Rental Application

Residential
Form 410
for use in the Province of Ontario

50 O'neill Rd Rd 320 Toronto M3C 0R1

l/We hereby make application to rent ....................................................................................................................................................................

1st
from the ............................ NOVEMBER
day of .......................................... 23
20............ at a monthly rental of $.........................................................................

to become due and payable in advance on the ...................................... day of each and every month during my tenancy.

1. Veron Kerr
Applicant #1 .................................................................. 09/11/2001
Date of birth ............................... SIN No. (Optional) .........................................

N/A
Drivers License No ......................................................... WORKING+STUDENT(REFER EMPLOYEMENT LETTER)
Occupation .........................................................................................................

2. Om Singh
Applicant #2 .................................................................. 06/02/2001 SIN No. (Optional)..........................................
Date of birth ..............................

N/A
Drivers License No ......................................................... Working+student(Refer employment letter)
Occupation .........................................................................................................

3. N/A
Other Occupants: Name ............................................................................ Relationship ............................................. Age ...................

N/A
Name ............................................................................ Relationship ............................................. Age ....................

N/A
Name ............................................................................ Relationship ............................................. Age ....................

N/A
Do you have any pets? ....................... If so, describe ..................................................................................................................................

Why are you vacating your present place of residence? ................................................................................................................................

APPLICANT #1 LAST TWO PLACES OF RESIDENCE APPLICANT #2 LAST TWO PLACES OF RESIDENCE

14 WANTANOPA CRESCENT SCARBOROUGH, M1H2B3

Present Address ................................................................................. 14 WANTANOPA CRESCENT SCARBOROUGH, M1H2B3
Present Address ..................................................................................

........................................................................................................ .........................................................................................................

04/01/2023
From ............................................... 10/31/2023
To ............................................ 04/01/2023
From ............................................... 10/31/2023
To .............................................

RITESH SHAH
Name of Landlord ............................................................................. RITESH SHAH
Name of Landlord ..............................................................................

4168458356
Telephone: ........................................................................................ 4168458356
Telephone: .........................................................................................

203-35 JANSUSIE ROAD, ETOBICOKE M9W4V4

Prior Address .................................................................................... N/A
Prior Address .....................................................................................

....................................................................................................... .........................................................................................................

01/01/2023
From ............................................... 03/31/2023
To ............................................ From ............................................... To .............................................

SHRUTI KAPADIA
Name of Landlord ............................................................................. Name of Landlord ..............................................................................

6479792299
Telephone: ........................................................................................ Telephone: .........................................................................................

APPLICANT #1 PRESENT EMPLOYMENT APPLICANT #2 PRESENT EMPLOYMENT

WIRELESS HOLDINGS
Employer .......................................................................................... TIM HORTONS
Employer ...........................................................................................

77 CITY CENTRE DRIVE, SUITE 501, MISSISSAUGA

Business address ............................................................................... 1269 COLLEGE ST, TORONTO, ON
Business address ................................................................................

6478046831
Business telephone ............................................................................ 4165382044
Business telephone ............................................................................

FREEDOM MOBILE SALES REPRESENTATIVE

Position held ..................................................................................... BARISTTA
Position held .....................................................................................

1 YEAR
Length of employment ........................................................................ 2 MONTHS
Length of employment ..........................................................................

AHMED KARIM
Name of supervisor ........................................................................... JASPER
Name of supervisor ...........................................................................

2,000.00
Current salary range: Monthly $ ......................................................... 1,400.00
Current salary range: Monthly $ ...........................................................

The trademarks REALTOR®, REALTORS®, MLS®, Multiple Listing Services® and associated logos are owned or controlled by
The Canadian Real Estate Association (CREA) and identify the real estate professionals who are members of CREA and the
quality of services they provide. Used under license.
© 2023, Ontario Real Estate Association (“OREA”). All rights reserved. This form was developed by OREA for the use and reproduction
by its members and licensees only. Any other use or reproduction is prohibited except with prior written consent of OREA. Do not alter
when printing or reproducing the standard pre-set portion. OREA bears no liability for your use of this form. Form 410 Revised 2022 Page 1 of 2
APPLICANT #1 PRIOR EMPLOYMENT APPLICANT #2 PRIOR EMPLOYMENT

N/A
Employer .......................................................................................... N/A
Employer ...........................................................................................

N/A
Business address ............................................................................... N/A
Business address ................................................................................

N/A
Business telephone ............................................................................ N/A
Business telephone ............................................................................

N/A
Position held ..................................................................................... N/A
Position held .....................................................................................

N/A
Length of employment ........................................................................ N/A
Length of employment ..........................................................................

N/A
Name of supervisor ........................................................................... N/A
Name of supervisor ...........................................................................

0.00
Salary range: $ ................................................................................ 0.00
Salary range: $ ..................................................................................

CIBC
Name of Bank ............................................... SCARBOROUG
Branch .................................
3453 LAWRENCE AVENUE
Address ...................................................................................

5710782
Chequing Account # ......................................................................... 8793182
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)

N/A
Make ................................................. N/A
Model .................................... N/A
Year ............................ N/A
Licence No ........................................................

N/A
Make ................................................. N/A
Model .................................... N/A
Year ............................ N/A
Licence No ........................................................

The Applicant consents to the collection, use and disclosure of the Applicant’s personal information by the Landlord and/or agent of the Landlord, from
time to time, for the purpose of determining the creditworthiness of the Applicant for the leasing, selling or financing of the premises or the real property,
or making such other use of the personal information as the Landlord and/or agent of the Landlord deems appropriate.

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.

........................................................................... ......................... .............................................................................. ........................

(Signature of Applicant #1) VERON KERR (Date) (Signature of Applicant #2) OM SINGH (Date)

2896231619
Telephone: ....................................................................................... 6478659374
Telephone: .........................................................................................

veron.kerr@gmail.com
Email Address: ................................................................................. oms77420@gmail.com
Email Address: ...................................................................................

The trademarks REALTOR®, REALTORS®, MLS®, Multiple Listing Services® and associated logos are owned or controlled by
The Canadian Real Estate Association (CREA) and identify the real estate professionals who are members of CREA and the
quality of services they provide. Used under license.
© 2023, Ontario Real Estate Association (“OREA”). All rights reserved. This form was developed by OREA for the use and reproduction
by its members and licensees only. Any other use or reproduction is prohibited except with prior written consent of OREA. Do not alter
when printing or reproducing the standard pre-set portion. OREA bears no liability for your use of this form. Form 410 Revised 2022 Page 2 of 2