Real Estate Tenant Hardship Questionnaire
This questionnaire is designed to assess the hardship circumstances of our tenants. Please complete all sections of this form with accurate and up-to-date information. Your responses will help us understand your situation better and determine the appropriate support or arrangements that can be made.
Tenant Information
Field | Information |
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Name: | |
Lease Start Date: | |
Property Address: | |
Contact Number: | |
Email Address: | |
Current Employment Status
Field | Information |
|---|
Employer Name: | |
Position: | |
Employment Status: | |
Date of Employment Start: | |
Date of Employment End (if applicable): | |
Financial Information
Field | Information |
|---|
Monthly Income Before Taxes: | |
Monthly Income After Taxes: | |
Other Income (Please specify sources): | |
Total Monthly Expenses: | |
Hardship Information
Field | Information |
|---|
Type of Hardship (e.g., unemployment, illness, reduced wages): | |
Date Hardship Began: | |
Is the hardship temporary or permanent? | |
Explanation of Hardship (Please provide a detailed explanation of your current circumstances): | |
Assistance Requested
What type of assistance are you seeking? (e.g., rent reduction, payment plan, lease termination) |
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How long do you anticipate needing this assistance? |
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Declaration
I/We hereby declare that the information provided above is true and accurate to the best of my/our knowledge. I/We understand that providing false information may result in the denial of assistance or other penalties.
[Date]
This questionnaire is provided by [Your Company Name] and is intended to assist in evaluating the tenant's request for hardship consideration. All information provided will be treated with confidentiality.
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