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Monthly Rent (in $)
Occupancy Date Desired
Birth Date (DD/MM/YY)
Drivers License/BC ID
Landlord phone number
Monthly Rent/ Mortgage $
Reason for Leaving
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.
License Plate #
Type of pet (dog/cat)
Relationship (ie. landlord, employer, etc)
Relationship (ie. parent, friend)
Have you ever been late with a monthly rent payment?
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...