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Statement of Rent

Complete this form if you want to receive (or continue receiving) the shelter allowance for the period from October 1, 2023, to September 30, 2024. One of the following situations must apply to you and your spouse (if applicable):

  • You rent a room, apartment or house.
  • You live with someone you pay rent to.
  • You live in a mobile home on rented land.

This form is used to provide us with information on your rent when you apply for the shelter allowance or when there is a change in your situation during the year. 

Enclose this form with your Shelter Allowance Application – 2023 (LEX-165-V).

2023-06 version

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