Application to Waive Filing Fee - British Columbia – 17 Application to Waive Filing Fee What is...

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#RTB – 17 Application to Waive Filing Fee What is the total number of household members? Tenants: Your household includes all tenants on the tenancy agreement and any family members or dependants of those tenants living in the rental unit or site. Unrelated individuals who are not on the tenancy agreement do not count as part of your household. Landlords: Your household includes you and all family members or dependents living in your residence. What is the total monthly income before deductions of all household members counted above? Box A: Total monthly household income $ Residential Tenancy Branch Office of Housing and Construction Standards #RTB-17 (2017/09) page 1 of 2 pages APPLICANT INFORMATION (the person applying for fee waiver) First and middle name(s) last name Current Address daytime phone province postal code unit/site # street # and street name city other fax phone HOUSEHOLD SIZE HOUSEHOLD INCOME Learn more about fee waivers online at: www.gov.bc.ca/landlordtenant/fees#Waiver Your Application for Dispute Resolution is not considered to have been made until your application has been submitted and either the fee has been paid or all documents for a fee waiver have been submitted. Your personal information is collected under section 26 (a) and (c) of the Freedom of Information and Protection of Privacy Act for the purpose of administering the Residential Tenancy Act and Manufactured Home Park Tenancy Act. If you have any questions regarding the collection of your personal information, please contact an information officer by calling 604-660-1020 in Greater Vancouver; 250-387-1602 in Victoria; or 1-800-665-8779 elsewhere in B.C. Please check the box(es) and attach copies of the documents that you are providing with this application. Income Assistance statement Recent pay stub(s) from employer(s) Other: Employment Insurance Benefits statement Bank statements for two most recent months Pension statement(s) Scholarship statement(s) PROOF OF INCOME (the Residential Tenancy Branch may ask for additional information or material) Proof of rental income (rent ledgers, rent receipts or bank statements)

Transcript of Application to Waive Filing Fee - British Columbia – 17 Application to Waive Filing Fee What is...

Page 1: Application to Waive Filing Fee - British Columbia – 17 Application to Waive Filing Fee What is the total number of household members? • Tenants: Your household includes all tenants

#RTB – 17

Application to Waive Filing Fee

What is the total number of household members? • Tenants: Your household includes all tenants on the tenancy agreement and any family members or

dependants of those tenants living in the rental unit or site. Unrelated individuals who are not on the tenancy agreement do not count as part of your household.

• Landlords: Your household includes you and all family members or dependents living in your residence.

What is the total monthly income before deductions of all household members counted above?

Box A: Total monthly household income $

Residential Tenancy Branch Office of Housing and Construction Standards #RTB-17 (2017/09) page 1 of 2 pages

APPLICANT INFORMATION (the person applying for fee waiver)

First and middle name(s) last name Current Address

daytime phone

province postal codeunit/site # street # and street name city

otherfax

phone

HOUSEHOLD SIZE

HOUSEHOLD INCOME

Learn more about fee waivers online at: www.gov.bc.ca/landlordtenant/fees#Waiver Your Application for Dispute Resolution is not considered to have been made until your application has been submitted and either the fee has been paid or all documents for a fee waiver have been submitted.

Your personal information is collected under section 26 (a) and (c) of the Freedom of Information and Protection of Privacy Act for the purpose of administering the Residential Tenancy Act and Manufactured Home Park Tenancy Act. If you have any questions regarding the collection of your personal information, please contact an information officer by calling  604-660-1020 in Greater Vancouver; 250-387-1602 in  Victoria; or 1-800-665-8779 elsewhere in B.C.

Please check the box(es) and attach copies of the documents that you are providing with this application.Income Assistance statement

Recent pay stub(s) from employer(s)

Other:

Employment Insurance Benefits statement

Bank statements for two most recent months

Pension statement(s)

Scholarship statement(s)

PROOF OF INCOME (the Residential Tenancy Branch may ask for additional information or material)

Proof of rental income (rent ledgers, rent receipts or bank statements)

Page 2: Application to Waive Filing Fee - British Columbia – 17 Application to Waive Filing Fee What is the total number of household members? • Tenants: Your household includes all tenants

page 2 of 2 pages#RTB-17

I understand that if I do not attend the hearing for any valid legal reason, and have not withdrawn my application before the hearing, I may be required to pay the waived filing fee. I confirm that all information I have entered is accurate, and I understand that submitting false information to the Residential Tenancy Branch to avoid paying the filing fee is a punishable crime.

Date:Applicant's Signature:

day month year

Approved Not approved

Low-income cut-off $

Notes:

Information officerCashier transaction No.

Cashier's initials

I have had the following extraordinary expenses within the past eight weeks (see information below about eligible expenses). You must include supporting evidence to prove these extraordinary expenses.

$

$

Description 1

Description 2

OFFICE USE ONLY

EXTRAORDINARY EXPENSES

Box B: Total of extraordinary expenses $

DECLARATION

$Description 3

Extraordinary expenses may include: • extraordinary medical expenses for you or your dependents; • extraordinary transportation costs for medically necessary procedures not available in your community; • funeral expenses including travel costs for immediate family (i.e. parent, spouse, child, grandchild,

grandparent or sibling or the parent, child, grandchild, grandparent or sibling of your spouse; • costs associated with an emergency such as a fire or flood, or other catastrophic event; or • loss of income because:

• you have lost your job but are not yet receiving unemployment benefits; or • you are not working due to illness or injury, but are not yet receiving disability benefits.

Box A Monthly household income $

minus Box B: Extraordinary expenses $

Box C: Monthly income after expenses $

FOR MORE INFORMATION RTB website: www.gov.bc.ca/landlordtenant

Public Information Lines 1-800-665-8779 (toll-free) Greater Vancouver 604-660-1020 Victoria 250-387-1602