Tenant Application Form

Application for Rental Accommodation

PERSONAL INFORMATION

* Indicates required field

Name *

First

Last

Phone *

Email *

Date of Birth *

Do you drive? *

Do you have your own vehicle? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Do you own your own residence at the present time? *

YES NO

Do you have a pet? If so what type? *

REFERENCES

If you presently rent, or have previously rented, please provide Landlord references:

Reference 1 - Present Landlord and Address *

Reference 2 - Previous Landlord and Address *

Phone # : *

Phone #: *

HEALTH

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

Disabilities/Health Problems *

For emergency purposes please provide:

Name of Doctor *

Phone Number *

INCOME INFORMATION

List gross monthly income (i.e. before deductions) from all sources. Proof of income will be required.

Source *

Total Monthly Income *

Please list the current value of all assets held by you:

Cash/Bank Balance *

Stocks, Bonds, Term Deposits *

Real Estate Owned *

Other - RRSP, Annuities, Mortgages etc. *

REASON FOR APPLICATION

Are you under notice to terminate your present tenancy? *

YES NO

If yes, a copy of your Notice to end Tenancy must be provided.

If not are NOT under notice, why do you wish to move in. Please be specific. *

EMERGENCY CONTACTS

Name *

Relationship *

Phone Number *

Name *

Relationship *

Phone Number *

RENT SUPPLEMENT PROGRAM

The province of British Columbia provides financial assistance to eligible tenants of subsidized housing units to limit their rent contributions to 30% of their gross income.

ACKNOWLDEGMENT

I acknowledge my understanding that this application does not constitute an agreement on the part of the Arrowtarian Senior Citizens Society to provide me with rental accommodation. I hereby certify that the information given in this application is true, correct and complete in every respect to the best of my knowledge and can be documented, if so required by the society. I understand that it is my responsibility to advise the Society of any changes to the information give above.

AGREE & SUBMIT

WE WOULD LOVE TO HEAR FROM YOU

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: arrowtarian@nakusp.net | Phone: 250-265-2020 | www.arrowtarian.com

Founded by the Rotary Club of Nakusp

Application for Rental Accommodation

PERSONAL INFORMATION

REFERENCES

HEALTH

INCOME INFORMATION

REASON FOR APPLICATION

EMERGENCY CONTACTS

RENT SUPPLEMENT PROGRAM

ACKNOWLDEGMENT

WE WOULD LOVE TO HEAR FROM YOU

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