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Type of apartment Type of apartment Studio/Flat 1 bedroom apt 2 bedroom apt Desired date for start of rental Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 Comments Name * Email * Telephone Fax     En cas d’urgence contactez-nous par GSM au +32–484-022571

Darimmo SA Rue Emile Claus 47 Bte 90 B-1050 Ixelles (Bruxelles) Belgique

Tel. : 02-644.14.92 Fax : 02-644.14.94 Email : info@darimmo.com Mobile : +32-497-555515

copyright 2006