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Tenant Application

PERSONAL INFORMATION

First name*

Last name*

Email*

Phone

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

HEALTH / DISABILITIES

List in lines any significant disabilities/health problems we should be aware of:*

INCOME INFORMATION

Income*

Source*

Income*

Source*

income*

Source*

Total Monthly Income*

ASSETS

Cash/Bank Balance*

Investments*

Real Estate*

Other *

REFERENCES

Current Landlord

Name Address: _________________________

Phone:__________________________________

Previous Landlord

Name & Address: _______________________

Phone: _________________________________

ADDITIONAL INFORMATION

Do you own a residence?*

Yes

Do you have pets?*

Yes

Do you drive?*

Yes

Do you own a vehicle?*

Yes

EMERGENCY CONTACT INFORMATION

Name of family doctor*

Phone*

Emergency Contact*

Phone*

Emergency Contact*

Phone*

REASON FOR APPLICATION

Are you under notice to terminate. your present tenancy?*

Yes

If yes, please attach notice.

If no, please explain:

DECLARATION

I confirm the information provided is accurate and complete.

Signature*

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Arrowtarian Senior Citizens Society
Office Open:
Monday to Friday 9am to 12-noon
212 - 7th Avenue, P. O. Box 688, Nakusp, BC V0G 1R0
Email: info@arrowtarian.com
Phone: 250-265-2020
Website: www.arrowtarian.com

Senior Citizens Society
Founded by the

Website updated 1/2026.

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