Please print Clearly - Confidential when completed - Completed forms may be faxed to (250) 785-3487

N.B. Each applicant who intends to occupy the unit applied for must complete an individual application
(Except for legally wedded spouse)

_______________________________________________________________________________________________

PREMISES APPLIED FOR

Address:

Dwelling Type: ___ House ___ Apartment ___ Other (specify):

___ Furnished ___ Appliances Only ___ Unfurnished

No. of Bedrooms:

Proposed Rent Date_____________________ Desired Security Deposit___________________ New Tenant: Y / N

1) APPLICANT

APPLICANT’S LAST NAME ___________________________________ FIRST ___________________________________

INITIAL_____ DATE OF BIRTH____________ SOCIAL INSURANCE NUMBER_____________________

DRIVER’S PERMIT NO. & PROV__________________

MARITAL STATUS: MARRIED / COMMON LAW / SINGLE / DIVORCED / WIDOWED / OTHER:

SPOUSES’ LAST NAME___________________________________ FIRST__________________________________________

INITIAL___ DATE OF BIRTH____________ SOCIAL INSURANCE NUMBER_____________________ DRIVER’S PERMIT NO. & PROV__________________

NUMBER OF OCCUPANTS (19 Years and Older) _________ CHILDREN _______________

PRESENT ADDRESS__________________________________ RENT $________________ HOW LONG______________________

LANDLORD’S NAME_______________________________________________________________________PHONE ________________

ADDRESS ________________________________________________________________________________________________________

PREVIOUS ADDRESS (IF ABOVE IS LESS THAN FIVE YEARS)

______________________________________________________________________________________________________________

PREVIOUS LANDLORD _____________________________________________________________________PHONE _________________________

ADDRESS _____________________________________________________________________________________________________

REASON FOR MOVING FROM PRESENT ADDRESS ____________________________________________________________________________

_______________________________________________________________________________________________________________

ARE ANY COURT ACTIONS PENDING, OR ANY JUUDGEMENTS OR WRITS OR EXECUTION, REGISTERED OR FILED
AGAINST YOU? YES / NO

IF YES, ADDRESS _________________________________________________ DATES: FROM_____________ TO _______________

2) EMPLOYMENT INFORMATION

EMPLOYER _______________________________________________________________ SUPERVISOR’S NAME____________________________

ADDRESS_________________________________________________________________ PHONE _____________________________

SALARY $_____________________________ JOB TITLE________________________________ HOW LONG___________________

PREVIOUS EMPLOYER SUPERVISOR’S NAME ______________________________________________

(IF ABOVE LESS THAN FIVE YEARS)

