Rental Application Form

Now Renting Properties

If you need assistance filling out your application, please consider the following local resources:

Public computers and printing available at Vancouver Island Public Library:

90 Commercial St Nanaimo, BC V9R 5G4 Phone: 250-753-1154. (10 public computers, 15–30-minute time limits, printing available)

In-person support by staff at:

Nanaimo Disability Resource Centre –
#2-4166 Departure Bay Rd, Nanaimo, BC V9T 4B7 Phone: 250-758-5547
Nanaimo Family Life Association –
1070 Townsite Rd Nanaimo, BC V9S 1M6 Phone: 250-754-3331

Please have your reference information, residency history, and co-applicant ready to sign before beginning.

Step 1 of 8

12%

How did you find us today?(Required)

Referred by a Tenant

Referred by Nanaimo Family Life

Referred by Seniors Resource Directory

Referred by a support agency

Rentals.ca

Voyager Magazine

Business Examiner Vancouver Island

Nanaimo Magazine

Other

Location(Required)

6010 Hammond Bay Road (Nanaimo)

10 Buttertubs Dr (Nanaimo)

77 Mill Street (Nanaimo)

858 Georgia Ave (Nanaimo)

360 / 364 Moilliet Street (Parksville)

Any Location

Select your preferred location.

Name(Required)

Prefix First Middle Last

Preferred Name

BIRTHDATE(Required)

YYYY dash MM dash DD

Please select your birth date, eg. 1977-11-23

Home Phone(Required)

Mobile Phone(Required)

Email(Required)

Enter Email Confirm Email

Housing Sought(Required)

Studio

1 Bedroom

1 Bedroom (accessible suite)

1 Bedroom + Den

2 Bedroom

3 Bedroom

Status(Required)

Canadian Citizen

Permanent Resident

Landed Immigrant

Refugee Status

Do you accept correspondence by email?(Required)

Yes

Current Home Address(Required)

Street Address Address Line 2 City Province Postal Code

Mailing Address

Same as previous

Street Address Address Line 2 City Province Postal Code

If you are living alone, please enter NONE or N/A in the first row below.

DETAILS OF THOSE WHO WOULD BE LIVING IN YOUR HOUSEHOLD(Required)

Last Name

First Name

Age

Status (Dependent, Spouse, Family, etc.)

Do you expect the number of people living with you to change in the next 12 months? (Please Explain)(Required)

RESIDENCY HISTORY (please list last five years)(Required)

Address

From (yyyy-mm-dd)

To (yyyy-mm-dd)

Landlord Name

Landlord Phone #

Reason for Leaving

Current Rent Amount:(Required)

Was hydro, cable etc. included in your rent?

Yes

PROVIDE A MINIMUM OF TWO REFERENCES

Current Employer

Contact Name

Phone Number

Email Address

Past Employer

Contact Name

Phone Number

Email Address

Current Landlord(Required)

Contact Name

Phone Number

Email Address

Past Landlord(Required)

Contact Name

Phone Number

Email Address

Personal Contact

Contact Name

Phone Number

Email Address

Applicant's Gross Monthly Income(Required)

All Income Source(s) (e.g. employment, EI, pensions, SAFER, etc.)(Required)

Do you have a Co-Applicant?(Required)

Yes

Co-Applicant's Gross Monthly Income(Required)

Co-Applicant's Primary Income Source(s): (e.g. employment, EI, pensions, SAFER etc.)

What date would you like to move in?(Required)

YYYY dash MM dash DD

Would you prefer a specific floor in the building?(Required)

Have you received a legal Notice to End Tenancy?(Required)

Yes

If yes, please explain:(Required)

Have you or any members of your household ever lived in affordable housing?(Required)

Yes

Note: Failure to declare past subsidized housing may result in the cancellation of your application.

Is money owing due to a past tenancy?(Required)

Yes

Note: Failure to declare past debts owed may result in cancellation of your application. Past tenants with a debt will be required to repay the debt prior to application acceptance.

Please provide the reasons you are considering a move from your current residence.(Required)

Please provide details regarding any accessibility requirements you or other members of your household may have.

Please list any supports you currently receive (e.g. Home Support, etc.)

How many parking stalls do you require?(Required)

Do you have an accessible parking pass (for persons with disabilities)?(Required)

Yes

*Landlord will need a copy of the pass to assign a parking stall and require a doctors note on file for specific disability*

The tenant shall provide proof of vehicle registration and proof of valid and current vehicle insurance and a valid driver’s license before consideration is given to a pay parking stall.
If a vehicle is temporarily unlicensed or uninsured, the tenant must immediately remove the vehicle from the residential property and the parking stall will be re-assigned.
The tenant may not use the parking stall for washing or repairing vehicles and must immediately remove any vehicle leaking oil or other fluids. The tenant will be responsible for spillage clean-up and associated costs.
No full-sized trucks, recreational vehicles, commercial vehicles, boats, or trailers are permitted on the residential property.
The landlord may tow, at the tenant’s sole risk and expense, any vehicle that is improperly parked or any vehicle that violates this tenancy agreement.

Do you have pets?(Required)

Yes

Applicants must disclose and register any pets with the landlord. A pet damage deposit will be required if your application is approved.

Pet Details

A pet damage deposit of fifty percent (50%) of the first month's rent will be required in accordance with the Residential Tenancy Act. A guide dog or service animal, as defined in the Guide Animal Act, is not a pet for the purpose of this agreement but will be subject to the pet damage deposit. A pet is defined as any domesticated animal which is kept, or fed. Tenants may keep one indoor house cat as a pet in units without patio or balcony access. One dog will be allowed for units located on the first floor of the building only. The tenant must provide the following documentation to Nanaimo Affordable Housing Society:

a description; sufficient to identify the pet
Name, address and telephone number of the tenant’s veterinarian
Pet’s tattoo number or microchip details (if available)
Details and certificate of all inoculations
Proof that the pet has been spayed or neutered
Photo of the pet
The licence number of the Pet if the Pet is required by law, bylaw or regulation to be licensed

The tenant is liable for any damage done to the unit or any common area of the residential property, or harm done to persons caused by the tenant’s pet, or a pet belonging to a guest of the tenant.

DECLARATIONS: (please read and sign this statement)

Ballenas Housing Society Agreement (Ballenas) with BC Housing:

The landlord has entered into an agreement with BC Housing designating the residential property as housing for low to moderate income households. Income testing is required and will be completed in compliance with the standards set by BC Housing.
The following Occupancy Standards will also apply to this project:
- No more than two (2) and no less than one (1) person per bedroom.

The Applicant Declares the Following:

I/We declare:

This is my application; and
I/We consent to the use of this information for the purposes of matching the housing (potentially available) within the Ballenas portfolio, with my/our needs.
All the information provided in this application is correct and complete to the best of my knowledge and belief.
I/we further state that in terms of my/our physical condition I/we can care for myself/ourselves.

I/We authorize:

Pursuant to both the Personal Information Protection Act (PIPA) and the Freedom of Information and Protection of Privacy Act (FOIPPA), I/We acknowledge to and agree with Ballenas that Ballenas is authorized to make any inquiries that are necessary to verify the information given in this application; and
Pursuant to PIPA and FOIPPA, I/We hereby consent to any person, firm, corporation or social agency or governmental department releasing to Ballenas any information requested by Ballenas pertinent to the assessment of this application by Ballenas; and
Ballenas to communicate to and receive from credit bureaus and my/our previous landlords, credit and other information about me/us, to be used by Ballenas in assessing this application for rental accommodation.

I/We understand that:

This application does not constitute any agreement on the part of Ballenas to provide me/us with rental accommodation;
Preference will be given to applicants who are current residents of Nanaimo;
10 Buttertubs Drive is a no-smoking property and a non-smoking agreement will need to be signed prior to the commencement of the tenancy;
10 Buttertubs Drive is a strata property and I/we will be required to comply in all respects with the Strata Bylaws, a copy of which I/we will receive if my/our application is approved;
It is my/our responsibility to advise Ballenas of any changes to the information given in this application and to provide any supporting materials required for my/our application; and [Note: I/we acknowledge that if I/we provide false or misleading information Ballenas shall be at liberty to deny my/our application]
Ballenas requires three (3) references to be provided with an application before it can be reviewed.

Signatures on Application - Application must be signed by all members of the household.

Please confirm how many applicants are applying(Required)

Applicant Signature:(Required)

Co-Applicant's Name

First Last

Co-Applicant's Signature:

Date Signed(Required)

YYYY dash MM dash DD

SUBMISSION

AUTHORIZATION TO COMPLETE CREDIT CHECK

I/We hereby warrant that all representations set forth above are true. To verify the above statements, I/We direct those persons named as references in this application to answer all questions posed to them about me/us.
I/We hereby waive any right of action arising from or relating to any information provided by those persons named as references in connection with any information they provide about me/us.
I/We hereby agree and authorize Ballenas Housing Society (Ballenas) to perform a credit check on me/us and hereby consent to any and all credit agencies releasing credit information about me/us to Ballenas.

