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Newfoundland and Labrador Rental Application Form


Newfoundland and Labrador Rental Application Form
Newfoundland and Labrador Rental Application Form
Social Insurance Number AES File Number (if applicable)
Applicant:
Where can you be contacted
Telephone: (Home) (Work) (Cell)
Email address:
Date of Birth: Gender:
______________ Marital Status: r Single r Married r Widowed
Aboriginal:
r
Yes
r
No
I hereby give consent for
to make enquiries or act on my behalf regarding this application.
Privacy section: Office Use Only
RENTAL APPLICATION
Newfoundland Labrador Housing (Housing) is subject to the
Access to Information and Protection Privacy Act. Applicants/
clients have a right of access to the existence, use and dis-
closure of their personal information.
Application #: __________________________________________
Date Received: _________________________________________
NL Housing
1.
2.
3.
4.
Is anyone in the household expecting a child [affects bedroom requirement(s)]
r
Yes
r
No Due date:
+ Relationship to Applicant can be either: Spouse, Child, Other Relative, or Not Related.
* Marital Status can be either: Single, Married, Widowed, Divorced, Separated, or Common Law.
HOUSEHOLD OCCUPANTS
(Please see Section 9 if more than four household occupants)
Relationship Marital Date of Birth Social Insurance
Full Name to Applicant+ Status* Gender Number*
D M Y
(Co-Applicant)
2
FCN 11,001
01/2012
*SIN is required by Housing to
operate its programs and services
NOTE: Incomplete applications will be returned unprocessed.
What are your present accommodations
r
own home
r
boarding house
r
transition house
r
rented apartment
r
living with family/friends
r
shelter
Currently, I live in:
r
Semi-detached
r
Row Housing
r
Apartment
r
Single Dwelling
If you are renting, what is the name of your landlord
Number of bedrooms in current dwelling:
When did you move into your current accommodation
Do you owe money to a current/past landlord
r
Yes
r
No Amount: $
What is your monthly cost for your present accommodtion including utilities $
Do you owe money to a power utility company
r
Yes
r
No Amount: $
CURRENT HOUSING
(Street/Apartment)
P.O. Box
Postal CodeProvince
(City/Town)
3
(Only list occupants that will be living with you and only list dependants for whom
you have joint or sole custody.)
APPLICANT INFORMATION
(Last Name)
(First Name)
(Initial)
(Title: Mr. Mrs. Ms.)
1
D M Y
r Divorced r Separated r Common-Law
(Name)
(Relationship)
(Home) (Work)
D M Y
D M Y
Newfoundland and Labrador Rental Application Form
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