ANN MARIE HILL CO-OPERATIVE INC.

170 Galloway Road, Scarborough, Ontario M1E 5A5

Tel. 416.281.5313

Fax. 416.281.5324

MEMBERSHIP APPLICATION
All information requested and contained in this document will be held in confidence and must be provided by each applicant.
ALL applicants 16 years of age and older must apply for membership.

1.

HOUSEHOLD INFORMATION
PLEASE PRINT

Applicant #1

PLEASE PRINT

Applicant #2

NAME: ________________________________________________

NAME: ________________________________________________

ADDRESS: _____________________________________________

ADDRESS: _____________________________________________

POSTAL CODE:_________________________________________

POSTAL CODE:_________________________________________

TELEPHONE:

TELEPHONE:

Home: __________________________________

Home: __________________________________

Work:__________________________________

Work:__________________________________

Cell:____________________________________

Cell:____________________________________

BIRTH DATE: (M/D/Y)___________________________________

BIRTH DATE: (M/D/Y)___________________________________

SOCIAL INSURANCE NUMBER:____________________________

SOCIAL INSURANCE NUMBER:____________________________

OTHER MEMBERS OF THE HOUSEHOLD

(UNDER THE AGE OF 16 YEARS)

_______________________________________________________________________________________________________________
Last Name
Given Name
Birth Date (M/D/Y)
Sex
Relationship
_______________________________________________________________________________________________________________
Last Name
Given Name
Birth Date (M/D/Y)
Sex
Relationship
_______________________________________________________________________________________________________________
Last Name
Given Name
Birth Date (M/D/Y)
Sex
Relationship
_______________________________________________________________________________________________________________
Last Name
Given Name
Birth Date (M/D/Y)
Sex
Relationship
_______________________________________________________________________________________________________________
Last Name
Given Name
Birth Date (M/D/Y)
Sex
Relationship
PLEASE NOTE: NO OTHER PERSON EXCEPT AS STATED ABOVE IS ALLOWED OCCUPANCY TO YOUR HOUSEHOLD
UNLESS PERMISSION IS GRANTED BY MANAGEMENT

2. ACCOMODATION REQUIREMENTS
The Co-op consists of:
a. Apartments in the high-rise building (1 and 2 bedrooms)
b. Townhouses (3 and 4 bedrooms) and
c. Apartments located over the townhouses (1 and 2 bedrooms)

Please indicate by checkmark ( )your preference below:

1 BEDROOM APT. - Apartment Building
1 BEDROOM APT. - Over townhouses
1 BEDROOM APT. - Wheelchair accessible

(
(
(

)
)
)

2 BEDROOM APT. Apartment Building

(
2 BEDROOM APT. - Over townhouses
(
2 BEDROOM APT. Disabled: - Apt. Building (

)
)
)

ANN MARIE HILL CO-OPERATIVE MEMBERSHIP APPLICATION

REVISED SEPTEMBER 28, 2010
PAGE 1 OF 4

3 BEDROOM TOWNHOUSE
4 BEDROOM TOWNHOUSE.

(
(

)
)

UNIT WAITING LIST:

3.

Yes (

No (

PETS
The Co-op By- laws permit Members to have 1 or 2 cats.

The Co-op does not allow dogs to new Members. Effective March 24, 2010
4.

PARKING REQUIREMENTS
Please Note: All Members vehicles must be registered with the Co-op office or they will be towed.
No. of parking spaces needed:

a. Surface Parking: (

b. Underground garage: (

Please list below each vehicle requiring parking. A copy of ownership for all vehicles is required.

Please Print
MAKE

MODEL

YEAR

COLOUR

LICENCE PLATE NUMBER

_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

Drivers Licence Number(s) ____________________________________________________________________________

Expiry Date(s) _______________________________________________________________________________________

5.

STATUS OF CANADIAN RESIDENCY

Applicant #1

6.

Applicant #2

Canadian

_______________________________

________________________________

Landed Immigrant

_______________________________

_________________________________

Refugee Claimant

_______________________________

_________________________________

ACCOMODATION HISTORY
The Co-op will conduct a Landlord check on each applicant.
Please complete the information requested below.

