A1 Level 1 : Learning activity 3 : Stage 3

MOVING TO A NEW PLACE

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application
Gorm
Please write the first or main applicants surname here

Lina Miranda

Important: Please make sure you read all the information presented in this document carefully before
you complete this form.

A. Your details
First name(s)

Lina Miranda

Give any other name(s)

you were previously known by

07/04/1981

Date of birth
For example 06/12/1968
Current address

transversal 5#5-55

Postcode

Contact/correspondence

55555

or safe address (if different

from above)
Contact telephone

555-5555

numbers(s)
Email address

linamiranda21@gmail.com

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

Do you experience difficulties

Yes

No

Female

with reading or writing?

Whats your gender?
What is your religion?

Male
Prefer not to say

Buddhist
Christian

Muslim Sikh

None

Hindu
Jewish
Other

(please specify)

B. Employment information
If you are working, please tell us:

Yes

No

What do you do?

Bacteriology

C. Your family or household

We need to know if other people will be moving with you. This will help us to know what type of home
you will need. Please give their details below.
1st

2nd

3rd

Last name

prencke

prencke

prencke

First name

hans

valerie

victoria

Date of birth

11/09/1976

21/04/2007

28/10/2013

Gender

male

female

female

Relationship

husband

daughter

daughter

to you (wife,
son, etc.)

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

D. Your present accommodation/circumstances

Tick the box against the property type in which you live or best describes your circumstances.

House

Trailer

Hostal

Flat/apartment

condominium

Hotel

Bungalow

Cottage

Terraced house

Detached house

Semi-detached house

No fixed address

E. Your house preferences

State your house preferences describing all the characteristics you want your new home to have.

House type (apartment, cottage, etc.)

house

Number of rooms

3 rooms

Number of bathrooms

3 bathrooms

Which floor (if located in a building)

Public utilities (gas, water, etc.)

gas, water, tv cable, eletricity

Location

santa marta

Price

500.000

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1

F. Special requirements
Write a more detailed description of the kind of house you want to have.

We want 2 floor house, full space, 3 rooms, linving room, study place, balcony, with garage
for 2 cars

G. Applicants signature
Name

lina miranda

Date

18/10/2015

Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.