Fillable Application for Housing

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Application for Housing

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Application for Housing
September 2021
Thank you for your interest in housing at KinVillage. To apply for independent housing, you must meet
age, residency, income and asset requirements as indicated below. Two options are available –
Subsidized Housing and Affordable Housing. Please review the requirements and chose a housing
option below or apply for both options.
Subsidized Housing Requirements – must be age 55 years plus OR if younger, in receipt of a recognized
disability pension or considered disabled for income tax purposes; income level below
$57,500.00; assets below $100,000; permanent resident of BC and meet Canadian citizenship
requirements. Rent will be based on $30% of income.
Do you want to apply for subsidized housing? □ Yes □ No
Affordable Housing Requirements – must be age 55 years plus; income level below $30,000; assets
below $100,000. Current rental rate is $769.50; this is adjusted periodically by KinVillage.
Do you want to apply for affordable housing □ Yes □ No
Please be sure to fully complete your application, including attaching any additional relevant
information. This will allow KinVillage to accurately assess your application and determine your
eligibility. Completed applications may be submitted by mail to: Tenant Community Liaison at 5492
11th Ave. Tsawwassen, BC, V4M 1Z3, or by email to housing@kinvillage.org
For assistance in completing your application, please contact the KinVillage office at (604) 943-4840.
Applicant Information
Legal Name (First and Last): Date of birth:
Phone: Cell:
E-mail:
Mailing address:
City: Province: Postal Code:
Alternative Contact (in case we can’t reach you):
Alternative Contact Phone:
Application for Housing
September 2021
Co-Applicant Information
Legal Name (First and Last):
Date of Birth: Relationship to 1
st
Applicant:
Current/Most Recent Accommodation
Address (if different than above):
City: Province: Postal Code:
From Date: To Date:
Type: House Apartment Trailer Other_______________
(Please check off box)
Owned Rented Free (Please check off box)
If you own or rent, what is your
total monthly cost
for housing expenses (includes rent, strata
fees, property taxes, utilities): $
Reason for leaving (Note: If Notice to End a Residential Tenancy received from Landlord, submit
a copy with this Application):
1.
2.
3.
Residency History, rentals in past 2 years & any prior subsidized accommodation
Address
From Date
To Date
Landlord Name
Phone #
Application for Housing
September 2021
References, excluding family members, if no previous Landlords listed
Name
Relationship
Address
Income Information (including Co-Applicant, if any)
GIS (Guaranteed Income Supplement):
Gross Monthly Income: $
OAS (Old Age Security):
Gross Monthly Income: $
CPP (Canada Pension Plan):
Gross Monthly Income: $
Other Pension(s) Description: Gross Monthly Income: $
Gross Monthly Income: $
Other Income Description:
Gross Monthly Income: $
Gross Monthly Income: $
TOTAL
Gross Monthly Income: $
Application for Housing
September 2021
Assets Information (including any Co-Applicant, if any)
Cash – Bank Accounts (List each of
chequing/savings):
1.
2.
3.
$
$
$
Canada Savings Bonds:
$
Term Deposits: $
GICs (Guaranteed Investment Certificates): $
Real Estate Equity, net of debt (List each house
address):
1.
2.
$
$
Other Assets Description:
1.
2.
$
$
TOTAL
$
Other Information
Do you use a wheelchair? Yes No (Please check off box)
Do you use an electronic scooter? Yes No (Please check off box)
Do you smoke? Yes No (Please check off box)
Application for Housing
September 2021
I hereby certify that all of the information provided in this application is correct. I further agree
that this information can be used by KinVillage and their associates in the evaluation of my
application.
ALL INFORMATION HEREIN IS DEEMED CONFIDENTIAL
Name Signature Date
Declaration
I/We declare that the information given in this application is correct and complete. I/We
understand that it is my/our responsibility to advise KinVillage Association (KinVillage) of
any changes to the information given in this application and to provide any supporting
materials (e.g. to verify income and assets) as and when requested by KinVillage.
Pursuant to relevant privacy legislation, I/We give KinVillage my/our consent to make any
inquiries that are necessary to verify the information given in this application and I/We
authorize any person, corporation or agency to release to KinVillage any information
pertinent to the assessment of my/our application.
I/We consent to KinVillage receiving and exchanging with credit bureaus and my/our previous
landlords, credit and other information about me/us. I/We understand that such information
will be a factor in KinVillage’s decision to provide me/us with rental accommodation. I/We
understand that this application does not constitute any agreement on the part of KinVillage to
provide me/us with rental accommodation; it is not possible to predict when or if a suite may
become available. Applicants who are offered and accept a suite must sign a Tenancy
Agreement and may be required to sign Tenancy Agreement addendums that cover topics such
as pets, parking, smoking, etc.
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Application for Housing

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Completed 11 October 2021

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