Rental Housing Improvement Program Application Form Housing Delivery 2 nd Floor - 352 Donald Street Winnipeg MB R3B 2H8 204-945-5566 in Winnipeg or toll-free 1-866-689-5566 in Manitoba Applicant Information Applicant name: Project name: Property owner name(s) (Please provide all names that appear on the title of the property): Property Information Address of Property to be Rehabilitated (only one property per application) Street Number and Name/Section Number Applicant Mailing Address Street Number and Name/P.O. Box City/Town Postal Code City/Town Postal Code Legal Description of the Property: (from Property Tax bill) Contact Information Contact name: Daytime telephone number: Other: Email address (optional): Dwelling Type Single Apartment Number of eligible units Semi-detached Triplex Units Duplex Other Row housing Age of building Previous assistance qyes or qno Total # units: Page 1 of 3 The Rental Housing Improvement Program is provided with the financial assistance of the Government of Canada
Estimated Project Costs for the Project (all inclusive taxes) Estimated cost of repairs to meet health and safety minimum standard $ Estimated legal fees $ Other eligible cost - Specify $ Other eligible cost - Specify $ Other eligible cost - Specify $ Total Estimated Project Cost $ Estimated Financing Details A Maximum Rental Housing Improvement Program forgivable loan available (number of eligible units multiplied by maximum dollars) Eligible Units X $ = $ Program Funding Max Loan B Total private financing and equity (breakdown the details below) $ A+B Total Estimated Financing (equals Total Estimated Financing below) $ Details of Private Financing (if available) Source Amount Interest Rate Annual Payment Term Maturity Date Loans (Specify) Lines of Credit (Specify) $ % $ $ % $ mm dd yy Cash (Equity) $ Other (Specify) Total Estimated Financing (equals B-Total Private financing and equity above) $ $ Page 2 of 3
Applicant Declaration and Consent Your personal information is collected under the authority of Manitoba Housing programs and will be used by Manitoba Housing and/or its designated representative(s) to determine your eligibility for the Rental Housing Improvement Program (RHIP). Your personal information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of personal information, please contact the Access and Privacy Coordinator, 600-352 Donald St., Winnipeg, MB (204) 945-3025. I/We acknowledge that any work carried out prior to receipt of written confirmation of RHIP loan approval is not eligible. I/We acknowledge that I/we understand the terms and conditions that shall govern any loan that may be approved and that I/we will enter into a rental operating agreement. I/we understand that this application is not an agreement on the part of Manitoba Housing to provide me/ us with a loan under the RHIP program. I/we understand that once submitted this application becomes the property of Manitoba Housing. I/We hereby confirm that I/we am/are the owner(s) of the said property, and no other entity or person having any matrimonial interest is an owner. The owner shall bear the additional costs of repairs over and above the limits of the program. I/We hereby apply for a forgivable loan, repayable in accordance with the terms and conditions of the loan. I/We certify that the information contained herein is true. I/We hereby consent to Manitoba Housing and/or its designated representative(s) carrying out any necessary inquiries for the purpose of verifying ownership of the property and any information in this application. I/We hereby consent to an inspection, and re-inspection as necessary, of the property by Manitoba Housing and/or its designated representative(s). Applicant signature Date Page 3 of 3
APPENDIX A Rental Housing Improvement Program Revenue and Expense Statement Applicant name: Property owner: Address of property: Project name: Estimated market value: Revenues Unit Type Number of Units Rent per Unit - Pre-RHIP Rent per Unit - Post RHIP Estimated Annual Revenue Pre RHIP Rent Post RHIP Rent Approved (Manitoba Housing Use Only) Total self-contained units and revenue Gross income residential rentals (total annual estimate for property) Vacancy allowance percentage (allowance of revenue lost per year due to vacancy) Effective gross income residential rentals (gross income less vacancy allowance) Non-residential revenue (less vacancies) (if applicable for project) Other revenues (if applicable) EFFECTIVE GROSS INCOME (EGI) for project (effective gross income, plus non-residential avenue, plus other revenue)
Expenses Pre RHIP Post RHIP Approved Taxes (including local improvements charges) Insurance (public liability, fire, boiler) Maintenance and repairs Electricity Heat Gas Water Janitorial services Administration (including advertising) Bad debts Professional fees Snow and garbage removal Other TOTAL EXPENSES Non-Residential Expenses Total Residential Expenses Net Operating Income (NOI) (EGI minus Total Expenses) Total annual principal and interest on all encumbrances Cash flow equals NOI minus annual principal and interest Services (indicate with an X if included in rent) Included Current Anticipated Approved Heating type Heat Heating fuel Gas Water TOTAL COST OF SERVICES Existing and/or proposed encumbrances on the property (include tax arrears) Payable to Balance Owing Date % rate Annual Payment Term Total Approved Declaration I/we, as owner(s) of this property, certify that the information provided on this revenue and expense statement is accurate as of the date shown below. Signature(s) of Owner(s) Date
APPENDIX B Rental Housing Improvement Program Summary of Rents and Tenant Income Information eligible units (to be completed by landlord) Company and Project Name: Property Address: Property Owners: Pre-RHIP Rental Information Post-RHIP Rental Information Unit # Unit Type Tenant Name Total Family Size Program Income Limit Total Gross Household Income Current Rent* (A) Adjustment for Services (B) Adjusted Rent (A - B) Renovation Rental Limit Proposed Rent* (C) Adjustment for Services (D) Adjusted Rent (C-D) * Rent and Proposed Rent include heat, water and gas only. Do not include other services such as parking and cable.
