SET-Form-Contact-Details

Personal Information Form

A printable copy of your notification will be emailed to you after this form is submitted.

A: OWNER/TENANT

Owner Tenant

Village:

Settlers Settlers Rest

Unit No:

Surname:

Full Names:

ID No:

Phone (Landline)

Email Address

Cell number

House Doctor:

Doctor Telephone:

Next of kin, other than spouse/partner:

Relationship:

Telephone(s):

B: SPOUSE/PARTNER

Yes No

Surname:

Full Names:

ID No:

Tel No(s):

House Doctor:

Doctor Telephone:

Spouse's Next of kin, other than spouse/partner:

Relationship:

Telephone(s):

C: VEHICLE INFORMATION

Number of vehicles:

Vehicle Registration:

Make, Model & Colour:

Vehicle 2 Registration:

Vehicle 2 Make, Model and Colour:

Vehicle 3 Registration:

Vehicle 3 Make, Model and Colour:

D: How would you like to receive communication/statements/accounts?

Village Post Box:

Yes No

Email:

Yes No

Email Address:

Confirm address:

Alternate Postal Address:

Yes No

Alternate Postal Address:

E: OTHER INFORMATION

Remote Controls received:

Any other information you feel we need to know:

Email address to send form confirmation to:

Date Submitted:

A printable copy of your notification will be emailed to you after this form is submitted.

I certify that the above information is true and correct.

Yes

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