Required fields are marked with asterisks (*)

Notice to DASH - Arrears

Use this form to notify DASH about former tenant or co-op member arrears.

You can report new arrears or changes to arrears owing. You can also use the form to report new repayment agreements or defaults on current repayment agreements.

Once you post arrears, you must keep DASH updated if there are changes (e.g. paid arrears, defaults on repayment agreements, etc.).

Name of Former Tenant or Co-op Member:

Aliases

SIN:

Date of Birth

Amount of Arrears $

Repayment Agreement

Yes

Repayment Agreement in Pay

Yes

Street Address:

City/Town:

Name of Property

Unit #

Other information:

Name of Housing Provider:

Staff Contact Name and Title:

Email:

Provider Telephone: