Please Email to zzh139231@hotmail.

com

Preferred Rent Start Date: __________________

APPLICANT INFORMATION
Ilia
Aboueimehrizi
Name: ____________________________ Birthdate: __________________
Surname Given Name MM/DD/YY

Applicant’s Home Tel #: _______________________________ Cell/Other Tel #): ____________________________

Current Place of Employment: _________________________________________ Work Tel #: ____________________

Start Date: __________________ Position: _________________________ Monthly Salary: $ ______________

MM/DD/YY

Employer’s Contact Name: ___________________________ Employer’s Contact Tel #: ______________________

Insurance: Do you presently insure your own belongings and maintain third-party liability coverage? ___________

APPLICANT’S CURRENT ADDRESS: _______________________________________________________________

Current Landlord’s Name: ____________________________________ Tel#: ________________________________

Present Rent: $ _________________________________ How Long There _______________________________

Reason for Leaving: _________________________________________________________________________________

 APPLICATION TO RENT – Page 2 of 2

OTHER:
Names of all other adult persons (19 or older) to occupy the premises. Include full name(s).

Names of minors (under age 19, including infants) to occupy the premises. Include full name(s) and age(s).

Will there be a pet or pets occupying the premises? NO____ YES_____: Type___________________ How Many? _________

REFERENCES
Name: ______________________________ Tel #: ______________________ Relationship: __________________

Name: ______________________________ Tel #: ______________________ Relationship: __________________

Name: ______________________________ Tel #: ______________________ Relationship: __________________

NEXT OF KIN
Name: ______________________________ Tel #: ______________________ Relationship: __________________

Emergency Contact: ________________________________________________ Tel #: ________________________

Dated at: ____________________ B.C., this _______ day of __________ (Month), ____________ (Year)

_____________________________________________
Signed Adult Applicant