Applicant Credit Check Consent(Required)

I agree to Complete Credit Check by Ballenas Housing Society

Applicant's Initials(Required)

Co-Applicant Credit Check Consent

I agree to Complete Credit Check by Ballenas Housing Society

*Only required if a second applicant is applying.

Co-Applicant's Initials

Type n/a if no co-applicant is applying.

Phone

This field is for validation purposes and should be left unchanged.

Step 1 of 8

12%

How did you find us today?(Required)

Referred by a Tenant

Referred by Nanaimo Family Life

Referred by Seniors Resource Directory

Referred by a support agency

Rentals.ca

Voyager Magazine

Business Examiner Vancouver Island

Nanaimo Magazine

Other

Location(Required)

6010 Hammond Bay Road (Nanaimo)

10 Buttertubs Dr (Nanaimo)

77 Mill Street (Nanaimo)

858 Georgia Ave (Nanaimo)

360 / 364 Moilliet Street (Parksville)

Any Location

Select your preferred location.

Name(Required)

Prefix First Middle Last

Preferred Name

BIRTHDATE(Required)

YYYY dash MM dash DD

Please select your birth date, eg. 1977-11-23

Home Phone(Required)

Mobile Phone(Required)

Email(Required)

Enter Email Confirm Email

Housing Sought(Required)

Studio

1 Bedroom

1 Bedroom (accessible suite)

1 Bedroom + Den

2 Bedroom

3 Bedroom

Status(Required)

Canadian Citizen

Permanent Resident

Landed Immigrant

Refugee Status

Do you accept correspondence by email?(Required)

Yes

Current Home Address(Required)

Street Address Address Line 2 City Province Postal Code

Mailing Address

Same as previous

Street Address Address Line 2 City Province Postal Code

If you are living alone, please enter NONE or N/A in the first row below.

DETAILS OF THOSE WHO WOULD BE LIVING IN YOUR HOUSEHOLD(Required)

Last Name

First Name

Age

Status (Dependent, Spouse, Family, etc.)

Do you expect the number of people living with you to change in the next 12 months? (Please Explain)(Required)

RESIDENCY HISTORY (please list last five years)(Required)

Address

From (yyyy-mm-dd)

To (yyyy-mm-dd)

Landlord Name

Landlord Phone #

Reason for Leaving

Current Rent Amount:(Required)

Was hydro, cable etc. included in your rent?

Yes

PROVIDE A MINIMUM OF TWO REFERENCES

Current Employer

Contact Name

Phone Number

Email Address

Past Employer

Contact Name

Phone Number

Email Address

Current Landlord(Required)

Contact Name

Phone Number

Email Address

Past Landlord(Required)

Contact Name

Phone Number

Email Address

Personal Contact

Contact Name

Phone Number

Email Address

Applicant's Gross Monthly Income(Required)

All Income Source(s) (e.g. employment, EI, pensions, SAFER, etc.)(Required)

Do you have a Co-Applicant?(Required)

Yes

Co-Applicant's Gross Monthly Income(Required)

Co-Applicant's Primary Income Source(s): (e.g. employment, EI, pensions, SAFER etc.)

What date would you like to move in?(Required)

YYYY dash MM dash DD

Would you prefer a specific floor in the building?(Required)

Have you received a legal Notice to End Tenancy?(Required)

Yes

If yes, please explain:(Required)

Have you or any members of your household ever lived in affordable housing?(Required)

Yes

Note: Failure to declare past subsidized housing may result in the cancellation of your application.

Is money owing due to a past tenancy?(Required)

Yes

Note: Failure to declare past debts owed may result in cancellation of your application. Past tenants with a debt will be required to repay the debt prior to application acceptance.

Please provide the reasons you are considering a move from your current residence.(Required)

Please provide details regarding any accessibility requirements you or other members of your household may have.

Please list any supports you currently receive (e.g. Home Support, etc.)

