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    Please complete the form below and then click submit.
    Canadian Residents Only

    If the application is in joint names please provide information for both. This form can be printed and sent to me by fax at (613) 384-4047 or simply fill it out and click the submit button at the bottom of the page.

    Personal Information:

    Please enter Agent's Name
    MrMs

    First Name: (*)
    Address: (*)
    How Long at current address?

    Last Name: (*)
    City: (*)

    Phone # (*)
    Previous Address:
    S.I.N #

    Business #
    Previous City:
    Date of Birth - Month/Day/Year


    Marital Status:

    Current Employer:

    How Long?

    Business Address:
    Current Position:
    Are you on:

    If hourly, what is your hourly rate:

    Number of hours per week:

    If Salary, what is your income:
    Are you Full-time or Part-time?

    Previous Employer:

    Previous Employer Address:

    Co-Applicant Information:

    MrMs

    First Name:
    Address:
    How Long at current address? (*)

    Last Name:
    City:

    Phone #:
    Previous Address:
    S.I.N #

    Business #:
    Previous City:
    Date of Birth - Month/Day/Year


    Marital Status:

    Current Employer:

    How Long?:

    Business Address:
    Current Position:
    Are you on:

    If hourly, what is your hourly rate:

    Number of hours per week:

    If Salary, what is your income:
    Are you Full-time or Part-time?

    Previous Employer:

    Previous Employer Address:

    Income:

    What did you each earn in gross income last year?

    Applicant:

    Co-Applicant:

    What will you each earn in gross income this year?

    Applicant:

    Co-Applicant:

    Note: If commission or self employed, we average your last three years of earnings. Please forward copies of your last three years Notice of Assessments from Revenue Canada.

    Banking Information:

    Bank Name:
    Bank Name:

    Branch Location:
    Branch Location:

    List of Assets and Approximate Value:

    What will you each earn in gross income this year?

    Cash:
    Stocks:
    GICs:
    Cottage:

    RSPs:
    Bonds:
    House:
    Boat(s):

    Cars

    Year:

    Make:

    Any other assets not classified above? Such as a Gift to come from a relative?

    Do you own your home? If yes, when was it purchased and for how much?

    What is the approximate value of your current home?

    Please comment here as to what you intend to use for down payment and how much. (If this is a house purchase)

    What:

    Amount:

    Address of house to be purchased. (If a purchase)

    Do you have a Real Estate Listing for this house? (If a new purchase)

    If yes, please forward a copy to this office.

    Liabilities:

    Credit Cards:

    Institution


    Payment Amount:


    Loans:

    Institution


    Payment Amount:


    Leases:

    Institution


    Payment Amount:


    How much is your current rent?

    Do you pay or receive child support? If yes, what do you pay/receive monthly?

    Existing Mortgages:

    Company Name:
    Current Payments:

    Outstanding Amount:
    Maturity Date:

    By submitting this Electronic Application, I/we declare the above information to be a true and accurate representation of our financial position. I/we authorize Blackburn Financial Services Inc. operating as The Mortgage Professionals to obtain a Credit Report through Equifax Canada and I/we authorize you to exchange credit information and other information as required for the purpose of securing a Mortgage Commitment. Blackburn Financial Services Inc. is a registered Mortgage Broker (1954) through the Ontario Ministry of Financial Institutions.

    Please enter any additional comments or questions you may have: