Real Estate Tenant Financial Hardship Application Form Template
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Real Estate Tenant Financial
Hardship Application Form

Please complete this form if you are experiencing financial hardship affecting your ability to pay rent. Provide detailed information to help us understand your situation and determine possible solutions.

Tenant Information

Name

Property Address

Phone

Email

Lease Start Date

Monthly Rent Amount

Financial Hardship Details

Nature of Financial Hardship

  • Job Loss

  • Medical Expenses

  • Other:                               

Date Hardship Began

Situation Description

  • Temporary

  • Permanent

Estimated Duration of Hardship

Current Financial Situation

Current Employment Status

  • Employed

  • Unemployed

  • Other:                               

Monthly Income

Additional Income Sources

Monthly Expenses

Assistance Requested

Type of Assistance

  • Rent Reduction

  • Payment Plan

  • Rent Deferral

  • Other:                               

Duration of Assistance

Proposed Rent Payment Plan
(if applicable)


Supporting Documentation

Please attach any supporting documentation related to your financial hardship (e.g., termination letter, medical bills).

Declaration and Consent

I/We hereby declare that the information provided is true and accurate to the best of my/our knowledge and belief. I/We understand that submitting this application does not guarantee approval of the requested assistance. I/We consent to the verification of the information provided and understand that additional documentation may be required.

[Tenant Name]

[Date]


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