Mortgage Application Form for Home Purchase - Valueland ...

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|[pic] |Tel: 416-238-2698 |Valueland Mortgages |

| |Toll Free: 1-877-479-9998 |7800 Woodbine Ave., Suite 202 Markham, ON. |

| |Fax: 1-877-479-9968 (Toll Free) |L3R 2N7 |

| |AskUs@valueland.ca | |

| | | |

|Personal Information |Applicant |Co-Applicant |

|Salutation (Mr./Ms/Miss): | | |

|First Name | | |

|Family Name | | |

|S.I.N. # | | |

|Date of Birth | | |

|Marital Status | | |

|Home Address | | |

|City and Postal Code | | |

|Ownership Status (pick one) |Owned | |

|Home Phone | | |

|Cell Phone | | |

|Previous Home Address | | |

|Email | | |

|Employer (Company) | | |

|Position (Job Title) | | |

|Annual Income | | |

|Employer Address | | |

|City & Postal Code | | |

|Work Phone | | |

|Years with this company | | |

|Previous Employer (If current employment is | | |

|less than 3 years) | | |

|Previous Position & Annual Salary | | |

|Years with this company | | |

|Number of Dependants | |Referrer/Agent: | |

Financial Information:

|Assets |Financial |Amount $ |Liabilities |Balance |Monthly Payment |

|(what you have) |Institution | |(What you owe) | | |

| | | | | | |

|Cash in Bank ($) |  |  |Bank Loans ($) |  |  |

|RRSP ($) |  |  |Credit Cards ($) |  |  |

|Other ($) |  |  |Car loan/lease |  |  |

Properties you have:

|Property Address |Rental / Owner |

| |Occupied |

|Down Payment | |

|Mortgage Amt ($) | |

|Source of Down Payments: (a) own savings; (b) gift; (c) own savings and gift; (d) sale of an existing property |

| |

|Disclosure Statements from Valueland Mortgages: |

| |

|Valueland’s relationship with me/us the Applicants: Valueland Mortgages or its broker/agent/associates/sub-broker is acting as an intermediary |

|between the applicant(s) and the lender(s) who have authorized Valueland to offer their mortgage products to borrowers. Valueland offers many |

|mortgage products from multiple lenders. |

| |

|Broker/Brokerage Compensation: Valueland Mortgages is primarily compensated by way of commission/income or fee paid by mortgage lenders. The |

|brokerage may also receive other non-monetary benefits from lenders. In cases of a fee to be paid by the borrower/applicant(s), a fee disclosure |

|shall be given to me/us prior to my/our commitment of the mortgage. |

| |

|Consent from Applicant(s): |

| |

|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 and to evaluate and respond to my/our request for mortgage financing. You, Valueland, are authorized to obtain|

|any information you may require for these purposes from other sources (including, for example, credit bureaux) and each source is hereby authorized |

|to provide you with such information. I/we also understand, acknowledge and agree 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, mortgage insurers, other service |

|providers, 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. I/we acknowledge that I/we have reviewed and understand Valueland’s disclosure statements. |

| |

|I/we further acknowledge and agree that each potential mortgage lender, mortgage insurer or service provider to whom you provide the mortgage |

|application and/or my/our personal information is permitted to receive such application and information and maintain records in relation to me/us and|

|my/our mortgage application and to hold, use, communicate and disclose personal information about me/us, including my/our social insurance number |

|(SIN) if I/we provide it, and collect personal information from me/us, you and from third persons, including credit bureaux, credit reporting and |

|collection agencies, financial institutions, my/our past and present employers, creditors and landlords, my/our spouse or any other person who has |

|information about me/us for the purposes of recording, evaluating and responding to my/our application for mortgage financing or related activities |

|and I/we specifically consent to the release and disclosure of personal information by such persons to and among you and each potential mortgage |

|lender, mortgage insurer or other service provider. I/we authorize the application through electronic transmission. |

| |

|By checking this box, I/we authorize Valueland Mortgages and its agents/brokers to send electronic communications through email addresses I/we have |

|provided. I/we have the right to withdraw the consent at any given time. |

| |

| |

|Applicant Signature: _______________ Co-Applicant Signature: _______________ Date: _____________ |

Documents Required: (1) Copy of Photo ID (e.g., Driver’s License). (2) One recent paystubs for all applicants

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