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INDEPENDENT LIVING

REGISTRATION FORM

INDEPENDENT SENIORS’ APARTMENT BUILDING 59+

RENTAL APPLICATION

4. Statement of Gross Annual Income and Assets

List all Annual Income and Assets for you and all other persons who will live with you in the Rental Unit.

Employment (from all Sources)

Applicant

Co-Applicant

Canada Pension

Applicant

Co-Applicant

Family Benefits

Applicant

Co-Applicant

Old Age Security

Applicant

Co-Applicant

Supplements

Applicant

Co-Applicant

Foreign Pension

Applicant

Co-Applicant

Worker's Compensation

Applicant

Co-Applicant

General Welfare

Applicant

Co-Applicant

Unemployment Insurance

Applicant

Co-Applicant

Other Income

Applicant

Co-Applicant

Total Applicant Income

Total Co-Applicant Income

4. Statement of Gross Annual Income and Assets - Continued

Asset Source - Combined for Applicant and Co-Applicant

Bank Account 1

Asset Value

Bank Account 2

Asset Value

Bonds

Asset Value

Securities/Stocks

Asset Value

Mortgages Held

Asset Value

Interest

Asset Value

Other Assets

Asset Value

Total Assets

Villa Charities Inc.
901 Lawrence Avenue West
Toronto, ON M6A 1C3
Tel: 416-789-7011
Fax: 416-789-3951

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INDEPENDENT LIVING

REGISTRATION FORM

INDEPENDENT SENIORS’ APARTMENT BUILDING 59+

RENTAL APPLICATION

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