BC Shelter Information Form (HR3037)

Enter Your First Name, Your Middle Name, Your Last Name and Birthdate (YYYY-MMM-DD).

Enter the Rental Start Date (YYYY-MMM-DD), Unit #, Street Address, City, Postal Code and Your Phone Number.

Enter the Mailing Address (if different from street address).

Under Preferred method of contact, mark Phone or My Self Serve.

Under Type of Shelter Allowance, mark Rental Unit (With or without roommates) or Room & Board (Meals are included); see reverse for definition.

Rental Unit: You are renting a unit such as an apartment, basement suite, or a separate suite in a house. This can be shared space with your landlord or roommates.

Room and Board: You are renting a unit where you are provided with meals and utilities. The meals and utilities are included in your rent payments. This does not refer to a room in a Special Care Facility.

Enter Your Monthly Rent or Shelter Amount.

Other Shelter Costs: All other rental situations not previously defined. Examples may include camp sites, recreation vehicles (RV), pad rental, parking rental, moorage, or home share providers.

Are utilities included in your monthly rent or shelter amount? Mark Yes or No. If no, what is your monthly share of utilities? If you share the cost of utilities, please only include what you pay.

Please provide copies of your utility bills (BC Hydro, Fortis BC, or other).

Utilities may include fuel for cooking or heating, water, hydro/electricity, garbage disposal, and/or rental of one basic residential single-line telephone. Cellphone plans are not eligible utilities.

Is a Security Deposit and/or Pet Damage Deposit required? Mark Yes or No. Enter Your Security Deposit Amount and Your Pet Damage Deposit Amount.

Security Deposit or Pet Damage Deposit: Money that is typically provided to a landlord, property manager, agent or home share provider to secure rental accommodation that may be used to pay for any damages to the property caused by the renter/renter's pet(s).

Enter the Full legal name, Street Address, Unit #, City, Postal Code and Phone Number of your Landlord, Property Manager or CLBC Home Share Provider.

A landlord or property manager is the person you are renting your unit from and pay rent to. This can be the owner of the unit, a company that manages the rental unit, or another person who acts on behalf of the owner.

If you would like your rent paid directly to your landlord, the Ministry may contact your landlord to arrange direct payments. Please ensure the phone number provided is accurate and your landlord is aware that the Ministry may contact them. Would you like your rent paid directly to your landlord? Mark Yes or No.

"I declare that all the information that I have provided on this form is true and complete."

Sign on the line for Your Signature and enter Today's Date.

If you own your residence, you do not need to submit this Shelter Information form (HR3037). Please provide your mortgage, insurance, and/or property tax documentation to the Ministry to confirm your Shelter Amount.

Do not use this form for admittance to a Special Care Facility.

For Special Care Facility Admissions, please have the facility complete and submit an HR3319 Facility/Residence Admittance, Transfer or Discharge form.

Shelter documents can be submitted through My Self Serve, in-person at an office, office drop box, or by mail.