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Please PRINT this form, complete and fax it to Kingsway Investments Ltd.at 905.815.8600.
APPLICATION FOR MORTGAGE
| Mortgage Consultant: | |
| Applicant: | Date of Birth: |
| Address: | S.I.N. |
| City: | Home Phone: |
| Province, Postal Code: | Bus. Phone: |
| Employer: | Position: |
| Address: | Years Employed: |
| City: | Annual Income: |
| Previous Employer: | Years Employed: |
| E-mail: | |
| Co-Applicant: | Date of Birth: |
| S.I.N. | |
| Employer: | Bus. Phone: |
| Address: | Position: |
| City: | Years Employed: |
| Annual Income: | |
| Previous Employer: | Years Employed: |
| FINANCING REQUIRED: | $ |
| Property Address:
|
|
| Purchase / Refinance (circle one) | 1st / 2nd (circle one) |
| Purchase Price: $ | Value of Property:$ |
| Down Payment: $ | Existing Mortgage:$ |
| Bank: | Branch: |
Please complete Financial Statement on next page.
FINANCIAL STATEMENT
| ASSETS | LIABILITIES | Details |
Amount |
Payment |
|
| Cash | $ | Mortgage | $ | $ | |
| Stocks / Bonds | $ | Mortgage | $ | $ | |
| Deposit | $ | Loan | $ | $ | |
| Real Estate | $ | Loan | $ | $ | |
| Auto | $ | Other | $ | $ | |
| RSP | $ | Credit Cards | $ | $ | |
| Other Assets | Other Liabilities | ||||
| $ | $ | $ | |||
| $ | $ | $ | |||
| $ | $ | $ | |||
| TOTAL ASSETS | $ | TOTAL LIABILITIES | $ | ||
| NET WORTH | $ |
I / We hereby certify that the statements above are accurate. I / We hereby authorize Kingsway Investments Ltd. to do any credit investigation as required for this transaction.
| Date: | Signature: |
| Date: | Signature: |