Application Form

Submit completed The Rental Assistance Program provides eligible low-income,

application with working families in British Columbia with direct cash assistance
supporting documents to: to help with their monthly rent payments for their housing in the
private market.
Rental Assistance Program
101 – 4555 Kingsway Who is eligible?
Burnaby, BC V5H 4V8
You may be eligible for the Rental Assistance Program if you
and your spouse, if applicable, meet all the following
conditions:
Please:
1. Have one or more dependent children.
Print clearly.
2. Some or all annual household income comes from
Do NOT include original employment or employment insurance.
documents (we require
photocopies only). 3. Your gross annual household income is $40,000 or less.
Do NOT use staples. 4. Have less than $100,000 in assets.
5. You file an annual Canadian income tax return.
6. You pay more than 30% of gross (before tax) monthly
household income towards the rent for your home,
Avoid Processing Delays: including the cost of pad rental for a manufactured home
Eligibility cannot be determined (trailer) that you own and occupy.
until you provide all required 7. You meet one of the following Citizenship requirements:
documentation. Canadian citizen(s), or authorized to take up permanent
The most common cause of residence in Canada, or Convention refugee(s);
processing delays is missing and are not under private sponsorship.
documents. 8. You or your spouse has lived in British Columbia for the full
Applications must: twelve (12) months immediately preceding your
application.
• Be complete, signed and
dated. 9. You do not receive income assistance through the B.C.
• Complete all sections
Employment and Assistance Act or the Employment and
and declarations. Assistance for Persons with Disabilities Act (excluding
Medical Services only).
• Include all supporting
documents as listed in
the attached checklist. For more information on eligibility, please see the Rental
Assistance Program brochure (online at www.bchousing.org)
Applications submitted without or call the Rental Assistance Program office at the number(s)
required supporting documents below.
can be held for a maximum of
90 days.

For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 1
 FOR OFFICE USE ONLY
PLEASE
Date: Status: File: PRINT
CLEARLY

1. Applicant Information
Social Insurance Number* Last Name First Name(s)

Birth Date (dd/mm/yyyy) Age Sex (M/F) Born in Canada? (Yes/No)

2. Spouse or Partner Information (if applicable)

Social Insurance Number* Last name First name(s)

Birth Date (dd/mm/yyyy) Age Sex (M/F) Born in Canada? (Yes/No)

*Required only if Option 1: Consent Granted is selected in question 3, below.

3. Consent for Release of Information from Canada Revenue Agency

To determine eligibility for the Rental Assistance Program, income tax information is required. You may give the Canada
Revenue Agency permission to provide the required information or you can provide it to BC Housing yourself.
SELECT Option 1 or Option 2 below. Do not check more than one box.

Option 1: Consent Granted Option 2: Consent Not Granted

I/We hereby consent to the release, by the Canada I/We do not give consent for the Canada Revenue
Revenue Agency, to BC Housing of information from Agency to provide my/our income tax information to
my/our income tax records, whether supplied by me/us or BC Housing. I/We understand that I/we will be responsible
by a third party. The information will be relevant to, and for providing verification of my/our income and assets in
used solely for the purpose of, determining and verifying order to confirm eligibility for rental assistance/subsidy.
my/our eligibility, entitlement for and the general I/We have attached the following proof:
administration and enforcement of rental
o Copy of Notice of Assessment for the last filed
assistance/subsidies from BC Housing.
tax year.
This authorization is valid for the current taxation year, o Copy of detailed Income Tax Return for the last
the two taxation years immediately preceding the current filed tax year.
taxation year and each subsequent consecutive taxation o If self-employed: Copy of Statement of Business
year for which I/we have applied for rental Activities and all related worksheets (only
assistance/subsidy. required for individuals with self-employment
income, either business or professional on their
I/we understand that if I/we wish to withdraw this
tax return).
consent, I/we may do so at any time by writing to:
NOTE: If you are not able to locate your Income Tax
Manager, Applicant Services
Return or Notice of Assessment, please contact the
BC Housing, 1701-4555 Kingsway
Canada Revenue Agency at 1-800-959-8281 or
Burnaby, BC V5H 4V8.
1-800-959-2221 and request a “Detailed Notice of
Assessment” or “Option C” print out.

Applicant:
Print Name Signature Date

Spouse:
Print Name Signature Date

For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 2
 4. Residency Information
4a. Have you lived in B.C. for the past twelve months?  Yes  No

If no, when did you move to B.C.?

How long have you lived in Canada?

