Tenant Application

Tenant Verification Worksheet

In order to activate and assure the service and protection plans validity, the Landlord hereby agrees to verify and confirm (and maintain a written recor and or copies of the stated documents) that the following information is true and correct. In the event of a breach or default of the lease, the following information (copies of documentation) will be used in our collection process and will be verified by members of the APG collection team. Every question must be answered accurately.

Landlord Name
(please use the same name as on Landlord application)
 Landlord Phone #:
 		 Landlord Email:
 

Tenant's Full Name

First:
 		 Middle:
 Last:
 
Tenant's Date of Birth:                                 Tenant's Social Security #:                                 --

Tenant's Present Address

Street Address:

 City:
 State:
 		 Zip Code:
    Dates of Occupancy:
Current Landlord Name:
 Current Landlord Phone #:
 From:
 To:
 

Tenant's Present Employer

Company Name:
Employed from:
to:
Employer Contact Name:
 Employer Telephone #:
Income Per Week:
$		 Income Per Month:
$
 

Tenant Additional Income and Expenses

This includes child support, social security, disability, food stamps, section 8, non-leasee spousal income or any other documented income.

List Other Income Sources Income per Month Duration of Expected Income
   
Month Day Year   Month Day Year
 
 
 
 
 
$
$
$
$
$

Total Additional Income per Month: $

List expenses: (auto, medical,
insurance, food, utilities, etc.)		 Cost per Month
$
$
$
$
$

Total Expenses per Month:
$

 

Total Monthly Employment Income: $
Total Additional Monthly Income: $
 
Combined Total Monthly Income: $
Total Expenses per Month: $
 
Net Income Before Rent: $
 
Rent: $
 

Tenant's Previous Employer

(If the Tenant has had more than one employer over the last year, please list the additional employment information.)
Additional employer Information: (Previous 12 months only)
Company Name:
Employed from:
to:
Employer Contact Name:
 Employer Telephone #:
Income Per Week:
$		 Income Per Month:
$
 

Present Resident Rental Payment History

(Previous 12 Months with this Landlord)
Most Recent Full Month: Rent Due: $ Date Paid:
Most Recent Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
Previous Month: Rent Due: $ Date Paid:
1) Has the Landlord verified that the stated employer(s) is correct? (Telephone documented verification [use Telephone Verification Report], fax documented verification or other written documentation from employer) NA if not employed Yes
No
N/A
2) Has the Landlord verified that the employment dates are correct? (Telephone documented verification [use Telephone Verification Report], fax documented verification or other written documentation from employer) NA if not employed Yes
No
N/A
3) If the Tenant derives their income partially or in full from employment, has the Landlord verified that the employment income is correct? (Employer document verification is required, such as Check stubs, W-2’s, bank statements, official letter on employer letterhead, etc.) fax documented verification is acceptable. NA if not applicable. Yes
No
N/A
4) Has the Landlord Verified that any other form of listed income is correct? (Check stubs, W-2’s, bank statements, official letter from source, child support documentation, food stamp documentation, Section 8 documentation, etc.) Yes
No
N/A
5) Has the Landlord verified that the residential history is correct? (Telephone documented verification (use Telephone Verification Report), fax documented verification or other written documentation from previous Landlord) Yes
No
6) Has the Landlord obtained at least one current copy of the Tenants Photo Identification? These must be legible (Government U.S. or foreign issued State or Federal photo I.D.) and at least one copy of other (non photo) identification such as birth certificate, social security card or utility bill in the Tenants name. Yes
No
7) Has the Landlord determined the reason why the Tenant is moving? (If the stated reason for moving involves problems with the prior Landlord or other potential problematic issues please describe below.) Yes
No
8) Does the Tenant currently have any garnishments, child support, settlement payments, levies are liens that do or may affect the listed income? Yes
No
9) Employment explanations:
10) Residential History Explanations:
11) Income Explanations:
12) Previous Landlord Problems Explanations:
13) Any other explanations or information:
14) Is this application for an existing tenant?

If you answered yes, please complete the Rental Payment History for the prior year or from the time of lease inception.

 Yes
No
15) Is the Tenant seeking residency immediately (within 96 hours)? Yes
No
 
Please explain any known reasons for late payments or fees:
Any additional employment information or explanations:
To submit this form to Assurance Protection Group the Landlord acknowledges agreement with the Terms and Conditions (link will open in a new window).

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