Resident Payment Capacity Questionnaire

We recognize that many of our residents may be experiencing financial hardship due to the impacts of
COVID-19 on the economy and local businesses. Hollyburn is committed to working together with
those who have had a reduction in hours or have become unemployed due to COVID-19 to ensure
your housing is secure throughout this time of uncertainty. If you can pay rent, you should as
assistance will be prioritized to those who have lost their jobs or reduced wages as a result of COVID-
19.

PLEASE NOTE: We will be processing and prioritizing all questionnaires received in order of greatest
need. Please provide all necessary information outlined below, so we can properly assess your
application.

*Please ensure that a copy of your ROE and/or Employer, BC Rent Supplement documents and/or pay
stub is attached to this application and all SIN information has been blacked out or otherwise
removed. For banking records, please ensure all account and transit numbers have been blacked out
or otherwise removed in order to safeguard your privacy.