4b. Please list your address(es) for the last 12 months:

From Date To Date
Address(es) Landlord Name Landlord Phone #
(dd/mm/yyyy) (dd/mm/yyyy)

Current address

4c. If you or your spouse were not born in Canada, please complete the following:
Date moved Sponsored Immigrants Only
Current status in
Name to Canada End Date of
Canada Name of Sponsor
(dd/mm/yyyy) Sponsorship Agreement

5. Spousal Information
A spouse is a partner through marriage or common-law, or the person with whom the Applicant is living in a marriage-like
relationship.
 Single – Never Married  Widowed

 Divorced or Separated Date Separated or Divorced:

 Married or Common Law

Does your spouse live with you at your B.C. residential address?
Yes  No  If No, provide their address:

6. Household Information
6a. List all other persons living with you. (If required, attach additional names on a separate sheet)
Relationship Birth Date* Sex* Rent
Last Name Given Names Age*
To Applicant (dd/mm/yyyy) (M/F/O) Contribution**

*Required for Dependents only

**Rent Contribution required only for non-dependents (i.e.: adult children, roommates, other)

For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 3
 6b. (Optional) Do you or anyone in your household identify as being an Indigenous person of Canada?
 Yes  No If yes, please select the option(s) that best describes your Indigenous identity:
 First Nations  Métis  Inuit  Other
Answers to Questions 6c. to 6f. are required only for spouse and/or dependent(s).
6c. For each household member not born in Canada please complete the following:
Date moved Sponsored Immigrants Only
Name to Canada Status in Canada Date Sponsorship
(dd/mm/yyyy) Name of Sponsor
Agreement Ends

If required, attach additional names on a separate sheet.

6d. Do all the people listed live with you full time right now?  Yes  No
If No, please provide the name of the person(s) and number of days per week they live with you.
Shared custody? If not shared custody, why does the person not live
Name Days per week
(Yes/No) with you full-time?

If required, attach additional names on a separate sheet.

6e. Is any member of your household aged 19 or older and a full-time student?  Yes  No
If yes, list names
 Note: See attached checklist for details of proof required.
6f. Is any member of your household a disabled dependent for income tax purposes?  Yes  No
If yes, list names
 Note: See attached checklist for details of proof required.

7. Contact Information
Home Phone Work Phone
( )- ( )-
Cell Phone Email
( )-
Optional: Name of person we can leave messages with Message person phone number
( )-
Optional: Authorized Contact* name and relationship to you Authorized Contact phone number
( )-
*By providing an authorized contact, you are giving permission for BC Housing to exchange information with that authorized contact in
order to maintain and update your Rental Assistance file. To remove an authorized contact, please contact BC Housing.

8. Residential Address
Apt # Street # Street Name

City Postal Code

B.C.

For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 4
 8a. Mailing Address *Mail is sent to the residential address, except for rural areas with no mail delivery.
Apt # Street # Street Name

City Postal Code

B.C.

8b. Landlord Information

Landlord Name Landlord Phone

Landlord Address

9. Rent Information
9a. Do you:  Rent  Own  Rent-to-own
How much is your rent? $______________ (Do not include hydro, cable or parking in rent amount)
Is this:  Monthly  Weekly  Nightly/Daily

Does your rent include heat?  Yes  No

Is your rent subsidized?  Yes  No
Do you share a kitchen or bathroom with another tenant or your landlord?  Yes  No

9b. Check all of the following that apply:

 I live in a self-contained unit (apartment,  I live with family or friends (other than spouse/common
house, townhouse) law partner)
 I live in a self-contained basement suite  I live in a Housing Co-operative
 I live in a Manufactured/Trailer/Mobile home  I live in a Hotel/Motel
 Other (describe)

If you live in a manufactured/trailer/mobile home, do you?  Own  Rent Trailer Rent $ ____________

Do you pay pad rental?  Yes  No Pad Rent $ ____________

10. General Income Information

10a. Have you (or your spouse) received income assistance through the British Columbia Ministry responsible for the
B.C. Employment and Assistance Act or the Employment and Assistance for Persons with Disabilities Act in the
last 24 months?  Yes  No
If yes, when was the last payment received?
Note: If you answered Yes, proof is required that your income assistance file has been closed. In addition, proof of all current
income sources is required. See attached checklist for details.