How many parking stalls do you require?(Required)

Do you have an accessible parking pass (for persons with disabilities)?(Required)

Yes

*Landlord will need a copy of the pass to assign a parking stall and require a doctors note on file for specific disability*

The tenant shall provide proof of vehicle registration and proof of valid and current vehicle insurance and a valid driver’s license before consideration is given to a pay parking stall.
If a vehicle is temporarily unlicensed or uninsured, the tenant must immediately remove the vehicle from the residential property and the parking stall will be re-assigned.
The tenant may not use the parking stall for washing or repairing vehicles and must immediately remove any vehicle leaking oil or other fluids. The tenant will be responsible for spillage clean-up and associated costs.
No full-sized trucks, recreational vehicles, commercial vehicles, boats, or trailers are permitted on the residential property.
The landlord may tow, at the tenant’s sole risk and expense, any vehicle that is improperly parked or any vehicle that violates this tenancy agreement.

Do you have pets?(Required)

Yes

Applicants must disclose and register any pets with the landlord. A pet damage deposit will be required if your application is approved.

Pet Details

a description; sufficient to identify the pet
Name, address and telephone number of the tenant’s veterinarian
Pet’s tattoo number or microchip details (if available)
Details and certificate of all inoculations
Proof that the pet has been spayed or neutered
Photo of the pet
The licence number of the Pet if the Pet is required by law, bylaw or regulation to be licensed

The tenant is liable for any damage done to the unit or any common area of the residential property, or harm done to persons caused by the tenant’s pet, or a pet belonging to a guest of the tenant.

DECLARATIONS: (please read and sign this statement)

Ballenas Housing Society Agreement (Ballenas) with BC Housing:

The landlord has entered into an agreement with BC Housing designating the residential property as housing for low to moderate income households. Income testing is required and will be completed in compliance with the standards set by BC Housing.
The following Occupancy Standards will also apply to this project:
- No more than two (2) and no less than one (1) person per bedroom.

The Applicant Declares the Following:

I/We declare:

This is my application; and
I/We consent to the use of this information for the purposes of matching the housing (potentially available) within the Ballenas portfolio, with my/our needs.
All the information provided in this application is correct and complete to the best of my knowledge and belief.
I/we further state that in terms of my/our physical condition I/we can care for myself/ourselves.

I/We authorize:

Pursuant to both the Personal Information Protection Act (PIPA) and the Freedom of Information and Protection of Privacy Act (FOIPPA), I/We acknowledge to and agree with Ballenas that Ballenas is authorized to make any inquiries that are necessary to verify the information given in this application; and
Pursuant to PIPA and FOIPPA, I/We hereby consent to any person, firm, corporation or social agency or governmental department releasing to Ballenas any information requested by Ballenas pertinent to the assessment of this application by Ballenas; and
Ballenas to communicate to and receive from credit bureaus and my/our previous landlords, credit and other information about me/us, to be used by Ballenas in assessing this application for rental accommodation.

I/We understand that:

This application does not constitute any agreement on the part of Ballenas to provide me/us with rental accommodation;
Preference will be given to applicants who are current residents of Nanaimo;
10 Buttertubs Drive is a no-smoking property and a non-smoking agreement will need to be signed prior to the commencement of the tenancy;
10 Buttertubs Drive is a strata property and I/we will be required to comply in all respects with the Strata Bylaws, a copy of which I/we will receive if my/our application is approved;
It is my/our responsibility to advise Ballenas of any changes to the information given in this application and to provide any supporting materials required for my/our application; and [Note: I/we acknowledge that if I/we provide false or misleading information Ballenas shall be at liberty to deny my/our application]
Ballenas requires three (3) references to be provided with an application before it can be reviewed.

Signatures on Application - Application must be signed by all members of the household.

Please confirm how many applicants are applying(Required)

Applicant Signature:(Required)

Co-Applicant's Name

First Last

Co-Applicant's Signature:

Date Signed(Required)

YYYY dash MM dash DD

SUBMISSION

AUTHORIZATION TO COMPLETE CREDIT CHECK

I/We hereby warrant that all representations set forth above are true. To verify the above statements, I/We direct those persons named as references in this application to answer all questions posed to them about me/us.
I/We hereby waive any right of action arising from or relating to any information provided by those persons named as references in connection with any information they provide about me/us.
I/We hereby agree and authorize Ballenas Housing Society (Ballenas) to perform a credit check on me/us and hereby consent to any and all credit agencies releasing credit information about me/us to Ballenas.

Applicant Credit Check Consent(Required)

I agree to Complete Credit Check by Ballenas Housing Society

Applicant's Initials(Required)

Co-Applicant Credit Check Consent

I agree to Complete Credit Check by Ballenas Housing Society

*Only required if a second applicant is applying.

Co-Applicant's Initials

Type n/a if no co-applicant is applying.

Name

This field is for validation purposes and should be left unchanged.