears*Upload lease agreement or other supporting documents here: Drop files here or Select filesAccepted file types: pdf, doc, docx, jpg, Max. file size: 64 MB, Max. files: 10. Give description of the terms of lease, if verbal*Address of Rental Property* Street Address Address Line 2 Town/City Postal Code Tenant(s) / Occupant(s) Details:Number of occupantsHow many children are there?0123456More than 6OccupantsClick the + at the end to add more occupantsName & SurnameID NumberOccupationPhoneEmail Add RemoveAre there any elderly occupants? Yes NoIs the household headed by a woman? Yes NoAre there any disabled persons? Yes NoPlease provide details of disabled occupantsDetails of LesseeLessee type* Individual BusinessThis field is hidden when viewing the formIndividual LesseeName*ID NumberPhoneEmail This field is hidden when viewing the formBusiness LesseeRegistered and Trading Name*Registration NumberPhoneEmail This field is hidden when viewing the formArrears Rental CollectionDetails of LesseeName and Surname*OccupationPhoneEmail Residential Address* Street Address Address Line 2 Town/City Postal Code Work Address Street Address Address Line 2 Town/City Postal Code Is there a second lessee? Yes NoDetails of 2nd LesseeName and Surname*OccupationPhoneEmail Residential Address* Street Address Address Line 2 Town/City Postal Code Work Address Street Address Address Line 2 Town/City Postal Code Terms & Conditions of ServiceBilling Preference:* Itemised Billing Phased BillingVisit Terms of Engagement to view the online version of SSLR's Terms & Conditions of Service.Terms of Engagement* I have read and understand SSLR's Terms of Engagement and agree to the contents thereof as it appears on their website.Date Signed*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature*How did you find us? TPN Estate Agent Internet Referral Legacy EPICNameThis field is for validation purposes and should be left unchanged.