10b. Did you receive any support payments last year (family, spousal or child support)?  Yes  No
Do you currently receive any support payments?  Yes  No
Did you earn any tax-exempted income last year?  Yes  No
(Tax-exempted incomes include on-reserve employment and employment insurance, private disability)
If you answered Yes to any of the questions in 10b please provide the following for each income source.
Last Year’s Gross Total Current Gross Monthly
Income or Payment Type
Amount Amount
Support payments (family, spousal)
Child Support (do not include child tax benefits or Universal Child Care Subsidy)
Employment Income
Employment Insurance Income
Other (describe):
For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 5
 10c. Did you (or your spouse) report income from employment or employment insurance on the previous year’s
tax return?
 Yes  No
10d. Was the combined gross income on the previous year’s tax returns for yourself and spouse under $40,000?
 Yes  No

If you answered No to either of the above two questions please complete section 11 (Current Income) otherwise proceed
to, and continue from Section 12 (Asset Information).

11. Current Income Information

You must declare all sources of current incomes and gross monthly amounts for each source. Attach extra sheet if
required.
Income Source (Employment, Employment Insurance, Pensions, Support Income, Other) Applicant Spouse

$ $

$ $

$ $

$ $

$ $
 Note: See attached checklist for details of proof required.

12. Asset Information

12a. Canadian and Foreign Finances: You must answer yes or no in the declaration for each line listed below.
Do you hold Bank, financial Total Value ($)
Type of Assets (including all bank any of this institution or company
accounts, even with negative balances) asset? name Applicant Spouse

Chequing and Savings account(s)  Yes  No

Stocks, GIC’s, Term Deposits  Yes  No

Certificate /(GIC)
RRSP/RESP/RSP/RDSP  Yes  No

Trust Funds  Yes  No

Bonds/Other Shares/Foreign Funds  Yes  No

Other Assets including Cash  Yes  No

Other  Yes  No

Shares in a company or business*  Yes  No

*If you own shares in a company or business provide legal name:

12b. Do you or your spouse (if applicable) own any Canadian or Foreign property? (e.g. house, cottage,
townhouse, condominium, land, commercial property, etc.)  Yes  No
If yes, please provide the following information:
Type of Property Location (Address) Year Purchased Value ($) Equity ($)

 Note: Proof of assets must be submitted with application. See attached checklist for details.

For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 6
 Purpose of this form:
This form collects personal information for contact purposes and to determine eligibility for assistance
through the Rental Assistance Program. The information is collected in accordance with section 26(c) of
the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection
of your information, please call 604-433-1711 and ask to speak to BC Housing’s Privacy Officer or write
to 4555 Kingsway, Burnaby, BC, V5H 4V8.

13. Declaration and Consent PLEASE READ AND SIGN

I/We declare:
 This is my/our application and all the information in it is true, correct and complete in every respect;
fully discloses my/our income from all sources; and accurately represents my current living
circumstances.
I/We permit:
 BC Housing to verify any of the information I/we have provided in this application in order to assess
my/our eligibility for benefits under the Rental Assistance Program.
I/We acknowledge and understand that:
 It is my/our responsibility to promptly provide, or cause to be provided, all information and
documentation that is reasonably requested by BC Housing to determine my/our eligibility for benefits
and/or for audit purposes. I/we are responsible to immediately inform BC Housing of any changes in
my/our address, rent, marital status, family size, or the people sharing my/our accommodation so that
my/our benefit can be adjusted accordingly.
 Failure to report changes in my/our address or household composition may result in an interruption or
suspension of benefits and may also result in an overpayment, which I/we will be required to repay.
 Failure to report if I/we begin to receive income assistance through the Ministry responsible for the
B.C. Employment and Assistance Act or the Employment and Assistance for Persons with Disabilities
Act will result in an overpayment of benefits which I/we will be required to repay.
 Benefits paid under this agreement are a reimbursement of actual rent paid and if I/we fail to pay the
full rental amount BC Housing may immediately stop payment of benefits and I/we agree to return to
BC Housing all benefits paid for periods in which the full rental amount was not paid.
 BC Housing will audit some Rental Assistance Program applications and benefits may be adjusted if
the audit reveals errors or omissions in any information.
 Misrepresentation of the information provided, in writing or by omission, may result in recovery of
benefits in addition to any other remedies available in law or equity.
 Failure to report if I/we acquire property or my/our assets exceed $100,000 will result in an
overpayment which I/we will be required to repay.
 If I/we wish to withdraw this Declaration and Consent, I/we may do so at any time in writing to
BC Housing, however withdrawal will result in my/our being ineligible for assistance through the
Rental Assistance Program.
Signature of Applicant Date Signature of Spouse (if applicable) Date

