Welcome to Legion Manor Victoria | Apply Online - Independent or Supported Living Application

Application for Tenancy - Independent Living

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NOTE: Please do not apply if you wish to maintain pets other than fish or caged birds.

General Information

Name of Applicant #1

Date of Birth

Marital Status

Name of Applicant #2

Date of Birth

Marital Status

Address

Postal Code

Phone Number

# of years in B.C.

In case of Emergency (other than joint occupant)

Name

Address

City

Postal Code

Phone Number

Name

Address

City

Postal Code

Phone Number

Name

Address

City

Postal Code

Phone Number

Doctor Contact Information

Name

Address

City

Postal Code

Phone Number

Financial Information - all monthly income

O.A.S & G.I.S.

Applicant #1

Applicant #2

G.A.I.N.

Applicant #1

Applicant #2

C.P.P.

Applicant #1

Applicant #2

War Disability Pension

Applicant #1

Applicant #2

W.V. Allowance

Applicant #1

Applicant #2

Superannuation

Applicant #1

Applicant #2

Other (specify)
Do not show interest

Applicant #1

Applicant #2

Monthly Totals

Assets (to be shown in $ amount)

A reasonable appraisal of your furniture

Approx. value of your vehicles (if applicable)

Bank Account

Value Of Bonds

Real Estate

Other Value Of Other Investments

Liabilities

Any unpaid balance on the foregoing assets or other financial commitments?

Yes No

Please Explain

Dollar Value of Liabilities

Present Accommodation

Present Monthly Rent

# of Rooms

Furnished?

Yes No

Heat included?

Yes No

Light & Power included?

Yes No

Are you under notice to vacate?

Yes No

References

Name

Address

Phone Number

Name

Address

Phone Number

Other Information

Are you a Veteran?

Yes No

Are you a Legion member?

Yes No

If yes, RCL Branch #

Declaration

I/We understand that this is not a CONTRACT and does not bind either party. The foregoing information is full, true and complete to the best of My/Our knowledge. I/We have no objections to discreet enquiries being made for the purpose of verification.

Please Note

Applications will not be considered unless all questions have been answered. All applicants will be notified upon receipt of their application and will be put on a waiting list. All accommodations are one bedroom suites. All tenants and occupants are to be 55 years of age or older.

An applicant, on being notified of a vacancy and accepting it, is required to submit a deposit of one-half of his/her first month's rent. This amount or the minimum as laid down by the B.C. Housing Management Commission. Cheques are to be made payable to S.V.I. Zone Housing Society. Should you move from the address shown on the application form, and are still interested in remaining on the list for accommodation, please inform the Placement Officer of your new address and telephone by writing to the above address. If applicant(s) is/are accepted, proof of Gross Income must be verified by providing the most recent Income Tax Assessment Notice for each person that will be living in the unit.

Name of Submitter

Email Address