APPLICANT

 

NAME

 

BIRTHDATE

 

SIN

 

OWN/RENT

 

ADDRESS

 

CITY

 

POSTAL CODE

 

HOW LONG?

 

HOME TELEPHONE:

(     )

BUSINESS TELEPHONE:

(     )

EMPLOYER

 

OCCUPATION

 

HOW LONG?

 

ANNUAL INCOME

 

 

EMPLOYER IF LESS THAN 3 YEARS

 

EMPLOYER

 

OCCUPATION

 

HOW LONG?

 

ANNUAL INCOME

 

 

CO-APPLICANT

NAME

 

BIRTHDATE

 

SIN

 

OWN/RENT

 

ADDRESS

 

CITY

 

POSTAL CODE

 

HOW LONG?

 

HOME TELEPHONE:

(     )

BUSINESS TELEPHONE:

(     )

EMPLOYER

 

OCCUPATION

 

HOW LONG?

 

ANNUAL INCOME

 

 

EMPLOYER IF LESS THAN 3 YEARS

 

EMPLOYER

 

OCCUPATION

 

HOW LONG?

 

ANNUAL INCOME

 

 

NET WORTH STATEMENT

ASSETS

 

 

 

LIABILITIES

 

BALANCE

MTHLY PMT

CASH IN BANK

$

 

BANK LOANS

$

$

REAL ESTATE

$

 

MTGS

$

$

MF/STOCK/BOND

$

 

CREDIT CARDS

$

$

RRSP'S

$

 

CREDIT CARDS

$

$

AUTOMOBILE

$

 

OTHER LOANS

$

$

YR

 

MAKE

 

 

LINE OF CREDIT

$

$

OTHER ASSETS

$

 

 

 

 

TOTAL ASSETS

$

 

TOTAL LIABILITIES

$

PROPERTY INFORMATION

CLOSING DATE

 

MORTGAGE AMOUNT REQUIRED

ADDRESS OF PROPERTY

 

 

$

CITY

 

PROVINCE

 

POSTAL CODE

 

 

LEGAL DESCRIPTION

 

 

PURCHASE PRICE

$

 

DOWN PAYMENT

$

 

LAWYER INFORMATION:

NAME

 

TEL:

(     )

REFERRED BY:

 

 

 

I CERTIFY THE INFORMATION AND THE ABOVE STATEMENT OF MY PROPERTY AND DEBTS IS TRUE.  I DECLARE THAT NEITHER MY SPOUSE NOR ANY OTHER PERSON HAS ANY CLAIM IN OR TO THE ASSETS SHOWN ABOVE EXCEPT AS SET OUT HEREIN.  THE WHOLE OF MY PROPERTY IS SHOWN AT FAIR VALUATION.  I AM NOT BEING SUED AND THERE ARE NO EXECUTIONS AGAINST ME NEITHER DO I OWE ANYTHING TO ANY OTHER INSTITUTION EXCEPT AS REPORTED ABOVE.

 

CONSENT:  I/WE AUTHORIZE, MAIN ST. MORTGAGE BROKERS LTD. TO OBTAIN SUCH FACTUAL AND INVESTIGATIVE INFORMATION REGARDING ME/US FROM OTHERS AS PERMITTED BY LAW.

 

APPLICANT SIGNATURE

 

CO-APPLICANT SIGNATURE

 

WITNESS

 

DATE