APPLICATION FORM: GENERAL INFORMATION

1. Accommodation consists of individual flats/ free-standing houses and cottages

2. Considerations will be given to the demographic profile of the complex and of our overall tenant population.
3. No pets allowed in our premises.
4. Enquiries will be made into each applicant’s financial situation which includes credit checks and a deeds search and may
include an assessment of moveable and immoveable assets.
5. Credit worthiness
6. Rental is only payable by debit order on the 1 st of every month
7. Approved applicants will be required to pay a deposit equal to 2 months rent;
8. Willingness to abide by the lease agreement
9. Capacity to live independently

Selection Criteria for accommodation

• Applicants for accommodation must be between 18 and 65 years and legally competent to contract.
• Married or single with or without dependents.
• Must not own any property or be receiving any state subsidy with respect to property.
• Must be either be self –employed or permanently employed

Selection Criteria for senior’s accommodation

• Applicants between age 50 and 65 years who are officially retired or who are still economically active and have no dependants
may apply for seniors’ accommodation.
• Seniors applicants will be subjected to an interview with a Social Development Officer and subject to the findings of the officer,
a decision will be taken as to whether or not the applicant qualifies for accommodation.
• Seniors applicants must be able to care for themselves as our facilities are not old age homes and do not have any sick bays.

Submit the following certified documents with the application form:

• Proof of Identity and Nationality (i.e. certified copy of ID document).
• Proof of Income (i.e. 3 months Salary Advice or Payslip / SASSA or other Pension Payment Advice / IT34)
• Proof of current physical address
• 3 Months Bank Statement (this information should not be more than three (3) months old).
• Certified copy of marriage certificate or divorce order where applicable.
• Certified copy/copies of dependents’ birth certificate(s).

• Proof that the applicant/spouse/partner is permanently disabled and in receipt of a disability grant from the Department
of Social Development or, (if applicable)

COMPLETED APPLICATION FORM WITH SUPPORTING DOCUMENTS

MUST BE EMAILED TO rental@communicare.org.za

Communicare Application Form (3) Page 1 of 5

Building Name of Accommodation applying for :

Date of occupation : 01/12/2021 Monthly rental R 4000.00

Parking required : YES NO *Due to limited parking in our buildings, kindly confirm the availability of parking with the leasing department.

Car Reg. No : not applicable

/ / Miss / Dr / etc :
Mr / Mrs Mrs
FULL NAME of applicant : BUSISIWE JEKEQA SULIEMAN

Cell No : 0671747573 Date of birth : 24-08-1987

ID or Passport No : 8708241326081

Present Address : PINOT BLANC STREET UNIT 27 BURGUNDY ESTATE

CAPE TOWN 8001

How long living/leasing/owning the above address : 2 YEARS

/ :
Landlord/Agent/Family FAMILY Tel : 0845908282
Present Employer (Company) : SHOPRITE CHECKERS PTY Tel : 021-1559976

Address : P O BOX 215

BRACKENFELL 7561
Fax : Your E-mail : yija90@yahoo.com

Period working : 3 YEARS

/ / Self Employed Nature of business :

Occupation/Title/If COFFEE SHOP ASSISTANT
Monthly income Gross (before deductions): R 5,013 Net (after) : R 3,415

FULL NAME of 2nd Occupant : HASHIM MOH. SULIEMAN Cell No : 0832455981

Date of birth : 01/01/1973 ID or Passport No : P07633147

Present Employer (Company) : TURKISH CONSULATE Tel : 0788211991
Address : PINOT BLANC STREET UNIT 27 BURGUNDY ESTATE
CAPE TOWN 8001

Fax : Your E-mail : hashims1973@gmail.com

Period working : 1 YEAR

/ Self Employed Nature of business :

Occupation/Title/If DRIVER
Monthly income Gross (before deductions): R 9,000.00 Net (after) : R NO DEDUCTIONS

Communicare Application Form (3) Page 2 of 5

Next of Kin (Emergency contact person) : FAIZ SALIH State relationship : COUSIN

Address : 16 EMILY HOB HOUSE STREET

GOODWOOD CAPE TOWN 7460
Tel : 0845908282

ALL OCCUPANTS (incl. Children): No

NAMES RELATIONSHIP AGE ID / PASSPORT / D.O.B SEX CELL PHONE

BUSISIWE J. SULIEMAN WIFE 34 8708241326081 F 0671747573

HASHIM MOH. SULIEMAN HUSBAND 47 P07633147 M 0832455981
AMINA SULIEMAN DAUGHTER 8 1303270461087 F 0671747573
JALLAL SULIEMAN SON 4 1706265640087

DECLARATION AND CONSENT:

In this declaration, the singular “I” and “my” should be read to include the plural “we” and “our””

I understand that the provision of the accompanying advertisement are part of the conditions of application and I have read them. I
declare that all information provided is true and correct to the best of my knowledge. I understand that any misrepresentation made in
this application or in additional information I may supply to Communicare may render me ineligible for Communicare accommodation.

