HALCYON HOLDINGS LTD CHARTWELL MANOR APPLICATION TO RENT PLEASE PRINT

HALCYON HOLDINGS LTD. CHARTWELL MANOR APPLICATION TO RENT PLEASE PRINT Date Date premises required Applicant’s legal name Applicant’s preferred name Social Insurance Number Applicant’s present residence Phone How long? Present landlord Fax Present monthly rent Cell Phone Reason for leaving Phone Number E-mail [ ] Driver’s License or [ Age ] Prov. Health ID No. Address of premises to be rented: 2315- 7th Street East, Saskatoon, Sask. S7H 1A2 Apt. No. Type of apartment desired: [ ] Bachelor [ ] 1 Bedroom Number of children under 18 Total number of occupants Occupation Average salary or annual income $ Number of adults to occupy apartment Ages of children Applicant is employed by Phone Former employer From Spouse’s full name Employed by Occupation to Phone Phone HALCYON APPLICATION FOR RENT — Page 1 of 2 Credit references: (List bank, credit union, type of accounts, or other credit references.) 1. 2. 3. Personal references: 1. Relationship 2. Relationship Referred to landlord by Phone Cell Phone Phone Cell Phone I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement. Signature Date Signature Date Witness Date The applicant declares all above statements to be true and authorizes the landlord to contact available references. This information is confidential and will not be released to anyone without the consent of the applicant. HALCYON APPLICATION FOR RENT — Page 2 of 2

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