The Kelson Group Rent Assistance Program is made available to eligible residents experiencing financial hardship due to income loss as a result of the COVID-19 outbreak in Canada.

You are eligible for this rent relief program if the following apply to you (please check all that apply):

You have experienced a loss of employment or income due to circumstances related to COVID-19.

OR You are ill or are taking care of someone who is ill with COVID-19 and this has affected your income.

AND You have applied to receive financial assistance from the Government of Canada or your province of residence.

Last Name

First Name

Current Rent Amount

Building Address

Suite Number

Approximate Move-in Date

Last Name

First Name

Adult or Child
Please choose... Adult Child (under 18)

Last Name

First Name

Adult or Child
Please choose... Adult Child (under 18)

Last Name

First Name

Adult or Child
Please choose... Adult Child (under 18)

Tenant Full Name

Business Name

Address

Contact Name & Phone Number

Monthly Income

Tenant Full Name

Business Name

Address

Contact Name & Phone Number

Monthly Income

Tenant Full Name

Business Name

Address

Contact Name & Phone Number

Monthly Income

Sources can include Employment Insurance (EI), Pensions, Support Income, Emergency Care Benefit, Relatives, Rent Relief from other providers.

Tenant Name

Source

Amount and date to be Received

Tenant Name

Source

Amount and date to be Received

Tenant Name

Source

Amount and date to be Received

Total Income

We understand that even with additional support, you may not be able to pay the full amount of your current rent. Please complete the following:

4.1 Are you able to make a rent payment the 1st?

4.2 What is the amount of rent you can pay the 1st?

4.3 If you are unable to pay the full amount of your rent, when can you make additional payments towards your rent?

Amount

Date

Amount

Date

4.4 Please provide any additional information which may help us in assessing your application for rental assistance:

This is my/our application and all the information in it is correct; fully discloses my/our income from all sources; and accurately represents my current living circumstances.

I/we permit Kelson Group Property Management to use the information provided in this application in order to assess my/our eligibility for rental assistance under the Kelson Group Rental Assistance Program.

If I/we wish to withdraw this declaration and Consent, I/we may do so at any time in writing to Kelson Group Property Management.

Name of Primary Applicant

Date

Name of Secondary Applicant

Date

1. Complete, sign and date application: Unsigned applications will be returned

2. Attach supporting documents. Do not send original documents.

3. Submit application: Applications may be emailed confidentially to [email protected], faxed to 250-372-1939 or put in the building manager’s mail drop box. Out of respect for social distancing at this time, please do not give this form personally to your building manager.

4. Your Building Manager will contact you to confirm your proposed payment plan and discuss various options: we are making every effort to help you through these challenging times.