Applicant #1

Applicant #2

How long have you lived at your present address? ______________________

__________________________

What is your monthly rent? ________________________________________

__________________________

Do you also pay for utilities? _______________________________________

___________________________

If yes, how much? ________________________________________________

___________________________

PRESENT LANDLORD OR MORTGAGE COMPANY INFORMATION

Applicant #1

Present Landlord: __________________________________ Mortgage Holder:___________________________________

Address: _________________________________________

Address: __________________________________________

Telephone Number: _______________________________

Telephone Number: ________________________________

If less than 2 years, please complete the following:

Name of previous Landlord ______________________________________________________________________________
ANN MARIE HILL CO-OPERATIVE MEMBERSHIP APPLICATION
REVISED SEPTEMBER 28, 2010
PAGE 2 OF 4

Address: ___________________________________________ Telephone Number: _______________________________

PRESENT LANDLORD OR MORTGAGE COMPANY INFORMATION
Applicant #2
Present Landlord: __________________________________ Mortgage Holder:___________________________________
Address: _________________________________________

Address: __________________________________________

Telephone Number: _______________________________

Telephone Number: ________________________________

If less than 2 years, please complete the following:

Name of previous Landlord ______________________________________________________________________________
Address: ___________________________________________ Telephone Number: __________________

7.

EMPLOYMENT INFORMATION OF ALL APPLICANTS:

Applicant #1

Applicant #2

Occupation: ________________________________________

_____________________________________________

Name of Employer: __________________________________

_____________________________________________

Address: ___________________________________________

_____________________________________________

Length of time with present Employer: _________________

_____________________________________________

If less than one year, please provide previous Employers name and telephone number:
Name: ___________________________________ Tel. No. ____________________________________________________

8.

GENERAL INFORMATION
How did you hear about our Co-op? (If through friends already living in the Co-op please provide their names)
_______________________________________________________________________________________________________
Why do you want to move into a Co-op? ___________________________________________________________________
_______________________________________________________________________________________________________
Have you ever lived in a Co-op before, or been involved in any other form of Co-operative? ________________________
_______________________________________________________________________________________________________
Are you now, or have you been involved with any other volunteer organizations such as community groups, service clubs
or trade unions? ________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

9.

PARTICIPATION
Each Member approved by the Board of Directors and who has been allocated a unit in the Co-operative is required to
participate in the Members meetings of the Co-operative, and the Co-op activities by volunteering 4 hours of their time
per month.
The last page of this application deals with participation. Each applicant is required to indicate what committee they
would be interested in and what skills or interests they may have.

ANN MARIE HILL CO-OPERATIVE MEMBERSHIP APPLICATION

REVISED SEPTEMBER 28, 2010
PAGE 3 OF 4

UNDERSTANDING AND SIGNING OF THIS APPLICATION

1.

I/We understand that only members who have gone through the application process and have had their applications
approved by the Board of Directors may occupy a unit. We hereby apply for membership at Ann Marie Hill Cooperative Inc.

2.

I/We understand that all household members 16 years of age and older must apply for Membership in the Co-op.

3.

I/We understand that Ann Marie Hill Co-operative Inc. has been formed for the purpose of providing housing at cost to
its members and that Membership includes full responsibility to PARTICIPATE in the Co-op.

4.

I/We understand that accomodation in Ann Marie Hill Co-operative Inc. depends on my/our application being accepted
for Membership in the Co-op; and that I/we will be required to attend an interview before the Board of Directors makes
a final decision on my/our application.

5.

I/We understand that in the event that my/our application is approved but no unit is available that I/we will have our
names placed on the Co-ops external waiting list.

6.

I/We understand that in the event that my/our application is approved for Membership and are allocated a unit, that
I/WE will be required to pay a one-time Membership fee (in accordance with the Co-ops Articles of Incorporation) for
each approved Member (16 years of age and older) in the amount of $15.00. per member.

7.

I/We declare that all information provided in this application or attached to this application is correct and hereby
authorize Ann Marie Hill Co-operative Inc. to verify any and all of the information contained herein, and to perform a
credit check.

8.

I/We understand and agree that in the event of the following; my/our application will be considered null and void and
further processing of my/our application will not take place:

i)
ii)
iii)

iv)

failure to pay the non-refundable credit cheque fee of $10.00 per person
failure to provide proof of income as required;
failure to attend the scheduled interview as required
Falsification of information provided

11. PIPED ACT:

The Co-op will conduct a credit check on each applicant. If you are aware of any credit problems that may affect your
application, please provide any information that might help the Co-op get an accurate picture of your credit history.
The Co-op keeps all information confidential in accordance with Privacy Legislation.
By signing the application below, you agree to have the Co-op obtain and file personal credit data.

Circle your choice of Committee

Board of Directors:

Finance:

On Call:

Membership:

Dated this _________ day of _______________________

Day
Month

Landscaping:

______________
Year

Signature of Applicant #1 ________________________________________________

Signature of Applicant #2 _______________________________________________
Signature of Applicant #3 _______________________________________________
Signature of Applicant #4 _______________________________________________

ANN MARIE HILL CO-OPERATIVE MEMBERSHIP APPLICATION

REVISED SEPTEMBER 28, 2010
PAGE 4 OF 4

Social:

Maintenance: