Purpose of Loan Purchase Pre-Approval Refinance Switch

Value of Home

Mortgage Amount Required

Approx Date Funds Required

Title Mr. Mrs. Miss. Ms. Dr. Rev.

First Name

Last Name

Initial

Date of Birth

SIN #

Home Phone

Work Phone

Email Address

Marital Status Married Widowed Separated Divorced Single

Children 0 1+ 2+ 3+ 4+ 5+

Address

City/Town

Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Residential Status Own Rent Live with Parents Other

Monthly Rent Payments

Years lived at Address

Occupation Type Manager Clerical Labourer/Tradesperson Retired Professional Self-Employed Other

Industry Sector Construction Government Health Education Hi-Tech Retail Sales Leisure/Entertainment Banking/Finance Transport Services Manufacturing Farming/Natural Resources Other

Name of Employer

Address

City/Town

Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Length of Employment

Years in Line of Business

Annual Income

Type of Income Salary/Hourly Commission Pension Alimony Other

Other Income Source

Other Income Amount

Notes for Applicant #1

Title Mr. Mrs. Miss. Ms. Dr. Rev.

First name

Last Name

Initial

Date of Birth

SIN #

Home Phone

Work Phone

Email Address

Marital Status Married Widowed Separated Divorced Single

Children 0 1+ 2+ 3+ 4+ 5+

Address

City/Town

Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Residential Status Own Rent Live with Parents Other

Monthly Rent Payments

Years lived at Address

Occupation Type Manager Clerical Labourer/Tradesperson Retired Professional Self-Employed Other

Industry Sector Construction Government Health Education Hi-Tech Retail Sales Leisure/Entertainment Banking/Finance Transport Services Manufacturing Farming/Natural Resources Other

Name of Employer

Address

City/Town

Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code

Length of Employment

Years in Line of Business

Annual Income

Type of Income Salary/Hourly Commission Pension Alimony Other

Other Income Source

Other Income Amount

Notes for Applicant #2

Note to Broker

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 such source is hereby authorized to provide you with such information. I/we also understand that the information given in the mortgage application form as well as other information you obtain in relation to my credit history may be disclosed to potential mortgage 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.

Online Applications

Please read the paragraph above prior to sending completed application. By transmitting the online mortgage application you are accepting the terms of the paragraph noted above.