Purcell View Apartments - Application Form

Purcell View Apartments - Application Form
If this application is printed, please return the completed application to Golden CED at PO Box 746, Golden, BC, V0A 1H0 or drop it off at 202-421 9th Ave. N (slide it under the door if closed).
Full Name

First NameLast Name
Date of birth

DayMonthYear
Phone Number

Area CodePhone Number
E-mail
example@example.com
Address

Street Address

Mailing Address

CityProvince

Postal Code
How long have you lived in BC?
How long have you lived in the Golden area?
Marital Status
Spouse's Name
Do you have a disability?
State the particulars of your disability
General state of health
Who is your regular doctor?
Total monthly income including all pensions, OAS, CPP, DVA, etc.:
Do you qualify for any income supplements?
Do you own real estate?
Assessed value
Location
Do you have any other assets (ex: savings, investments)?
Value
Describe your present accommodation
Amount of rent
Why do you wish to move?

Please provide two references:

Alternate contact in Golden (if we cannot reach you when a unit becomes available):

Rows	Name	Phone Number	Email	Relationship
Alternate contact

In signing this application, I agree to the following terms and conditions (check all boxes):
Date application is submitted

DayMonthYear
Should be Empty: