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
Name:
Lease Start Date:
Property Address:
Contact Number:
Email Address:

Current Employment Status

Field	Information
Employer Name:
Position:
Employment Status:	Full-time Part-time Unemployed
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?	Temporary 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)

How long do you anticipate needing this assistance?

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.