SECTION ONE: Tell us about what type of mortgage you need.

1. What type of mortgage are you looking for?

2. When will you need this mortgage?

3. If you are buying a home, how much will you have for a downpayment?

4a. Where will the downpayment come from?

4b. If Other, please specify:  

5. Will anyone be Guarantying or Co-signing for you?

6. What amount of mortgage are you looking for?

SECTION TWO: Personal Information.

This is a very critical section on the application. We need to have a 3 year history of your employment and where you have lived. If you can’t provide a full 3 years please provide a reason in the final comments section.

Main Applicant Information

First Name:  

Last Name:    Initial:  

Social Insurance Number:  

Date of Birth:  

Number of Dependents:  

Home Phone Number:  

Business Phone Number:  

E-mail Address:  

Marital Status:  

Present Address:  

City:    Province:  

Postal Code:  

How long have you lived here? Years:    Months:  

How much is the rent?  

Previous Address:  

How long did you live here? Years:    Months:  

Current Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long have you been there?  

1st Previous Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long were you there?  

2nd Previous Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long were you there?  

Other Annual Income:  

Source of Other Income:  

Co-Applicant Information

First Name:  

Last Name:    Initial:  

Social Insurance Number:  

Date of Birth:  

Home Phone Number:  

Business Phone Number:  

E-mail Address:  

Present Address:  

City:    Province:  

Postal Code:  

How long have you lived here? Years:    Months:  

Previous Address:  

How long did you live here? Years:    Months:  

Current Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long have you been there?  

1st Previous Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long were you there?  

2nd Previous Employer:  

Address:  

Occupation:  

Gross Annual Income:  

How long were you there?  

Other Annual Income:  

Source of Other Income:  

SECTION THREE: Tell us about your net worth and assets.

Cash in the bank:     Which Bank:  

Bank Location:  

Principle Residence Value:  

(Please complete existing mortgage section below on all mortgages.)

Rental Properties Value:  

(Please complete existing mortgage section below on all mortgages.)

RRSPs:  

Stocks & Bonds:  

Automobiles:  

Household Contents:  

Other Assets (please list items and value):

Total Assets:  

Tell us about your liabilities.

We will be obtaining a credit report and this will provide us with details of accounts. Please provide Account name and amount owed (no account numbers).

Credit Cards:

1. Credit Card Type:    Amount Owed:  

2. Credit Card Type:    Amount Owed:  

3. Credit Card Type:    Amount Owed:  

4. Credit Card Type:    Amount Owed:  

Credit Lines or Loans:

1. Name:    Amount Owed:  

2. Name:    Amount Owed:  

3. Name:    Amount Owed:  

4. Name:    Amount Owed:  

Mortgage Information: Primary Residence

Who is the current lender?  

How much do you still owe on this mortgage?  

What is the interest rate?  

What is your payment?  

When is your renewal date?  

Rental Property #1

Who is the current lender?  

How much do you still owe on this mortgage?  

What is the interest rate?  

What is your payment?  

Rental property #2

Who is the current lender?  

How much do you still owe on this mortgage?  

What is the interest rate?  

What is your payment?  

Rental property #3

Who is the current lender?  

How much do you still owe on this mortgage?  

What is the interest rate?  

What is your payment?  

Do you have any other liabilities?

Please list the creditor, amount owing, and payment:

Which bank do you deal with and where is your bank?  

How long have you been with this bank?  

If you are doing a renewal or switch, when will your mortgage come up for renewal?  

Do you have any other comments or important infomation that we should know?

How did you hear about me:

It is very important for me to track how my clients have been referred to me. Please choose one of the below that best describes how you came to this web site.

Directed to website by mortgage broker:

Responding to FREE BOOK:

Read ad in flyer or postcard:

Directed to website by realtor:   Which realtor:  

Surfing the Web:   Which search engine did you use:  

Other method:   How:  

FINAL STAGE: Your Permission to proceed

In this final section we just need you to review this statement and provide us with permission to proceed with your application. We will also need you to sign a copy of this application and fax it to us as a back-up to our files.

I/we warrant and confirm that the information given in this application is true and 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. You are further authorized to disclose in response to direct inquiries from any other lender or credit bureau. I/we agree to indemnify you against and save you from harm from any and all claims in damages or otherwise arising from such disclosure. You are authorized to retain the application whether or not the relative mortgage is approved.

Applicant Name:    Yes   No

Co-applicant Name:    Yes   No

Date you completed this application: