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1. Personal Information
First Name
MI
Last Name
D.O.B.
S.I.N.
Marital Status
Dependents
Current Address
City
Prov.
Postal code
Years There
Residential Status
   
Previous Address (if less than 3 years ago)
City
Prov.

Postal code
Years There
2. Contact Information
E-mail Address
Home Phone
Pager
3. Job Details
Current Occupation
Current Employer
Work Phone
Ext.
Gross Yearly Income
$
Years There
Current Employer Address
Type of Income
Previous Occupation (if less than 3 years ago)
Previous Employer
Gross Yearly Income
$
Years There

4. Co-Applicant Information (Complete this section if you are married or have a co-applicant.)

First Name
MI
Last Name
D.O.B.
S.I.N.
Relation to Co-Applicant
Current Occupation
Current Employer
Work Phone
Ext.
Gross Yearly Income
$
Years There
Current Employer Address
Type of Income
Previous Occupation (if less than 3 years ago)
Previous Employer
Gross Yearly Income
$
Years There
 

5. Details of Mortgage Loan

I am applying for a mortgage. How much of a loan are you asking for? $
Monthly property taxes? $ Current value of your home (if you own)? $
Date purchased? (Approx.)   Original purchase price? (Approx. if you own) $
 

6. Details of Second Mortgage

Mortgage

Mortgage Lender
Mortgage Number

$
Balance
Rate %

$
Mthy Paymnt
Maturity Date
Property Address
 
7. Liabilities (what & how much you owe)
Total outstanding balances: Credit Cards $   Loans/Lines of Credit $  
  Principle Res. $          
Enter total monthly
payments:
Car Payments $  Alimony/Support/Other $  
 

8. Assets

Principle Res. $     Rentals/property $  
Credit Lines/Loans $   RRSPs $
Vehicle 1 (Year, Make, Model) Stocks/Bonds $
Vehicle 2 (Year, Make, Model) Cash/Savings $
Name of your bank(s)        
 

9. Property Information

Dwelling Type Property Age Tenure
Dwelling Style Square Footage Garage Size
Heating Type Lot Size Garage Type
 
10. Comments (Provide any additional financial information which could help us.)
 
I/We warrant and confirm that the information given in the mortgage application form is true and correct and I/we understand that it is being used to determine my/our credit responsibility. You are authorized to obtain any information you may require relative to this application from any sources to which you may apply and each such source is hereby authorized to provide you with such information. You are furthermore authorized to disclose, in response to direct enquiries from any other lender or credit bureau, such information on my loaning account as you consider appropriate, and I agree to indemnify you against and save you harm from any and all claims in damages or otherwise arising from such disclosure on your part. You are also authorized to retain the application whether or not the relative mortgage is approved.