Contact Form Students Contact detailsPlease fill out all the required fields, so we can register you correctly. Given name (first name)* Family name (last name)* Gender:* Male Female Gender neutral Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home address* Zipcode & city/town of your home address* Nationality* Country you live in* Phone number* E-mail address* Contact details in case of emergencyPlease fill out who we can contact in case of any emergency.Relationship to tenant* Given name (first name)* Family name (last name)* Phone number* E-mail address* Home address* Zipcode & city/town* Country* Details for checkout & depositIn order to repay your deposit, we need some additional details. If there are any changes in these details, please let us know as soon as possible as we can make sure the deposit will be refunded correctly. Name of the account holder* IBAN or bank account number* BIC or SWIFT of the bank* Name of the bank* Bank code* Address of the bank* Zipcode & city/town of the bank* Country of the bank* Additional information (not obligatory) Thank you for filling out this form! If there are any questions, please contact us: student@thuisbijantares.nl.
