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Property Address
Monthly Rent (in $)
Occupancy Date Desired
Last Name
Middle Name
First Name
Birth Date (DD/MM/YY)
Drivers License/BC ID
Home Phone
Cell Phone
Email
Name
Age
Present Address
City
Prov.
Postal Code
Date In
Date Out
Landlord name
Landlord phone number
Monthly Rent/ Mortgage $
Reason for Leaving
Past Address
Occupation
Company
Employment Dates
Employer Address
Employer Phone Number
Name of Supervisor
Current monthly salary/ wage
Other monthly income (ie. Parental Support, Income Assistance, Savings)
Not applicable, if I have no vehicle.
Make
Model
Colour
License Plate #
Type of pet (dog/cat)
Breed
Colour/ markings
Size
Phone Number
Relationship (ie. landlord, employer, etc)
Relationship (ie. parent, friend)
Have you ever been late with a monthly rent payment?
YesNo
Have you ever filed for bankruptcy?
Are you under 19 years of age?
Does anyone in your household smoke?
Do you have any water‐filled furniture (waterbed, aquarium)?
Do you currently have tenants’ contents and personal liability insurance?
Have you ever received a ‘Notice to End Tenancy’? If yes, please describe reason below...
Signature Upload
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