Mortgage Application

Purpose of Application

PurchaseRefinanceConstruction Loan

Have you, in the last 60 days, applied for a mortgage or have a pending application with another broker or bank ?

YesNo

How did you hear about us ?

Primary Applicant Details

Birth Date

SIN and Marital status

Current address

RentOwn

If number of years at this address is less than 3, then please enter previous address details

(Total years of all addresses should be equal or greater than 3)

Phone number

Employer information

If your length of employment is less than 3 years, then please enter previous employer details

(Total years of all employment should be equal to or greater than 3)

Since your time at job is less than 3 years, please enter the previous employer details

Co Applicant

YesNo

List Assets, Approximate Amount and Institution (if applicable)

Do you receive child credit benefit ?

YesNo

Income tax owing : CRA/HST/GST

Do you owe any property tax ?

Do you own any other properties ?

YesNo

Disclaimer

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 for these purposes from other sources (including, for example, credit bureau) and each source is hereby authorized to provide you with such information. I/we also understand that the information given in the application form as well as other information you obtain in relation to my credit history may be disclosed in writing, including fax, e-mail, or other electronic transmission with potential lenders, financial intermediary and mortgage insurers, organizations providing technological or other support services required in relation to this application and any other parties with whom I/we propose to have a financial relationship. I/we further understand that any potential lender, financial intermediary, or any other of the aforementioned parties to whom this information is forwarded may obtain its own credit report and I/we hereby authorize those parties to do so. I/ we confirm that I/we read and understand the above.