Declaration of Income

Declaration of Income

Please read the agreement and follow the instructions carefully.
Information is collected under Section 26(c) of the Freedom of Information and Protection of Privacy Act to determine eligibility for affordable rental housing. If you have any questions about the collection and use of this information, please contact inclusion powell river's privacy officer at quality@inclusionpr.ca or call review our Privacy Policy.
Instructions
1. Complete Declaration of Income: Please ensure all sections are filled out.

2. Sign and date: The tenant(s) and anyone occupying the unit over the age of 19 must sign the Declaration of Income.

3. Attach proof of income from all sources (do not send original documents): Proof is required for all sources of income for the tenant(s) and all occupants aged 19 or older.

You must include:

a. Canada Revenue Agency Notice of Assessments (NOAs) for the two most recent tax years

b. Two most recent pay slips

c. Any pertinent information that will affect further earnings (retiring, reduced hours, etc)

4. Submit: Include the signed Declaration of Income and copies of all supporting documentation with your application for housing.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date

DayMonthYear
File number (if updating application)
List all tenants and occupants on your application or in your unit. Proof of total monthly income for each person over 19 must be included.
Agreement
Please click all the boxes below to acknowledge that you have read and agree to each statement.
I/we consent to:
Click the boxes to acknowledge that you have read and consent to the following.
No failure or delay on the part of Inclusion Homes in exercising any right, power, or privilege under this Agreement will operate as a waiver thereof, nor will any single or partial exercise of any right, power, or privilege preclude any other or further exercise thereof or the exercise of any other right, power, or privilege.

This Declaration of Income must be signed by the tenant(s) and all occupants aged 19 years or older living at the rental unit.
Signature
Date

DayMonthYear
Signature
Date

DayMonthYear
Signature
Date

DayMonthYear
Signature
Date

DayMonthYear
Signature
Date

DayMonthYear
Signature
Date

DayMonthYear
Please verify that you are human
Should be Empty:

Declaration of Income

Instructions

Agreement

I/we consent to: