Windsor Essex County Housing Application Page 6
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116. Income
Please list all monthly income from all sources.
Income from all sources for every member of the household must be declared.
For other examples of income see page 2.
Gross Monthly Income (Before Deductions)
Applicant
Co-Applicant
Other Household Members
$
$
$
$
Old Age Security (OAS)
Federal Guaranteed Income Supplement (GIS)
Provincial Guaranteed Annual Income System (GAINS)
Canada Pension Plan (CPP) – Retirement
Canada Pension Plan - Disability (CPP-D)
Workplace Safety Insurance Board (WSIB)
Department of Veteran’s Affairs Allowance
War Pension - Other Countries
Private Pensions (Specify)
Ontario Disability Support Program (ODSP)
Employment Income - Full or Part-Time
Ontario Works (OW)
Old Age Pension - Other Countries
Alimony/Support
Employment Insurance
OSAP
Other (Specify)
7. Assets
Please list all assets from every member of the household – For more examples of assets see page 2.
Bank name
List all accounts and amounts below
Applicant
Co-Applicant
Other Household Members
Savings acct. #
$
$
$
$
Chequing acct #
Trust Companies, Credit Unions
Bonds/Savings Certificates
Annuities, Shares, Securities, Stocks,
Debentures
Registered Retirement Savings Plans
Property and/or Buildings
Rent Revenue
Business Assets
(Partnership, etc.)
Monies Owed to you
(Amounts over $500.00)
Paid-up Life Insurance
Other (Specify e.g. Mortgage)
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