Self-Disclosure Form

Personal Details

First Name*

Last Name*

Citizenship*

Date of Birth*

Gender*

Tel.*

Private Email*

Work Email

Current Residence (Please make sure this is your legally registered address)

Street*

Street No.*

City*

Zip Code / Postcode*

Country*

How long have you been living at this address?*

Are you being supported by a Relocation Agency.*

[group RelocationAgency]

If yes, which one?

[/group]

Current Landlord’s Contact Details

Full Name

Tel.

Delivery Address

Street*

Street No.*

City*

Zip Code / Postcode*

Country*

Eviction proceedings have been brought against me in the past five years.*

Are there or have there been in the last 10 years any dunning proceedings or actions for payment, foreclosures, proceedings for the submission of an affidavit, insolvency or settlement procedure?*

Current Employer

Employer

Position

Address

City

Zip Code

Country

Employment contract expiration date

Monthly Gross Salary*

Monthly Net Salary*

You hereby confirm that all the information you have provided for the credit check is true and complete. You also declare that you have taken note of the Schufa Authorisation Form and agree to the conditions contained therein.*

You've read and understood our terms and conditions and our privacy policy.*

* Required fields

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