Family Composition

1
Definition of Income and Assets:

The following list identifies some common sources of income and types of assets, but is by no means a complete list. Households must report all sources of household income, payments received by the household and all assets.

Income:
- Employment income: WSIB, E.I., Tips, Commission, Gratuities, Strike pay
- Self-Employment Income: Babysitting, Craft Sales, etc.,
- Student Income: OSAP, Grants, Bursaries, Training Allowances
- Annuity Income: RRSP payments
- Disability Payments, Pension Income, Social Assistance
- Support Payments received

Assets:
- Bank Accounts
- Term Deposits, Bonds, Stocks, Shares, Mutual Funds, RRSP’s
- Life Insurance with cash surrender value
- Residential and non-residential property; Other interest in real estate
- Financial Holdings
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Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Area Code
Phone Number
5
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Social Insurance Number* This field is required.
7
Date of Birth
Date
Year
Month
Day
8
Sex
Please Select
Please Select
Male
Female
Unassigned/ Other
9
Marital Status* This field is required.
Please Select
Please Select
Single
Married
Common Law
Divorced/Separated
Widowed
10
Identification* This field is required.
Please Select
Please Select
Indigenous (Status or Non-Status)
Non-Indigenous
Metis
Inuit
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Income Source* This field is required.Please list your source of income
12
Name of Tenant No.2* This field is required.Second Tenant is someone in the household over the age of 18. If no second tenant please put N/A
First Name
Last Name
13
EmailIf no second tenant put example@example.com
example@example.com
14
Phone Number* This field is required.If no second tenant 000-000-0000
Area Code
Phone Number
15
Social Insurance Number* This field is required.If no second tenant put 000 000 000
16
Date of Birth* This field is required.If no second tenant put today's date
Date
Year
Month
Day
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Sex
Please Select
Please Select
Male
Female
Unassigned/Other
18
Marital Status
Please Select
Please Select
Single
Married
Common Law
Divorced/Separated
Widowed
19
Identification
Please Select
Please Select
Indigenous (Status/Non-Status)
Non-Indigenous
Metis
Inuit
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Income Source* This field is required.Please list the source of income for tenant no. 2
21
Persons Living in the Unit* This field is required.Please list every individual living in the unit who have not been documented in the previous questions. NOTE: misrepresentation could result in the loss of subsidy and/or housing
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Vehicle Information* This field is required.Please complete for each vehicle on the premises
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Has your family composition changed in the last 12 months:* This field is required.If yes, please explain. Examples: births, deaths, move in/out etc. If no changes to your family composition put N/A
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Emergency Contact* This field is required.Who should we contact in the event of an emergency
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Terms and Conditions* This field is required.I make the following representations and warranties knowing that they will be relied upon by K-W Urban Native Wigwam Project to assess my qualifications for continued rent subsidy and to establish my rent. 1. I have read over the definitions of Income and Gross Family Income set out in this form and I fully understand them. 2. The information given in the form as to the occupants of the unit and the gross family income is accurate and complete. 3. I authorize the K-W Urban Native Wigwam Project to make any inquiries that it may deem necessary to verify the information given in this form. I agree to provide any support material K-W Urban Native Wigwam Project may require. I authorize any person, corporation or any social agency having knowledge of any required information to release such information to K-W Urban Native Wigwam Project and authorize K-W Urban Native Wigwam Project to provide the information set out in this form to any social agency providing any form of assistance to me.
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Please upload your Notice of Assessment and Income Verification* This field is required.Please upload the information for each member of your household that has an income
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Signature* This field is required.
Clear
28
SignatureTenant No. 2 if applicable
Clear
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Signature Tenant No.1* This field is required.Type your Full Name to confirm your signature
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Signature Tenant No.2Type your Full Name to confirm your signature
Should be Empty: