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A deposit of $60 per applicant to cover the screening costs has been remitted and will be retained by the landlord only if I refuse to sign a lease after having been informed that my application has been accepted. The landlord reserves its remedies for any other damage suffered should I refuse to sign a lease. *This deposit will be deducted from the first month's rent

I attest that this information is complete and truthful and that I have in no way misrepresented, falsified or omitted facts that could invalidate this form or influence the landlord's decision. I am advised that a false declaration may result in the annulment of the lease and may constitute fraud under the Criminal Code. I authorize the landlord and their representatives to obtain or exchange personal information with any personal information agent, financial institutions, employers, landlords or other institutions and persons mentioned above for the purpose of establishing my creditworthiness and my ability to meet the obligations of the lease. I authorize CORPIQ, in its capacity as a personal information agent, to collect and to communicate to the landlord or their representative any personal information, including information it may already hold about me under a prior consent. This consent to the collection and communication of personal information is valid for 14 calendar days from the date of signature. If a lease is signed, the consent remains valid until three years after the expiry of that lease, solely for the purpose of recovering rent or, if a judgment has been rendered by the tribunal, to recover any other debt relating to the lease.