Next Steps
1. Sign & Date Application: Unsigned applications will be returned which will result in a processing
delay.
2. Attach Supporting Documents: (Do not send original documents)
Review the attached checklist for more information on supporting documents.
3. Submit Application: Rental Assistance Program, 101 – 4555 Kingsway, Burnaby, BC V5H 4V8.
NOTE: The most common cause of processing delays is missing documentation. Applications submitted
without all required supporting documents can be held for a maximum of 90 days.
For help with this form, please contact the Rental Assistance Program at 604-433-2218 or 1-800-257-7756 RAP-001 (2018-09-24)
Page 7
 Checklist
Rental Assistance Program
Before submitting this application for the Rental Assistance Program, please review the following to make sure that all
required information is included with the application.
➢ Applications are effective the latter of the month in which they are received by the Rental Assistance Program or
the month in which an applicant is deemed eligible.
➢ Incomplete applications will be held for up to 90 days to allow applicants time to gather missing documentation.
➢ After 90 days, incomplete applications will be cancelled and the applicant will be required to submit a new
application with supporting documents.
➢ Please do not submit original documents.

1. Income Tax Information (Required for applicant and spouse, if applicable.)

 Provide consent for release of tax information from Canada Revenue Agency (CRA) on page 2 of this application; or
 Provide copies of last year’s Income Tax Notice of Assessment AND detailed Income Tax return (include all pages); or
T-slips from all income sources.
Note: If you are not able to find your Income Tax Return or Notice of Assessment you can submit a Proof of Income
Statement (Option C print) from Canada Revenue Agency (CRA). This can be obtained by either logging into your
CRA My Account at www.cra.gc.ca/myaccount and printing your assessment or calling CRA at 1-800 959-8281.
 Note: If bankruptcy was declared within the last two taxation years, provide copies of the Income Tax Notices of
Assessment and detailed Income Tax returns for both the pre- and post-bankruptcy.
2. Proof of Current Income
 Proof of any regular ongoing funds from non-taxable sources (alimony, family support, on-reserve income, private
disability pension, etc.)
 Proof of current income from all sources if you answered No to questions 10c or 10d.
3. Bank Information for Direct Deposit
 Blank cheque marked VOID; or
 A Preauthorized Debit Form provided by your financial institution; or
 The Direct Deposit page included with this application completed by your financial institution.
4. Proof of status in Canada (Proof is required for all family members.)
 Copy of Canadian birth certificate(s) for all family members born in Canada; and
 For family members not born in Canada, provide copies of Permanent Residence documents.
Acceptable proof includes:
▪ Record of Landing (IMM1000) or Confirmation of Permanent Residence (IMM5292); or
▪ Any immigration document showing the date landed and the immigration code; or
▪ Canadian Citizenship Card, if you have been a Canadian Citizen for more than eight years.

5. Students. Children age 19 to 24 in full-time attendance at a school, university or vocational institution must provide proof
of enrolment.

6. Proof of Rent
 Rent Receipt showing address, rent amount, date and landlord name; or
 Copy of recent Rent Increase Notice; or
 Copy of Lease or Tenancy Agreement (if signed within the past 12 months).

7. Proof of Assets (Include all that apply.)

 Copies of bank statements from all bank accounts.
 Property tax assessments for value of property owned and proof of outstanding mortgage(s) for equity calculation.
 Other statement showing total value of asset(s).
 If you have shares in a business, please include proof of corporate shares.
8. Proof of self-employment (If applicable.)
If last year’s annual income included income from self-employment, attach:
 Statement of Income and Expenses from last year’s Income Tax return and all related worksheets (form T2125).

For assistance call 604-433-2218 or toll free at 1-800-257-7756 from outside the Lower Mainland.

RAP-001 (2018-09-24)
 Direct Deposit
Rental Assistance Program

Assistance is paid by direct deposit to your account on the last business day of each month. The
account must be in the name of the applicant and/or spouse (if applicable). The information
requested below will provide BC Housing with the required financial institution, transit and account
numbers needed for processing automatic payments to your account.

Please provide one of the following:

 A printed, personalized blank cheque marked VOID; or
 A Preauthorized Debit Form provided by your financial institution; or
 Have your financial institution complete the information below:

Name of Applicant

Have the following completed by your financial institution if you are not attaching a void cheque or
a Preauthorized Debit form.
Transit Number Bank Number Account Number

Name(s) on the account Phone number of financial

institution

Financial Institution Stamp:

Please return to:

Rental Assistance Program
BC Housing
#101 – 4555 Kingsway
Burnaby, BC V5H 4V8

RAP-001 (2018-09-24)