Form 410 - Rental Application

Rental Application

Residential

Form 410

for use in the Province of Ontario

Date:

I/We hereby make application to rent

from the

day of

, 20

at a monthly rent of $

to become due and payable in advance on the

day of each and every month during my tenancy.

Name

Date of birth

Social Insurance No.

Drivers License No.

Occupation

Name

Date of birth

Social Insurance No.

Drivers License No.

Occupation

Other Occupants

Name

Relationship

Age

Name

Relationship

Age

Name

Relationship

Age

Do you have any pets?

If so, describe

Why are you vacating your present place of residence?

LAST TWO PLACES OF RESIDENCE

Address:

From

Name of Landlord

Telephone No.

PRESENT EMPLOYMENT

PRIOR EMPLOYMENT

Occupation

Employer

Business address

Business telephone

Position held

Length of employment

Name of supervisor

Current salary range

Monthly $

SPOUSE’S PRESENT EMPLOYMENT

PRIOR EMPLOYMENT

Occupation

Employer

Business address

Business telephone

Position held

Length of employment

Name of supervisor

Current salary range

Monthly $

Name of Bank

Branch

Address

Chequing Account #

Savings Account #

FINANCIAL OBLIGATIONS

Payments to:

Amount:

Payments to:

Amount:

PERSONAL REFERENCES

Name:

Address:

Telephone:

Length of Acquaintance:

Occupation:

Name:

Address:

Telephone:

Length of Acquaintance:

Occupation:

AUTOMOBILE(S)

Make:

Model:

Year:

License No.

Make:

Model:

Year:

License No.

The applicant represents that all statements made above are true and correct. The applicant is hereby notified that a consumer report containing credit and/or personal

information may be referred to in connection with this rental. The applicant authorizes the verification of the information contained in this application and information

obtained from personal references. This application is not a Rental or Lease Agreement. In the event that this application is not accepted, any deposit submitted by the

applicant shall be returned.