Pre-RHIP Rental Information Post-RHIP Rental Information Unit # Unit Type Tenant Name Total Family Size Program Income Limit Total Gross Household Income Current Rent* (A) Adjustment for Services (B) Adjusted Rent (A - B) Renovation Rental Limit Proposed Rent* (C) Adjustment for Services (D) Adjusted Rent (C-D) * Rent and Proposed Rent include heat, water and gas only. Do not include other services such as parking and cable. If there isn t enough room to provide information on all of your units please use additional paper as necessary.
Declaration I/we declare that the tenant income information contained herein accurately states the information provided to me/us by the tenant. These are the average costs of services not included in the rents stated above: Heat Water Gas Other Total I/we, as owner(s) of this rental property, certify that the rents stated herein are accurate as of the date shown below. I/We certify that each tenant has consented to the collection of the personal information on this form for the sole purpose of determining eligibility for the Rental Housing Improvement Program (RHIP) and to its disclosure by the landlord to Manitoba Housing and/or its designated representative(s). Personal information is collected under the authority of Manitoba Housing programs and will be used by Manitoba Housing and/or its designated representative(s) to determine eligibility for the Rental Housing Improvement Program. Personal information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of personal information, contact the Access and Privacy Coordinator at 600-352 Donald St. Winnipeg, MB or call 204-945-3025. Signature(s) of Owner(s) Date MG-8608
Appendix C RENTAL HOUSING IMPROVEMENT PROGRAM QUESTIONNAIRE PROPERTY ADDRESS 1. List the major repairs that, in your opinion, are required to bring the property up to a minimum level of health and safety. Check all that apply. Repair Category Specify Repair Needed Estimated Cost Structural i ii Electrical i ii Plumbing i ii Heating i ii Fire & Life Safety i ii TOTAL 2. List the major repairs you have completed in the last 2 years. Check all that apply. Repair Category Specify Repair Needed Estimated Cost Structural i ii Electrical i ii Plumbing i ii Heating i ii Fire & Life Safety i ii TOTAL RHIP 2016 CFA Questionnaire
Appendix C RENTAL HOUSING IMPROVEMENT PROGRAM QUESTIONNAIRE 3. What maintenance or upgrades have you completed in the last 2 years? i ii iv. RHIP 2016 CFA Questionnaire Maintenance or Upgrade TOTAL Estimated Cost 4. Are you willing and able to provide an equity contribution to cover the cost of all mandatory repairs that cannot be completed with the maximum funding available through RHIP? Yes No. Equity in the form of Cash or Financing If yes, Maximum equity you can provide $ 5. How long have you operated this property as rental housing? Year Months 6. How long have you operated rental properties? Year Months 7. How many rental properties do you own? Properties Units 8. Are the current rent amounts stated in the application registered at the Residential Tenancies Branch? Yes No 9. All bachelor, one-bedroom and two-bedroom units in this property are dedicated to low-income seniors. Yes No Not Applicable 10. Have you previously received or are you currently receiving federal, provincial or municipal repair program funding assistance for this property? Yes No If yes, funding amount $ Year received 11. Have you previously received or are you currently receiving federal, provincial or municipal repair program funding assistance for any other property you own or have owned in the past? Yes No If yes, funding amount $ year received. Address of property funded 12. Are any of the occupants related to the Landlord? Yes No. If yes, please provide unit details and name of the relatives. 13. Other comments you feel are relevant to understand your property and review your submission: I/we, as owner(s) of this residential rental property, certify that the information stated herein is accurate as of the date shown below. Signature(s) of Owner(s) Date