rental application - Kekinow Native Housing Society

Kekinow Native Housing Society
1014-7445 132nd Street • Surrey, BC V3W 1J8 • Telephone 604-591-5299 • Fax 604-591-5112
RENTAL APPLICATION
Important! All information is mandatory. Incomplete applications will not be placed on our
waitlist! This application is valid for a period of one year from the date received by Kekinow
Native Housing Society. It is your responsibility to update your application annually and/or
call if you change your phone number. All other updates must be in writing.
Applicant's Name: ____________________________ Co-Applicant’s Name: _________________________
(Please print clearly)
(Please print clearly)
Do you expect your family size to change in near future? (If yes, explain) _____________________________
Current Address: _______________________________________________________________________
(Street Address)
(City)
(Province)
(Postal Code)
How long at this address: ___________ Contact Phone #s h: ______________ c: ___________________
(Phone number must be provided)
Do you own any vehicle/motorbike(s) etc. (If yes, how many and what) _____________________________________________________
Personal Status: Married ___ Common-law ___ Single ___ Single-Parent/Family ___ Partners ___ Widow___
Birthdate _______ Age ______ Name your Aboriginal Ancestry: ___________________________
(i.e. - Band, Métis, Inuit)
Full name of who will all be residing with applicant(s):
(First/Last Name)
(Copies of all Ancestry/status must be provided)
(Spouse, Son, Daughter, etc.)
Name______________________________ Relationship_____________ Birthdate
Age____
Name______________________________ Relationship_____________ Birthdate
Age____
Name______________________________ Relationship_____________ Birthdate
Age____
Name______________________________ Relationship_____________ Birthdate
Age____
Name______________________________ Relationship_____________ Birthdate
Age____
Name______________________________ Relationship_____________ Birthdate
Age____
Accommodation required: __ 1Bedroom __ 2 Bedrooms __ 3 Bedrooms __ 4 Bedrooms __ Handicap
Do You Have A Physical Disability?
Yes
No
Do You Use A Wheelchair?
Yes
No
Please Specify Your Type of Disability: ____________________________________________________
Please Choose Which City:
(One only)
What Type Of Application Are You Filling Out?
Surrey
Original
Chilliwack
Update Information
**KEKINOW NATIVE HOUSING SOCIETY HAS A STRICT "NO PETS" POLICY **
(See over)
Income Source: (If employed job position & company) _________________________________________________
(ex: Employed, Self-Employed, Social Assistance, Pensions etc.)
Are You A Relative Or Know Any Of The Kekinow Native Housing Staff Or Tenants?
Yes
No
If yes, please state who: _________________________________________________________________
Have You Ever Been A Tenant Of Kekinow Native Housing Society? __Yes __ No If yes, unit # ______
And complex: ________________ When: _______ Reason for leaving: __________________________
Are You Currently In Low Income Housing?
Yes
_ No If yes, how long? __________________
If yes, with which one: ______________________ Reason for leaving: _______________________
Previous Landlord information: Full name: ___________________ Landlord phone#_______________
When and where: _______________________ Reason for leaving: _________________________
Current Landlord information: Full name: ___________________ Landlord phone# _______________
Address: ___________________________ Reason for leaving: ____________________________
**Please read all information**
Information collected is in accordance with section 26 (c) of the Freedom of Information and Protection of
Privacy Act (the FOI Act).
I authorize Kekinow Native Housing Society to contact my current, previous landlords
and references necessary to process my application. This information will be used to
determine your eligibility for housing.
I understand that accommodation availability is subject to placement on a waiting list
and that Kekinow Native Housing Society does not provide Emergency Shelter, nor can
the Society accommodate “Urgent” referrals from other agencies.
I agree to all of the above by signing, that the information provide herein is true and
correct. I realize that any false information provided could result in cancellation of this
application.
_________________________
Applicant's Signature
__________________________
Co-Applicant's Signature
Office use only: Copies of all documents provided:
 or X
_____________________________
Date
KNHS Initials: ________