I authorize Communicare to undertake any enquiries necessary to arrive at a decision concerning my application for
accommodation and to conduct such enquiries from time to time during tenancy. These would include, but are not limit to enquiry
into my personal information and credit record(s) with any credit reference agency. I further consent to the company carrying out
identity and fraud prevention checks and sharing information relating to this application through fraud prevention agencies.

I understand and accept the terms and conditions of this application. I also understand that Communicare is unable to
guarantee accommodation to applicants.

I understand that either withholding or giving false information will disqualify my application.

Date : Signature :

Communicare Application Form (3) Page 3 of 5

 MONTHLY INCOME AND EXPENDITURE DECLARATION

MONTHLY INCOME DETAILS 1st APPLICANT/LEASEHOLDER 2nd APPLICANT

R 9,000.00
Gross income (before deductions)
R 5,013.00

R N/A
Allowances
R
Fringe benefits (subsidies,
discounts, etc.) R R N/A
Other regular income from
employer (specify) R R N/A

R R N/A

R R N/A

R 5,013 .00 R 9,000.00

Total gross income

R 9,000.00
Less Deductions: PAYE/TAX/SARS
R
Less Deductions:
Pension/Provident fund R N/A R N/A
Less Deductions: UIF
R 54.00 R N/A

R N/A R N/A
Less Deductions: Medical aid

Less Deductions: Other

R 53.00 W Compensation R N/A
Less Deductions: Other
R 363.00 R N/A

R 1,597 .00 R N/A

Total deductions

R 3,415.00 R 9,000.00
Nett income
ANY other regular income that you
receive such as alimony/support, R 800.00 SASSA Grant R N/A
dividends, interest, rent,
commission, etc. (please specify) R N/A R N/A
Total nett income:
R 4,215 .00 R 9,000.00

Communicare Application Form (3) Page 4 of 5

 MONTHLY EXPENSE DETAILS 1st APPLICANT/LEASEHOLDER 2nd APPLICANT

R 1500.00 R 1500.00
Accommodation:
Accommodation:
House expenses Home
Board/Rent
loan/Board/Rent
Insurances R Insurances R
Rates and taxes R Rates and taxes R
Security R Security R
Upkeep (e.g. house Upkeep (e.g. house
R R
and garden) and garden)
Utilities: Electricity R 250.00 Utilities: Electricity R 250.00
Utilities: Water R 100.00 Utilities: Water R 100.00
Other R Other R
Vehicle expenses Fuel/Petrol/Diesel R Fuel/Petrol/Diesel R
Insurance R Insurance R
Maintenance R Maintenance R
Vehicle finance /
R Other R
Car loan

Policies: Total premiums R Total premiums R

Life Assurances Total premiums R Total premiums R
Short Term Insurances Total premiums R Total premiums R
Other Insurances Total premiums R Total premiums R
Funeral Total premiums R Total premiums R
Living expenses Support/Alimony/Maintenance R 500 Support/Alimony/Maintenance R 500 .00
Bank charges/costs R Bank charges/costs R
Cellular/Airtime/Data R 200 Cellular/Airtime/Data R 200.00
Clothing R 200 Clothing R 200.00
Credit Cards R Credit Cards R
Domestic employees R Domestic employees R
Donations R Donations R
Education/School Fees R 200.00 Education/School Fees R 200.00
Entertainment R Entertainment R
Groceries R 1,000 Groceries R 1,000 .00
Instalment accounts R Instalment accounts R
Medical Aid, Health Medical Aid, Health
Professionals, Homeopaths, R Professionals, Homeopaths, R
Chemists Chemists
Memberships R Memberships R
Personal Loans R Personal Loans R
Pet care R Pet care R
Retail accounts R Retail accounts R
Security R Security R
Subscriptions R Subscriptions R
Telephones R Telephones R
Transport R Transport R
TV / Mnet / DSTV / Netflix R 60 TV / Mnet / DSTV / Netflix R 60
Any other expenses not listed R R
R R
R R
Total expenses per month Total per month: R 4,010 Total per month R 4,010

Communicare Application Form (3) Page 5 of 5