Required fields are marked with asterisks (*)

Annual Information Review

Rental Unit Address

Unit Number:

Street Address:

City:

Postal Code:

Section 1 - Tenant Information

Tenant #1

First Name

Last Name:

Date of Birth: (mm/dd/yyyy)

Phone Number:

E-mail Address:

Section 2 - Dependant Information

Please Note: If dependent is attending school full time, additional documentation may be required.

Section 3 - Income Information

Section 4 - Assets

OR: IF YOU HAVE NO ASSETS TO DECLARE, PLEASE CHECK THE BOX BELOW:

By checking this box, I/we confirm that I/we do not have any assets to declare

Section 5 - Vehicle Information

Section 6 - Pets

By checking this box, you agree to all rules and responsibilities to be a responsible pet owner. You also agree to abide by all municipal regulations pertaining to pets, including licensing, immunization, hygiene and maintaining proper control of the pet

Agree

Section 7 - Emergency Evacuation

As a tenant, you are responsible for informing the Housing office if you require assistance in the event of an emergency.

Tenant #1 - Name

Tenant #1

Do you have any hearing impairments?

Do you have any vision impairments?

Do you experience any mobility challenges?

Do you use a walker?

Do you use a wheelchair?

Do you use a mobility scooter?

Do you experience confusion or memory concerns?

Is oxygen used in your home?

If yes, do you have an “Oxygen in Use” sign posted on your door?

SECTION 8 - EMERGENCY CONTACT INFORMATION

Below, please provide the name and contact information of the person(s) we may contact in the event of an emergency

Contact #1 - Name

Address

Phone #

Contact #2 - Name

Address

Phone #

Please provide the name and contact number of your family doctor

Name

Phone #

Please provide any additional details below

Notice of Assessment & Tenant Insurance

I/we acknowledge that I/we are required to submit the Notice of Assessment for the applicable tax year and proof of tenant insurance. Renfrew County Housing Corporation may request additional supporting information if needed. If you are unsure which tax year applies, please contact your Caseworker.

By checking this box, I/we acknowledge that I/we agree to the above Notice of Assessment conditions

Agree

Signature Date: (mm/dd/yyyy)

Tenant #1 -BY SIGNING BELOW, I CONFIRM THAT THE INFORMATION PROVIDED IS TRUE, ACCURATE AND COMPLETE.

Clear

Annual Information Review

Rental Unit Address

Section 1 - Tenant Information

Tenant #1

Section 2 - Dependant Information

Section 3 - Income Information

Section 4 - Assets

Section 5 - Vehicle Information

Section 6 - Pets

Section 7 - Emergency Evacuation

SECTION 8 - EMERGENCY CONTACT INFORMATION

Notice of Assessment & Tenant Insurance

Apply

Pay and Donate

Report and Request