ADDRESS _____________________________________________________ PHONE_________________________________

SPOUSE’S EMPLOYER _________________________________ SUPERVISOR’S NAME ____________________________________

ADDRESS_________________________________________________________________ PHONE _____________________________

SALARY $_____________________________ JOB TITLE________________________________ HOW LONG___________________

OTHER INCOME SOURCES ______________________________________ TOTAL ANNUAL AMOUNT _____________________

3) FINACIAL INFORMATION

BANK NAME & ADDRESS _____________________________________________________________________ PHONE ______________________

CHEQUING/SAVINGS ACCOUNT NUMBER_______________________________________ CREDIT CARD TYPE _________________________

BANK NAME & ADDRESS _____________________________________________________________________ PHONE ______________________

CHEQUING/SAVINGS ACCOUNT NUMBER_______________________________________ CREDIT CARD TYPE _________________________

HAVE YOU EVER DECLARED BANKRUPTCY? YES / NO IF YES: DATE ________________________ LOCATION ________________________

4) IN CASE OF EMERGENCY CONTACTS

NAME _________________________________________________ HOME PHONE _______________________ BUS ______________

ADDRESS ___________________________________________________________________RELATIONSHIP ____________________

NAME _________________________________________________HOME PHONE ________________________ BUS _____________

ADDRESS ___________________________________________________________________ RELATIONSHIP ____________________

5. REFERENCES (NO RELATIVES)

NAME ______________________________________________________NAME___________________________________________

ADDRESS ___________________________________________________ADDRESS________________________________________

HOME PHONE______________________BUS _____________________ HOME PHONE ___________________________

BUS ______________

5) VEHICLES

MAKE ___________________________ MODEL____________________COLOR______________________

LICENCE PLATE # _____________

MAKE ____________________________ MODEL ___________________COLOR _____________________

LICENCE PLATE # _____________

APPLICANT’S ACKNOWLEDGEMENT ____________________________________________________________________

I/We understand that this application does NOT constitute an agreement on the part of Li-Car Management Group (A Division of
392343 BC Ltd.) to provide me with accommodation.

I/We acknowledge the right of Li-Car Management Group (A Division of 392343 BC Ltd.) at any time prior to execution and
delivery tome of a lease covering the property hereby applied for, to withdraw, revoke or cancel, without penalty or liability for
damages otherwise, any acceptance or approval of this application previously made or given,

I/We agree and consent that credit inquiries, and any other inquiries as deemed necessary by Li-Car Management Group (A
Division of 392343 BC Ltd.) may be made at any time in connection with this application.

I/We understand that the deposit given with this application is refundable only if this application is rejected and for no other reason.

I/We agree and consent that DOGS or OTHER PETS are not allowed.

DATE _______________ APPLICANT’S SIGNATURE ___________________________

SPOUSE’S SIGNATURE ___________________________

DATE ACCEPTED _____________________ ACCEPTED BY: __________________________ ADDRESS __________________________________  

FOR OFFICE USE ONLY  

• CREDIT BUREAU INFORMATION

Account __________________________ Number ______________________________ Status ___________________________

NSF Experience_______________

Type of loan ___________________ Date Borrowed _________________ Date of Maturity __________________

Monthly Payment __________________

• LANDLORDS

PRESENT ____ HOW LONG ______________ RENT_____________ COMMENTS ____________________________________________________________________

PREVIOUS __ HOW LONG ______________ RENT ______________ COMMENTS __________________________________________________________________

• EMPLOYERS

PRESENT ________ HOW LONG _______________ SALARY ________________ COMMENTS _________________________________________________________

PREVIOUS ______ HOW LONG ________________ SALARY _______________ COMMENTS ________________________________________________________

SPOUSE _______ HOW LONG _________________ SALARY _________________

COMMENTS________________________________________________________

RENTAL INFORMATION

Base Rent______________ Occupancy Date __________________ Termination Date ________________

Total Deposit with Application _______________________

CONSENT RE: PERSONAL INFORMATION

I/We hereby consent and agree to the following:

• Li-Car Management Group, a division of 392343 BC LTD (Li-Car) which term shall also include any landlord of
  any premises of which I/We may become tenants as a result of this application, including any successor to such landlord
  is hereby authorized to obtain whatever personal information about me/us as it may reasonably require, including but
  not limited to, employment history and income, tenant history and credit information from;
• current and former employers
• current and former landlords
• current and former suppliers, creditors and financial services
• credit agencies; or
• Any person in a substantially similar relationship to me/us.

This Consent shall be sufficient authorization for such parties to disclose to Li-Car any personal information relating to me/us.

• Li-Car is hereby authorized to disclose personal information about me/us gained from my/our application and personal
  information about me/us relating to an obtained in connection with any tenancy that may result from this application
  to any person who bona fide purports to be a prospective or current employer or landlord of me/us without obtaining
  any further consent from me/us.
• Li-Car Management Group is hereby authorized to retain personal information about me/us as follows:

• Where a tenancy results from this application, during any such tenancy and for up to 7 years after cessation of such
  tenancy, provided that Li-Car shall be entitled to retain information about performance or default of any tenant
  obligations indefinitely; and
• Where no tenancy results form this application, for up to 5 years for the purpose of considering it in connection
  with possible future vacancies and/or subsequent application I/we may make.

And I/We agree that this is reasonable.

I acknowledge having read and understood the above and freely agree to it.

Date: ___________________________

Signature of Applicant

__________________________________

Signature of Applicant

__________________________________