BARANGAY POBLACION WARD III

MINGLANILLA, CEBU

RENTERS REGISTRY FORM

Registry No. 000__-19

NAME: _______________________________ DATE OF BIRTH:_____________

NAME OF SPOUSE: _____________________ AGE: _____
MARITAL STATUS: _____________ GENDER: ______________
CONTACT #:__________________ E-MAIL ADDRESS:______________________
CURRENT ADDRESS:___________________________________________________
___________________________________________________
PREVIOUS ADDRESS:__________________________________________________
__________________________________________________
PROVINCIAL ADDRESS:________________________________________________
________________________________________________
DATES OF TENANCY (PREVIOUS): _____________________
NAME OF LANDLORD/LANDLADY: ______________________
CONTACT # (PREVIOUS LANDLORD/LANDLADY): ____________
REASON OF LEAVING FROM THE PREVIOUS LESSOR: _________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
PRESENT NAME OF LANDLORD/LANDLADY: __________________________________
DATE OF OCCUPANCY: _______________________

ADDITIONAL OCCUPANTS:
NAME AGE RELATIONSHIP TO THE LESSE
1. __________________________ ____ _______________________
2. __________________________ ____ _______________________
3. __________________________ ____ _______________________
4. __________________________ ____ _______________________
5. __________________________ ____ _______________________
6. __________________________ ____ _______________________
7. __________________________ ____ _______________________
8. __________________________ ____ _______________________
9. __________________________ ____ _______________________
10. _________________________ ____ _______________________
(Use additional paper if needed)

EMPLOYMENT STATUS:
OCCUPATION: ___________________
COMPANY NAME: _____________________________
OTHER SOURCE OF INCOME: ____________________

CERTIFIED TRUE AND CORRECT

_____________________________
PRINTED NAME OVER SIGNATURE

Cegu’19