77 Mill Street Tenant Application Form

PROPERTY DETAILS

ADDRESS: 77 Mill Street, Nanaimo BC | MONTHLY RENT: Units Starting at $925.

CLICK ON THE THUMBNAIL TO VIEW THE PHOTOS AND FLOOR PLANS:

PLEASE READ BEFORE BEGINNING APPLICATION

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

Date*

Name*

Prefix First Middle Last

Preferred Name

Home Phone*

Mobile Phone*

Email*

Enter Email Confirm Email

Seniors (65+) Housing Sought*

1 Bedroom
1 Bedroom (accessible suite)

Status*

Canadian Citizen
Permanent Resident
Landed Immigrant
Refugee Status

Do you wish to receive correspondence by email?*

Yes
No

Current Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BC Housing File Number

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 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)*

RESIDENCY HISTORY (please list last five years)*

Address	From (yyyy-mm-dd)	To (yyyy-mm-dd)	Reason for Leaving

Current Rent Amount:*

Was hydro, cable etc. included in your rent?*

Yes
No

Services Included at your Current Address*

Select All
Hydro
Cable
Phone
Internet
Other

Other Service*

PROVIDE A MINIMUM OF TWO REFERENCES

Current Employer

Contact Name	Phone Number	Email Address

Past Employer

Contact Name	Phone Number	Email Address

Current Landlord

Contact Name	Phone Number	Email Address

Past Landlord

Contact Name	Phone Number	Email Address

Personal Contact

Contact Name	Phone Number	Email Address

Applicant's Gross Monthly Income*

Primary Income Source(s) (i.e. employment, EI, pensions, etc.)*

Additional Sources of Income: (Do not include alimony, child support, or child tax benefit)

Do you have a Co-Applicant?*

Yes
No

Co-Applicant's Gross Monthly Income*

Primary Income Source(s): (e.g. employment, EI, pensions, etc.)

Co-Applicant's Additional Sources of Income: (Do not include alimony, child support, or child tax benefit)

What date would you like to move in?*

Would you prefer a specific floor in the building?*

1
2
3
4

Have you received a legal Notice to End Tenancy?*

Yes
No

If yes, please explain:*

Have you or any members of your household ever lived in subsidized housing?*

Yes
No

Note: Failure to declare past subsidized housing or debts owed may result in cancellation of your application. Past tenants with a debt may be required to either repay the debt or enter into a repayment agreement.

Is money owing due to a past tenancy?*

Yes
No

Note: Failure to declare past subsidized housing or debts owed may result in cancellation of your application. Past tenants with a debt may be required to either repay the debt or enter into a repayment agreement.

Please provide the reasons you are considering a move from your current residence.*

Please provide details regarding any accessibility requirements you or other members of your household may have related to mobility or health conditions.

Please list any support services you currently receive (e.g. SAFER, Home Support, Home Care, etc.)

How many parking stalls do you require?*

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

Yes
No

*Landlord will need a copy of the pass to assign a parking stall*

The tenant shall have the privilege of parking one (1) automobile or light truck in the parking stall provided by the landlord; this stall is only intended for the use of the tenant.
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 in designated visitor parking areas only.
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 require scooter storage? (Subject to availability)*

Yes
No

Do you require bike storage? (Subject to availability)*

Yes
No

Subject to availability, the tenant shall have the option to store personal items in the storage room.
The storage room will be for the use of the tenant only and cannot be sublet.
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 and assign storage as the landlord deems appropriate.

Do you have pets?*

Yes
No

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. One dog will be allowed for units located on the ground 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 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)

Nanaimo Affordable Housing Agreement 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 standards will apply:

No more than two (2) and no less than one (1) person per bedroom.
Spouses and couples 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 NAHS 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 physical condition I/we can care for myself/ourselves.

I/We authorize:

Pursuant to the Personal Information Protection Act (PIPA) and the Freedom of Information and Protection of Privacy Act (FOIPPA), Nanaimo Affordable Housing Society to make any inquiries that are necessary to verify the information given in this application; and
Pursuant to PIPA and FOIPPA, any person, corporation or social agency to release Nanaimo Affordable Housing Society any information pertinent to the assessment of my/our application; and
Nanaimo Affordable 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:

This application does not constitute any agreement on the part of Nanaimo Affordable Housing Society to provide me/us with rental accommodation;
Preference will be given to applicants who are current residents of Nanaimo;
77 Mill Street is a non-smoking building and a non-smoking agreement will need to be signed prior to the commencement of the tenancy; and
It is my/our responsibility to advise Nanaimo Affordable Housing Society of any changes to the information given in this application and to provide any supporting materials required for my/our application. (Note: Providing false or misleading information will result in the cancellation of your application.)
Nanaimo Affordable Housing Society requires three (3) references to be provided with an application before it can be reviewed.

Application must be signed by all applicants over the age of majority.

Please confirm how many applicants are applying*

1
2

Applicant Signature:*

Co-Applicant's Name

First Last

Co-Applicant's Signature:

Date Signed*

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 Nanaimo Affordable Housing Society to perform a credit check on me/us.

Applicant Credit Check Consent*

I agree to Complete Credit Check by Nanaimo Affordable Housing.

Applicant's Initials*

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 Nanaimo Affordable Housing Society to perform a credit check on me/us.

Co-Applicant Credit Check Consent

I agree to Complete Credit Check by Nanaimo Affordable Housing.

*Only required if a second applicant is applying.

Co-Applicant's Initials

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

Fill out the 77 Mill Street Tenant Application Form

DECLARATIONS: (please read and sign this statement)

SUBMISSION