Georgia Heights Tenant Application Form Address: 858 Georgia Avenue, Nanaimo BC Property Details Please have your reference information, residency history, and co-applicant ready to sign before beginning. "*" indicates required fields Step 1 of 9 - APPLICANT INFORMATION 0% Date* YYYY dash MM dash DD Name* Mr.Mrs.MissMs.Mx.Misc.Ind.Dr.Prof.ElderRev.RabbiFatherSisterTheNo PrefixOther Prefix Prefix First Middle Last Preferred Name* Preferred Name Home Phone*Mobile Phone*Email* Enter Email Confirm Email Housing Sought* 1 Bedroom + Den 2 Bedroom Other Status* Canadian Citizen Permanent Resident Refugee Status Do you wish to receive correspondence by email?* Yes No Current Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Mailing Address Same as previous Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 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*Last NameFirst NameAgeStatus (Dependent, Spouse, Family, etc.) Add RemoveDo you expect the number of people living with you to change in the next 12 months? (Please Explain)* RESIDENCY HISTORY (please list last five years)*AddressFrom (yyyy-mm-dd)To (yyyy-mm-dd)Reason for Leaving Add RemoveCurrent Rent Amount:*Was hydro, cable etc. included in your rent?* Yes No What date would you like to move in?* YYYY dash MM dash DD Would you prefer a specific floor in the building?* 1 2 3 PROVIDE A MINIMUM OF TWO REFERENCESCurrent EmployerContact NamePhone NumberEmail Address Add RemovePast EmployerContact NamePhone NumberEmail Address Add RemoveCurrent LandlordContact NamePhone NumberEmail Address Add RemovePast LandlordContact NamePhone NumberEmail Address Add RemovePersonal ContactContact NamePhone NumberEmail Address Add Remove Gross Monthly Income*Primary Income Source(s) (i.e. employment, EI, pensions, etc.)* How many parking stalls do you require?*01234Do you have an electric vehicle?* Yes No The tenant shall have the privilege of parking one automobile or light truck in the parking stall provided by the landlord; this stall is only intended for the use of the tenant. Subject to availability, the tenant shall have the option to rent an electric vehicle stall at the cost of $60 per month. (This cost includes a service charge for the use of the buildings common electricity.) Subject to availability, the tenant shall have the option to rent an undercover parking stall at the cost of $35 per month. Subject to availability, the tenant shall have the option to rent an exposed parking stall at the cost of $25 per month. If a vehicle is temporarily unlicensed, the tenant must carry storage and liability insurance and provide the landlord with proof of that insurance; The tenant may not use the parking stall for repairing vehicles and must remove any vehicle leaking oil or other fluids; Full-sized trucks, recreation vehicles, commercial vehicles, boats or trailers with landlord written permission Guests may park only in designated visitor parking areas; and 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. Tenants are not permitted to wash their personal vehicles on the residential property. Do you wish to rent a storage locker for an annual cost of $100? (Subject to availability)* Yes No Do you require bike storage?* Yes No Subject to availability, the tenant shall have the option to rent a storage locker at an annual cost of $100. If a storage locker is rented by the landlord, to a tenant, the locker will be for the use of the tenant only and cannot be subletted. All items placed in storage will be at the tenant’s sole risk and expense. The tenant is responsible for any damage that is caused by their use of the storage facility including; damage to the storage facility itself or to other tenants’ items within the facility. Tenants are not permitted to conduct repairs, complete maintenance, use power tools, store flammable materials, combustible materials, or unsealed noxious materials in the storage area. Weapons (as defined by the Canadian Criminal Code) are prohibited on the property. The landlord may reallocate storage lockers as the landlord deems appropriate. Do you have pets?* Yes No Any pets must be disclosed and registered with the landlord. A pet deposit will be required if your application is approved. Pet Details Leave A pet damage deposit of $100 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 deposit. A pet is defined as any domesticated animal which is kept or fed. Tenants can keep one indoor house cat as a pet. 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 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. Ballenas Housing Society Agreement with BC Housing: The landlord has entered into an agreement with BC Housing designating the residential property as housing for middle income households. Income testing is required and will be completed in compliance with the standards set by the HousingHub with the standards set by BC Housing. The following standards will apply: No more than two (2) and no less than one (1) person per bedroom. Spouses and couples share a bedroom. Dependents of the opposite sex age five (5) or over do not share a 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 the needs of the applicant. 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 physical condition I/we can care for myself/ourselves. I/We authorize: Pursuant to the Freedom of Information and Protection of Privacy Act (the FOI Act), Ballenas Housing Society to make any inquiries that are necessary to verify the information given in this application; and Pursuant to the FOI Act, any person, corporation or social agency to release Ballenas Housing Society any information pertinent to the assessment of my/our application; and Ballenas Housing Society to receive and exchange with credit bureaus and my/our previous landlords, credit and other information about me/us, to be used in the decision-making process to provide me/us with rental accommodation. I/We understand: That this application does not constitute any agreement on the part of Ballenas Housing Society to provide me/us with rental accommodation; That, preference will be given to applicants who are current residents of Nanaimo; That, Ballenas Housing Society has guaranteed that rental rates will remain frozen for a period of (2) two years following the initial offering of units. That, Georgia Heights is a non-smoking building and a non-smoking agreement will need to be signed prior to the commencement of the tenancy; and That it is my/our responsibility to advise Ballenas Housing Society of any changes to the information given in this application and to provide any supporting materials required for my/our application. Application must be signed by everyone age 19 or older.How many applicants over the age of 19?* 1 2 3 4 Applicant Signature:*Co-Applicant's Name First Last Co-Applicant's Signature:Third Applicant's Name First Last Third Applicant's Signature:Fourth Applicant's Name First Last Fourth Applicant's Signature:Date Signed* 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 ask questions about me/us. I/We waive all rights of actions for consequences as a result of such information. I/We agree and authorize and give permission to Ballenas Housing Society to perform a credit check on me/us.Applicant Credit Check Consent* I agree to Complete Credit Check by Ballenas Housing SocietyApplicant's Initials* 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.NameThis field is for validation purposes and should be left unchanged.