PERSONAL CHOICE Mortgage Services Inc.
ON-LINE APPLICATION FOR MORTGAGE LOAN

Name of applicant(s) in full:     D.O.B.:     

S.I.N. #:  

Spouse:     D.O.B.:

S.I.N. #:

Present Address:     

City:     Province:     Postal Code:     

How long have you lived there? Years:    Months:     

Do you: Own    Rent    Rental Payment: $

Previous Address:     

City:     Province:     Postal Code:     

How long did you live there? Years:     Months:

Did you: Own    Rent    Rental Payment: $

Telephone #'s:     Residence:     Applicant's Business #:    

Co Applicant's Business #:

Dependants:     Martial Status:    

Ever been Bankrupt? No    Yes    If "Yes" in what year?

Current Employer:     

Address:

Position with company:     

Length of service:  Years:     Months:     Annual Salary: $    

Other Income: $

Previous Employment:     

Address:

Position held:     

Length of service:  Years:     Months:     Annual Salary: $   

Spouse's Employer:     

Address:

Position with company:     

Length of service:  Years:     Months:     Annual Salary: $    

Other Income: $

Spouse's Previous Employment:     

Address:

Position held:     

Length of service:  Years:     Months:     Annual Salary: $    

Banking Institution:

Address:

Banking Institution:

Address:

Law Firm:     

Address:

Lawyer:     Telephone #:     Fax #:

DETAILS OF MORTGAGE REQUIRED

Amount: $    Term of Mortgage:     

Amortization period:    Date funds Required:   

Purpose of Mortgage:

PARTICULARS OF SECURITY

Lot No(s):     Plan No.:     City, Borough, or Township:    

Bldg Occupied: / To be Occupied:     

Applicant: / Tenant:    

Location: (civic address)     

Lot Size: X     Date Property Acquired:    Purchase Price: $    

Down Payment: $    Present Value: $    Taxes: $

Type and Construction:     

Garage:     # of cars:     Carport:     Age of Bldg (in years):     

Type of Heating:     Sq. Ft. in Bldg:

Services: Full    Septic    Well       Basement:

Present Encumbrances

First Mortgage: $    Interest Rate: %    

Monthly Payment Due Date:

Held By:

Second Mortgage: $    Interest Rate: %    

Monthly Payment Due Date:

Held By:

Third Mortgage: $    Interest Rate: %    

Monthly Payment Due Date:

Held By:

Details of Rental Income:

APPLICANTS FINANCIAL STATEMENT
ASSETS VALUE

Cash in Bank:                                                                                 $

Stocks and Bonds                                                                          $

RRSP's                                                                                          $

Mutual Funds                                                                                 $

GIC's, Term Deposits                                                                     $

Real Estate (at market)                                                                   $

Life Insurance (CSV)                                                                     $

Personal Effects                                                                             $

Automobile(s):

Year: Make:                                  $

Year: Make:                                   $

Year: Make:                                   $

Year: Make:                                   $

OTHER ASSETS - please explain

                                  $

                                  $

                                  $

 

TOTAL ASSETS                                                                         $

 

Liabilities Outstanding Balance Monthly Payment
Bank / Finance Co.'s Loans                       $                            $

                                                                 $                            $

                                                                 $                            $

                                                                 $                            $

                                                                 $                            $

                                                                 $                            $


Mortgage(s)                                              $                            $

                                                                 $                            $

                                                                 $                            $

                                                                 $                            $


Other Liabilities                                         $                            $

                                                                 $                            $

                                                                 $                            $

                                                                 $                            $


TOTAL LIABILITIES                              $                            $

 

Total Assets                                                                                              $

Less Liabilities                                                                                           $

NET WORTH                                                                                          $



In connection with my application for credit, I hereby acknowledge that you may be procuring and may be referring to a consumer report respecting me and containing personal information and / or credit information and I hereby consent thereto and to the disclosure of such information to other credit grantors or consumer reporting agency.

With respect to this transaction it is understood and agreed that a placement fee or other fee may be paid to Personal Choice Mortgage, Services Inc. by a lender and if such is the case, the undersigned does hereby irrevocably authorize and direct such payment and further acknowledges that Personal Choice Mortgage Services Inc. shall be solely entitled to same, without credit or notification of same to the undersigned being required.

By submitting this application, I/we certify that the information given in this mortgage application is true and complete, and can be relied upon by Personal Choice Mortgage Services Inc. to determine my/our credit responsibility. I/We authorize you to obtain any information from any sources relative to this application and each such source is hereby authorized to provide you with such information. I/We further authorize you to disclose such information to any lender or credit bureau as you consider appropriate. I/We 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.