Reference number : #

Name of owner investigating you :
Email of owner investigating you :
Rental address : , ,
Produce report in :
Rent amount :

First name :

Last name :

Email :

Address of the potential tenant :

Date of birth of the potential tenant :

Telephone number of the potential tenant :


Number of occupants of the premises?
adult(s)
children(s)

PART C :

Name of the current owner :
Telephone number :
How long have you lived at this address? :
Other phone number :
Are you related to the current owner?
Lease in your name :
Amount of rent :
Lease expiry date :

PART D :

Previous address :
Name of previous owner :
Telephone number :
Are you related to the previous owner?
Lease at your name :

PART E :

Employer's name :
Supervisor :
Address :
Phone :
Type of employment :
Since how long :
Hours/week :
Net monthly salary :

The potential tenant authorizes Enquêtes de pré-location Excellence Inc. and the owner identified above to obtain all necessary information from his financial
institution, credit bureaus or other sources in order to establish his solvency. He also authorizes to check his criminal record and to communicate any information
about his credit experience to all lenders, credit bureaus and any other service provider, for the duration of the contract with the owner identified above. He solemnly affirms,
in accordance with the provisions of the Evidence Act, that all of the information identified in this form is true, including his address and date
of birth. I understand that any false declaration is subject to judicial sanctions. The tenant will be able to consult and correct the obtained report if necessary.