Lulworth Student Company

LULWORTH APPLICATION 24/25

General Details

Guarantor Information

Emergency Contact

Education

Accommodation Requirement

Payment Details

Preferences

First Name

Surname

Nationality

Gender

Male Female

Room Type

Date of Birth

E-Mail

Password

Phone

Smoker?

No Yes

ID Type

Passport / ID Number

Address

Name Surname

Address

Relation

Phone

Name Surname

Phone

Relation

University

Grade

Student number

Do you have any disabilities or Medical Conditions?

Do you have a Disability?

If say yes, please give details.

Risk Assessment

Do you have any special requests?

What would be your Preferred Payment Plan once your booking is confirmed?

Please enter your referral Code if applicable Please enter the referral code here

Date

Signed

I confirm that the information provided in this application form is true to the best of my knowledge.

I Confirm.

I'm happy for "Lulworth Student Company" and "Union House Management Ltd" to contact my referees, with personal information which has been provided in this form to allow you to verify about my previous tenancy.

I Confirm.

I agree that "Lulworth Student Company" and "Union House Management Ltd" will use my personal information for in-house use regarding my application and/or any communication, but no longer.

I Confirm.

Please enter your referral Code here if applicable Enter a referral Code if applicable