Household type : --- Single person Household without children Household with 1 child Household with 2 children Household with 3 children Household with 4 children Household with 5 children Household with 6 children Household with 7 children Household with 8 children Household with 9 children Household with 10 children Household with 11 children Household with 12 children

Amount of rent :

Monthly net income and expenses

	Applicant A	Applicant B	Other person	Other person	Total
Income
Salaried occupation					0.00
Unemployment benefits					0.00
Revis					0.00
Revis supplement					0.00
RPGH					0.00
RPGH supplement					0.00
FNS rental supplement					0.00
Pension/annuity					0.00
Personal alimony					0.00
Alimony for children					0.00
Parental leave					0.00
Other					0.00
Expenses
Paid personal alimony					0.00
Paid alimony for children					0.00
Total	0.00	0.00	0.00	0.00	0.00
				25% of the income =	0.00