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 NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Birth Date*

MonthDayYear

Occupant Information
List All Occupants Other Than Applicant
Name

First NameLast Name
Birth Date

MonthDayYear
Relationship
If "Other" please explain:
Name

First NameLast Name
Birth Date

MonthDayYear
Relationship
If "other" please explain:

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 AssistanceOther
If "Other", please explain:
Employer Information
Current or Most Recent Employer
Length of Employment
Employer Contact Name

First NameLast Name
Employer Phone #

Area CodePhone Number

Rental History
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Move in Date*

MonthDayYear
Move Out Date*

MonthDayYear
Amount Paid Monthly*
Landlord or Company Name*
Landlord Phone #*

Area CodePhone Number
Landlord Email
(if available)
Reason for Leaving*
If "other" please explain:
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Move in Date

MonthDayYear
Move Out Date

MonthDayYear
Amount Paid Monthly
Landlord or Company Name
Landlord Phone #

Area CodePhone Number
Landlord Email
(if available)
Reason for Leaving
If "other" please explain:
Note that the following documentation will be required if chosen for an interview.

Proof of Current Address and Rent

 Copy of current rent Receipt or recent rent increase notice; or
 Copy of lease or tenancy agreement showing current rent amount.

Financial Information
Annual Income *
From all sources
Bank Balance *
From all bank/investment accounts
Note that the following documentation will be required if chosen for an interview.

Proof of income and Assets

 If receiving income assistance from the Ministry of Social Development and Social
Innovation (SDSI): copy of cheque stub or confirmation of monthly assistance from your
worker at SDSI.
 If employed: proof of current gross monthly income (last three consecutive cheque
stubs or letter from employer).
 Copies of cheque stubs, bank statements showing direct deposit of pensions, or other
confirmation of income for any other income source.
 Copies of bank statements or letter from financial institution stating total value of
asset(s).
 Property tax assessments for value of property owned and proof of outstanding
mortgage(s) if you own property.
 Income Tax Notice of Assessment for the tax return for the calendar year if filed or
previous calendar year if this calendar year has not yet been filed

Personal References
Reference #1 Full Name *

First NameLast Name
Relationship to Applicant*
Phone Number*

Area CodePhone Number
E-mail
Reference #2 Full Name *

First NameLast Name
Relationship to Applicant*
Phone Number*

Area CodePhone Number
E-mail

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 *

MonthDayYear
ALL INFORMATION HEREIN IS DEEMED CONFIDENTIAL
Should be Empty: