RESIDENTIAL RENTAL APPLICATION

For inquiries about the rental property, please contact Allan Martin at:
Email Address: martin.bills1@proton.me
Phone: (250) 517-8553

RENTAL PROPERTY

Rental Property Address: 111-5005, River Road, Pritchard BC V0E 2P0

Date of Availability: August 1, 2022
Type of Lease Term: Fixed term
Minimum Term of Lease: 1 year
Monthly Rent Payment: $2,000.00
Initial Security Deposit: $1,000.00 + 500 per pet

APPLICANT'S PERSONAL INFORMATION

Name: ____________________________________________________________________
Email Address: ____________________________________________________
Home Phone: (_________) ______________ Alternative Phone: (_________) ______________
Date of Birth: _________________________Social Insurance Number: _______________
DESIRED MOVE-IN DATE: _________________

CO-APPLICANT’S PERSONAL INFORMATION (if applicable)

Name: ____________________________________________________________________
Email Address: _____________________________________________________
Home Phone: (_________) ______________ Alternative Phone: (_________) ______________
Date of Birth: _________________________Social Insurance Number: _______________

Page 1 of 6
Residential Rental Application Page 2 of 6

OTHER OCCUPANTS’ INFORMATION (if applicable)

Name: ____________________________________________________________________
Relation to Applicant: _____________________________Date of Birth: ____________________

Name: ____________________________________________________________________
Relation to Applicant: _____________________________Date of Birth: ____________________

RENTAL HISTORY

I. Current Residence

Current Address:
_________________________________________________________________________
How long have you been residing at this address? _________________________________
Monthly Rent: _______________
Landlord's Name: ___________________________________________
Landlord's Contact Number: __________________________________
Reason(s) for leaving this property:
_____________________________________________________________________________
_____________________________________________________________________________

II. Previous Residence (If applicable)

Previous Address:
_________________________________________________________________________How
long did you stay at this address? __________________________________________
Monthly Rent: _____________________
Landlord's Name: __________________________________________
Landlord's Contact Number: __________________________________
Reason(s) for leaving this property:
_____________________________________________________________________________
_____________________________________________________________________________
Residential Rental Application Page 3 of 6

Have you ever been evicted from a rental residence? Yes No

Have you missed two or more rental payments in the past 12 months? Yes No
Have you ever refused to pay rent when due? Yes No
If you have answered YES to any of the above, please state your reasons and/or
circumstances:
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________

EMPLOYMENT DETAILS

I. Current Employment

Employment Status: [ ] Full-Time [ ] Part-time [ ] Student [ ] Unemployed [ ] Retired

Current Employer: _________________________________________________________
Supervisor's Name: _______________________________
Phone: ________________
Job Title: _______________________________________
Date Hired: ____________________
Monthly Income:$ _________

Other Sources of Income:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________

II. Previous Employment

Previous Employer (if any): ________________________________________________

Supervisor's Name: _______________________________
Phone: ________________
Job Title: _______________________________________
Period of Employment: __________________________
Residential Rental Application Page 4 of 6

PROOF OF INCOME

The applicant is required to attach proof of their income to this rental application form. Acceptable
documentation includes pay stubs, employer’s letter/certificate, bank statements or copies of the
previous year’s tax return.

CREDIT HISTORY AND BACKGROUND CHECK AUTHORIZATION

Have you declared bankruptcy in the past seven (7) years? Yes No
Do you consent to a credit check? Yes No
Is there anything that we may find in our credit check that you want to comment on?

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

CRIMINAL BACKGROUND CHECK AUTHORIZATION

Do you consent to a criminal check? Yes No

Is there anything that we may find in our criminal check that you want to comment on?

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

ADDITIONAL INFORMATION

I. PETS

The Landlord allows pets in the rental property, with the following restrictions:

a. The Landlord requires a pet deposit in the amount of $500.00 per

pet. Maximum 2 pets
Residential Rental Application Page 5 of 6

b. No dangerous breeds
c. 2 pets Maximum, 2 dogs or 2 cats or one of each
d. Only the pets on the initial lease allowed
e. No constant barking allowed. Removal of pets will result.
f. Unit 111's property not to be used for pets "bathroom"needs.
g. Any pet fecal matter on common property, must be removed immediately.
Do you own a pet? Yes No
If YES, please describe the pet:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

II. SMOKING

The Landlord does not allow smoking of cigarettes in the rental property.

The Landlord does not allow smoking of marijuana in the rental property.

III. WATERBEDS

The Landlord does not allow the use of waterbeds on the premises.

IV. PARKING

The rental property includes 2 Parking stalls in front of home for the tenant's use.
Will you bring a vehicle? Yes No

I declare that the information I have provided is true and correct, and contain no misrepresentations. If
misrepresentations are found after a residential lease agreement is entered into between the Landlord
and Applicant, the Landlord shall have the option to terminate the residential lease agreement and seek
all available remedies.
Residential Rental Application Page 6 of 6

The Applicant authorizes the Landlord to verify all references and facts, including but not limited to
current and previous landlords, employers and personal references. The Applicant understands that
incomplete or incorrect information provided in the application may cause a delay in processing or may
result in the denial of application.

Applicant's Signature ______________________ Date ___________

Co-Applicant's Signature ______________________ Date ___________

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