YASARLA RENT APPLICATION

VIJAYAWADA
PERSONAL INFORMATION

First Name: Surname:

Farther / Mother Name:

Date Of Birth: Marital Status: Signal/ Married /Divorced

Cell phone: Work phone:

Door No:
Permanent Address: Street Name:
City /Village:
State:
PRESENT HOME ADDRESS:

Door No: Street Name:

City /Village: State:

Owners Name: Phone:

Length of Time Stay: Reason for Leaving:

PRESENT HOME ADDRESS:

Door No: Street Name:

City /Village: State:

Owners Name: Phone:

Length of Time Stay: Reason for Leaving:

PROPOSED OCCUPANT(S)
Name and Aadhar Number Relationship Occupation Age
 YASARLA RENT APPLICATION
VIJAYAWADA
VEHICLE (S) INFORMATION
Year Name Modals Color Number Plate State

EMPLOYMENT:

Name of current employer: __________________________________________ Phone: _____________________________

Address:________________________________________________________________________________________________________

Name of supervisor: ___________________________________ Supervisors phone: ______________________

Dates employed at this job: _________________ to ____________ Position or title: _____________________________

REFERENCES AND EMERGENCY CONTACT

Personal reference 1: _________________________________________________ Relationship: _____________________

Address: _________________________________________________________________ Phone: _____________________________

Personal reference 2: ___________________________________________________ Relationship: _____________________

Address: ______________________________________________________________________ Phone: ________________________

I certify that all the information given above is true and correct and understand that my lease or
rental agreement may be terminated if I have made any material false or incomplete statements in
this application. I authorize verification of the information provided in this application from my credit
sources, current and previous landlords and employers and personal references.

Signature of applicant: __________________________________ Date: ___________________

Notes: ______________________________________________________________________________________________________

1.Aadhar card Xerox

2. Resent Group Photo /Passport Size Photo
YASARLA RENT APPLICATION
VIJAYAWADA