Covid-19

Request for Rent Deferral Form (Covid-19)

IMPORTANT NOTICE: Tenants are still obligated to pay their rent balance in full.

However, during the emergency period (through May 31, 2020), tenants that can substantiate one or more of the outlined circumstances below due to the financial impacts related to COVID-19, will not be evicted for failure to pay their monthly rent in full during this time period.

Tenants will have up to twelve (12) months (City of Los Angeles) / six (6) months (City of Santa Monica/Culver City) following the expiration of the local emergency to repay all of the back rent due. Failure to pay the rent within the time period provided may subject you to legal proceedings and other remedies available to the landlord in seeking unpaid rent, including eviction.

(Your monthly rent is not being reduced, waived or offset. The eviction moratorium was drafted to allow tenants experiencing negative financial impacts related to the COVID-19 emergency, additional time to pay their monthly rental obligations over a longer period. )

Tenant Basic Information

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Property Address *

Line 1

Line 2

City

State

Zip Code

Country

Alternative/Emergency Contact

Alternative/Emergency Contact Name *

First

Last

Alternative/Emergency Contact Phone Number *

Alternative/Emergency Contact Email *

Deferment of Rent Request Reason

Check Boxes: I/We hereby request deferment of Rent due to the following reason(s): (Check all boxes that apply) *

Loss of income due to work place closure or reduced hours or services due to COVID-19 Child care expenditures or inability to work due to school closures Health care expenditures stemming from COVID-19 infection of the tenant or a member of the tenant’s household who is ill with COVID-19 Reasonable expenditures stemming from government ordered emergency measures

Explanation *

What evidence will you provide (via e-mail) to support your hardship claim? *

By checking this box, you declare under the penalty of perjury under the laws in the State of California that the representations herein (and that you've e-mailed) are true and accurate *

By checking this box, I declare under the penalty of perjury under the laws in the State of California that the representations herein (and that I've e-mailed) are true and accurate

By checking this box, you acknowledge having read or obtained a copy of the Ordinance for future reference through the link provided below. *

I have read and obtained a copy of the ordinance through the link provided below.

Upon receipt of all qualifying documentation submitted by the tenant(s), the property owner will review the information for compliance with the criteria outlined herein. Tenants will be notified within 7 business days of the decision based on the documentation provided. If additional information is required, a management representative will be in contact with you directly. Tenants experiencing hardship due to the COVID-19 emergency will have the ability to set up a payment plan to repay any missed rent over a period of time not to exceed twelve (12) months (City of Los Angeles) / six (6) months (City of Santa Monica / Culver City). We appreciate your patience and cooperation during this extremely trying and difficult time. Thank you.

Requested Payment Plan

Requested payment plan options *

Deferment of April rent Deferment of May rent Deferment of June rent

Repayment Period *

Your new monthly rent for the repayment period, which includes a prorated portion of your deferred rent based upon the number of months selected for your repayment plan: *

Any additional details regarding repayment plan *

By submitting this form, you are providing notice that you have been impacted by one or more of the circumstances related to the COVID-19 Emergency as described herein. Accordingly, in order to temporarily delay any potential eviction proceedings against you for non-payment of rent, you are obligated to provide specific, verifiable and supporting documentation for review which demonstrates how your specific issues related to the COVID-19 Emergency are impacting your ability to pay rent. Please note that without sufficient supporting documentation, your request may be denied. Furthermore, you are hereby acknowledging this request for a partial or full deferment of your next monthly rent payment is solely for purposes relating to the COVID-19 Emergency; and for no other reason including the habitability or any other general conditions of your dwelling at this time.

Submit

City of Los Angeles: A copy of the Ordinance outlining the protections of this article is available for viewing here: Los Angeles Municipal Code

City of Santa Monica: A copy of the Ordinance outlining the protections of this article is available for viewing here: City of Santa Monica Temporary Eviction Moratorium and Santa Monica City Ordinance

Culver City: A copy of the Ordinance outlining the protections of this article is available for viewing here: Culver City Ordinance

Request for Rent Deferral Form (Covid-19)

Tenant Basic Information

Alternative/Emergency Contact

Deferment of Rent Request Reason

Requested Payment Plan

Locations

KEYBOX

DRE 02086236

What Our Clients Are Saying

Request for Rent Deferral Form (Covid-19)

Tenant Basic Information

Alternative/Emergency Contact

Deferment of Rent Request Reason

Requested Payment Plan

Locations

KEYBOX

DRE ​02086236

What Our Clients Are Saying

DRE 02086236