Kingsley Non-Sudsidized Rental Application

Kingsley Low Rental Housing Society

Non-Subsidized Tenancy Application Form
Forty Niner Manor - 280 Moilliet St, Parksville, BC V9P 2P2

IMPORTANT: THIS IS A NON-SMOKING FACILITY
IMPORTANT: NO PETS ARE ALLOWED. Guide and service animals may be exempt from this restriction with proper documentation.
Applicant Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
E-mail *
Birth Date *

Month Day Year

Employment and Income Sources
Please choose from the following income sources. Check ALL that Apply. *

Employed (Complete Employer Information below) Retired (with Pensions/CPP/OAS) Receiving Income Assistance Other
If "Other", please explain:
Employer Information
Current or Most Recent Employer
Length of Employment
Employer Contact Name

First Name Last Name
Employer Phone #

- Area Code Phone Number

Present Address *

Previous Address

Final Submit
Terms
TENANCY WILL BE DENIED IF you misrepresent any information on the application. If misrepresentations are found after the rental agreement is signed, your rental agreement will be terminated. This is to advise that I the applicant give the Kingsley Low Rental Housing Society permission to make any inquiries as deemed necessary to determine eligibility for tenancy. I understand that the information set out in this rental application form may be used for purposes of ensuring the orderly management of the tenancy, complying with legal requirements and for collection purposes should rent be left owing or rental property damaged at termination of lease or end of tenancy. If your application is approved, your first month’s rent, and a security deposit (if applicable, equal to one half a month’s rent) will be required prior to occupancy. Thereafter, rent will be due on or before the 1st day of every month. *

I Agree
Type your name below (digital signature): *
Date *

- Month - Day Year
ALL INFORMATION HEREIN IS DEEMED CONFIDENTIAL
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Kingsley Low Rental Housing Society