I/We hereby make application for housing accommodation in Eagle Valley Haven:
Given NAME AND ADDRESS OF NEXT OF KIN – (or person to be notified in case of accident, sickness or death)
Name and Address of Two Character References – NOT Relatives:
FINANCIAL STATEMENTThis information is confidential
Part One – Monthly Income Pensions Received – State exact amount of last cheque received. Note – if single, fill in left column only. If married and living with spouse fill in both columns. Please provide your three most recent bank statements and your latest income tax statement.
Old Age Security Pension -OR- Old Age Security and Federal Supplement Combined
Province of British Columbia G.A.I.N. or Income Supplement
Please tell us a bit about yourself.
Tell us about your present accommodations.
I/We declare that the above financial statement is correct and can be verified, if required, by the Eagle Valley Senior Citizens Housing Society.
GENERAL: This is an APPLICATION ONLY and DOES NOT necessarily guarantee that the applicant will be given occupancy or accommodation in Eagle Valley Haven.