Please fill out this form and fax to 1-866-314-1583 (toll free) for Danelle Poitra.
If you don’t have access to a fax machine call for a pick up or drop off time and location.

 PERSONAL                                                                                                                   

First Name:____________________ Initial:_________ Last Name:________________
 
SIN:________-_______-_______    Birth Date: MM______ DD_____ YYYY_______
 
Dependants:_____  Marital Status: (Married/Single/Divorced/Separated/Widowed/Common Law)
 
Address: ______________________________________________________________
 
_____________________________________________________________________
 
Length of time at current address: Years______________ Months_________________
 
Residential Status: (own/rent/live with parents/other)   Rent (if applicable): $_______________
 
Res.Phone:________________________  E-mail:______________________________
 
Previous Address (if less than 3 years @ current):__________________________________
 
_____________________________________________________________________
 
Length of time at previous address: Years__________   Residential Status:___________
 
Current Employer:_______________________________________________________
 
Address:______________________________________________________________
 
Bus. Phone #:______________________________________Ext:__________________
 
Number of Years: __________________     Years in current line of bus.: ____________
 
Occupation:__________________________ Gross annual income: $________________
 
Previous Employer        Address                     Occupation               Years      Income
 
_________________   ________________   ________________   _____  $_________
 
_________________   ________________   ________________   _____  $_________
 

 CO-BORROWER                                                                                                            

Coborrower First Name:________________ Initial:_____ Last Name:_______________
 
Dependants:_____ Marital Status: (Married/Single/Divorced/Separated/Widowed/Common Law)
 
SIN:________-_______-_______   Birth Date: MM______ DD_____ YYYY ______
 
Address:________________________________________________________________
 
_______________________________________________________________________
 
Length of time at current address: Years_____ Months_____ Res. Phone____________
 
Relationship to Applicant_________________ Email Address_____________________
 
Current Employer:________________________________________________________
 
Address:________________________________________________________________
 
Bus. Phone #:______________________________________Ext:___________________
 
Number of Years: __________________  Years in current line of bus.:_____________
 
Occupation:__________________________ Gross annual income:$________________
 
Previous Employer       Address                   Occupation              Years     Income
 
_________________   ________________   ________________   _____  $_________
 
_________________   ________________   ________________   _____  $_________
 
Other Income Source - Either Party Amount
 
___________________________________________________ $_______________
 
___________________________________________________ $_______________
 

 FINANCIAL NET WORTH                                                                                           

Assets                                                 

Bank Account      ______________________________      $_______________ 
 
                             ______________________________      $_______________                       
 
Real Estate           ______________________________      $_______________  
 
Automobile           ______________________________      $_______________ 
 
Other Assets         ______________________________      $_______________
 
                             ______________________________      $_______________

Liabilities            Financial Institution                          Balance            Monthly Payment

Bank Loans    ________________________     $______________  $_____________
 
                       ________________________     $______________  $_____________ 
 
Mortgages      ________________________     $______________  $ _____________
 
Credit Cards  _________________________    $______________  $_____________
 
                      _________________________    $______________  $_____________
 
                      _________________________    $______________  $_____________
 
Other Loans   _________________________    $______________  $_____________
 
                      _________________________    $______________  $_____________

 
The sum of $___________________________________ is available for a down payment
 
Source of down payment: _________________________________________________
 

 ADDITIONAL INFORMATION                                                                                   

I/We require a: 1^st mortgage / 2ndmortgage / mortgage renewal / other________________
 
Price Range: $___________________________ to $____________________________
 
Mortgage Type:  Closed Term / Open Term / Convertible Term   
 
Rate Type:  Fixed / Variable   
 
Amortization:  15 / 20 / 25 / 30    Term:  1 / 2 / 3 / 4 / 5 / 7 / 10

 COMMENTS                                                                                                                     
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________

 CLIENT CONSENTS                                                                                                          

I understand that in submitting my application to my TMG Mortgage Agent, I am hereby expressly consenting
to the submission of my application and the disclosure of Information to third parties, such as lenders and
insurers, for the purpose of arranging and/or renewing mortgage(s). I understand that this will allow lenders to
submit commitments for my review.

I hereby consent to and agree that my TMG Mortgage Agent may use the Information in order to identify me,
protect me from fraud and error, understand my needs and eligibility for products and/or services, recommend
particular products and services to meet my needs, provide ongoing services, and comply with legal and
regulatory requirements.

I consent to and agree that my TMG Mortgage Agent may use the information for the above-noted purposes
and may obtain Information about me from others, including consumer reporting agencies, credit bureaus,
financial institutions, and real estate appraisers and may confirm the accuracy of the Information by contacting
such third parties. I further consent to and agree that each lender considering my application may obtain
information about me (and all co-applicants) from others, including consumer reporting agencies, and credit the
Information by contacting such third parties.

I also consent to and agree that my independent mortgage agent can retain and use our personal contact
information for these purposes for seven years after the last loan/mortgage application made on our behalf.

I certify that the information provided is true and accurate, that all my debts are current and in good standing,
that I have no outstanding judgments, and that I have not declared bankruptcy in the last 6 years. I acknowledge
that you may be receiving a finder's fee from a lender in respect of arranging a mortgage/loan and I hereby waive
any right to deny or dispute your receiving said fee. I also acknowledge that the evaluation, inspection and legal
expenses incidental to this application will be paid by me/us.

I will not make any claims against you for any failure to obtain a loan / mortgage commitment, or for any actions
or omissions to act by any lender.

In consideration of your acting for me, I agree to the terms and provisions listed in this Privacy
Protection and Client Consent.

Applicant_________________________________ Date________________________

Co-applicant______________________________ Date________________________

Other information that will be required before formal approval can be obtained
(not necessary for first consultation):


• Copy of Drivers Licence and S.I.N.
• Offer to Purchase/Construction Contract
• Confirmation of Down Payment / Gift Letter
• Satisfactory employment letter on company letterhead confirming position, gross income and
  length of employment (with no probation)
• Up to 3 years of past NOA's showing no outstanding taxes and current year to date payslip
  (unless using no proof of income product)
• Statement of Investments (Bank Account, Stocks, Bonds, RSP's)
• Lawyers Name, Phone Number, Fax Number, Full Address
• Realtors Name, Phone Number, Fax Number as well as MLS listing or feature sheet