P.O. Box 2703 410G Jarvis Street Whitehorse, Yukon Y1A 2H5 Phone: (867) 667-5712 Fax: (867) 393-6386 APPLICATION FOR TEMPORARY RENT REDUCTION Date of Request: ______________________________________________________________________ Tenant Name (Primary Leaseholder): ______________________________________________________ Tenant Name (Secondary Leaseholder): ___________________________________________________ Address: ____________________________________________________________________________ Phone Number (home): ____________________ Phone Number (alternate): ______________________ I/we require a rent reduction because my/our gross income has been reduced by a significant amount (more than 20%). The reason(s) my/our income has dropped are: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I/we expect this drop in income to last for ______________________ days / months (please circle one). To apply for a rent reduction, you must provide the housing office with the following documents:  All current income information from the previous month for all persons in the home over 19 years of age  Other documentation to verify the change in income, if applicable (e.g. layoff notice, cancellation of EI benefits, official notice of reduction in work hours, etc.) I/we understand that this is an application for a rent reduction based on the information I/we have provided. I understand that this application will be reviewed by Yukon Housing Corporation and that, if approved, it may take up to 30 days for the reduction in rent to be applied. I also understand that an approved rent reduction is only valid for 3 months of rental payments and that longer rent reductions require another application. I/we declare that the information provided on this application is true. I/we understand that signing this application is of the same force and effect as if made under oath. Signature (Primary Leaseholder): _________________________________________________________ Signature (Secondary Leaseholder): _______________________________________________________