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Application to Waive Filing Fee

#RTB – 17
Learn more about fee waivers online at: www.gov.bc.ca/landlordtenant/fees#Waiver

Your Application for Dispute Resolution is not considered to have been made until your application has
been submitted and either the fee has been paid or all documents for a fee waiver have been
submitted.
APPLICANT INFORMATION (the person applying for fee waiver)

First and middle name(s) last name


Current Address

unit/site # street # and street name city province postal code


fax other
daytime phone phone

HOUSEHOLD SIZE
What is the total number of household members?
• Tenants: Your household includes all tenants on the tenancy agreement and any family members or
dependants of those tenants living in the rental unit or site. Unrelated individuals who are not on the
tenancy agreement do not count as part of your household.
• Landlords: Your household includes you and all family members or dependents living in your
residence.

HOUSEHOLD INCOME
What is the total monthly income before deductions of all household members counted above?

Box A: Total monthly household income $

PROOF OF INCOME (the Residential Tenancy Branch may ask for additional information or material)
Please check the box(es) and attach copies of the documents that you are providing with this application.
Income Assistance statement Employment Insurance Benefits statement Pension statement(s)

Recent pay stub(s) from employer(s) Bank statements for two most recent months Scholarship statement(s)

Proof of rental income (rent ledgers, rent receipts or bank statements)

Other:

Your personal information is collected under section 26 (a) and (c) of the Freedom of Information and Protection of Privacy Act for the
purpose of administering the Residential Tenancy Act and Manufactured Home Park Tenancy Act. If you have any questions regarding the
collection of your personal information, please contact an information officer by calling 604-660-1020 in Greater Vancouver; 250-387-1602
in Victoria; or 1-800-665-8779 elsewhere in B.C.

Residential Tenancy Branch


Office of Housing and Construction Standards
#RTB-17 (2017/09) page 1 of 2 pages
EXTRAORDINARY EXPENSES
I have had the following extraordinary expenses within the past eight weeks (see information below about
eligible expenses). You must include supporting evidence to prove these extraordinary expenses.

Description 1 $

Description 2 $

Description 3 $

Box B: Total of extraordinary expenses $

Box A Monthly household income $

minus Box B: Extraordinary expenses $

Box C: Monthly income after expenses $

Extraordinary expenses may include:


• extraordinary medical expenses for you or your dependents;
• extraordinary transportation costs for medically necessary procedures not available in your community;
• funeral expenses including travel costs for immediate family (i.e. parent, spouse, child, grandchild,
grandparent or sibling or the parent, child, grandchild, grandparent or sibling of your spouse;
• costs associated with an emergency such as a fire or flood, or other catastrophic event; or
• loss of income because:
• you have lost your job but are not yet receiving unemployment benefits; or
• you are not working due to illness or injury, but are not yet receiving disability benefits.

DECLARATION OFFICE USE ONLY


I understand that if I do not attend the hearing for any valid legal reason, and
Low-income cut-off $
have not withdrawn my application before the hearing, I may be required to pay the
waived filing fee. Approved Not approved
Notes:
I confirm that all information I have entered is accurate, and I understand that
submitting false information to the Residential Tenancy Branch to avoid
paying the filing fee is a punishable crime.

Information officer
Cashier transaction No.
Cashier's initials

Applicant's
Signature: Date:
day month year
FOR MORE INFORMATION
RTB website: www.gov.bc.ca/landlordtenant
Public Information Lines 1-800-665-8779 (toll-free) Greater Vancouver 604-660-1020 Victoria 250-387-1602

#RTB-17 page 2 of 2 pages

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