The document appears to be a mortgage application form requesting personal and financial information from borrowers. It requests details about the borrower and co-borrower's identity, contact information, employment, assets, debts, current address, and authorization to collect and use personal information. It also asks about the type of mortgage being applied for, including loan type, term, interest rate and payment frequency. Additionally, it requests documentation to support the application such as pay stubs, bank statements, proof of insurance and property tax assessments.

1. 0257*$*( Nadine Walsh
Mortgage Consultant Mortgage Application
nwalsh@mortgagealliance.com Please complete each section and sign your application
(709) 693-6865 for prompt and accurate processing.
$ / / , $ 1 & ( (709) 229-1358
Please Tell Us About Yourself
BORROWER C0-BORROWER
TITLE: FIRST NAME: LAST NAME: TITLE: FIRST NAME: LAST NAME:
RES PHONE: BUS PHONE: RES PHONE: BUS PHONE:
CELL/PAGER: EMAIL: CELL/PAGER: EMAIL:
BIRTH DATE: MONTH DAY YEAR BIRTH DATE: MONTH DAY YEAR
SOCIAL INSURANCE NO: SOCIAL INSURANCE NO:
MARITAL STATUS: RELATIONSHIP TO BORROWER:
Ì MARRIED Ì SINGLE Ì DIV./SEP. Ì NO. OF DEPENDENTS Ì MARRIED Ì INVESTOR
Ì COMMON-LAW Ì ENGAGED Ì WIDOWED (EXCLUDE SPOUSE) _____
HOW DID YOU HEAR ABOUT US? __________________________________ Ì COMMON-LAW Ì ENGAGED Ì OTHER
PRESENT ADDRESS: PRESENT ADDRESS:
UNIT #: YEARS AT RESIDENCE: UNIT #: YEARS AT RESIDENCE:
CITY: PROVINCE: POSTAL CODE: CITY: PROVINCE: POSTAL CODE:
DO YOU OWN OR RENT? CURRENT RENT DO YOU OWN OR RENT? CURRENT RENT
RENT Ì OWN Ì $ ____________ RENT Ì OWN Ì $ ____________
IF YOU HAVE LIVED HERE LESS THAN THREE YEARS, WHAT WAS YOUR PREVIOUS ADDRESS? IF YOU HAVE LIVED HERE LESS THAN THREE YEARS, WHAT WAS YOUR PREVIOUS ADDRESS?
PREVIOUS ADDRESS: PREVIOUS ADDRESS:
UNIT# YEARS AT THAT RESIDENCE: UNIT# YEARS AT THAT RESIDENCE:
CITY: PROVINCE: POSTAL CODE: CITY: PROVINCE: POSTAL CODE:
Our Mortgage Professionals have the knowledge and expertise to get you the Right Mortgage. With access to
over 40 lenders and coast-to-coast service, we can provide you with the choice, convenience, and counsel you
deserve. All at no cost to you on approved credit! When you use the Right Broker, you get the Right Mortgage.
Please pass on my name and number to at least one person you know - Thank you!
Choice, Convenience and Counsel
Corporate Office: 200, 2005 Sheppard Ave E, Toronto ON, M2J 5B4 Phone: 1-877-366-3487

2. Tell Us About Your Employment
BORROWER C0-BORROWER
E
M CURRENT EMPLOYER: __________________________________________________ CURRENT EMPLOYER: ________________________________________________
ADDRESS / DEPARTMENT: ______________________________________________ ADDRESS / DEPARTMENT: ____________________________________________
P CITY / PROVINCE: ______________________________________________________ CITY / PROVINCE: ____________________________________________________
L JOB TITLE / POSITION: __________________________________________________ JOB TITLE / POSITION: ________________________________________________
O YEARS THERE: ______ FULLTIME ________ PART TIME ______ SEASONAL ______ YEARS THERE: ______ FULLTIME ________ PART TIME ______ SEASONAL____
HOW MANY YEARS IN THIS LINE OF BUSINESS? ____________________________ HOW MANY YEARS IN THIS LINE OF BUSINESS? __________________________
Y GROSS ANNUAL INCOME (BEFORE TAXES): ________________________________ GROSS ANNUAL INCOME (BEFORE TAXES): ______________________________
M DO YOU COLLECT / EARN OTHER INCOME? DETAILS:______________________ DID YOU COLLECT / EARN OTHER INCOME? DETAILS: ____________________
E
IF LESS THAN THREE YEARS, WHERE DID YOU WORK PREVIOUSLY? IF LESS THAN THREE YEARS, WHERE DID YOU WORK PREVIOUSLY?
N PREVIOUS EMPLOYER: __________________________________________________ PREVIOUS EMPLOYER: ________________________________________________
T GROSS ANNUAL INCOME:________________________________________________ GROSS ANNUAL INCOME: ______________________________________________
JOB TITLE / POSITION: __________________________ YEARS THERE: ________ JOB TITLE / POSITION: ________________________ YEARS THERE: ________
F Tell Us About Your Finances
I ASSETS (MARKET VALUE) LIABILITIES FINANCIAL PAYMENT/MO. TOTAL DEBT
INSTITUTION
N PRINCIPAL RESIDENCE ____________________ CURRENT MORTGAGE ______________________ ______________________ ____________________
A CASH / SAVINGS ____________________ PERSONAL LOANS ______________________ ______________________ ____________________
N STOCKS / BONDS ____________________ LINE OF CREDIT ______________________ ______________________ ____________________
C AUTO (YR., MAKE, MODEL) ____________________ CAR PAYMENT ______________________ ______________________ ____________________
I AUTO (YR., MAKE, MODEL) ____________________ CAR PAYMENT ______________________ ______________________ ____________________
RRSP’S (AMT. & INSTITUTION) ____________________ RRSP LOAN ______________________ ______________________ ____________________
A OTHER REAL ESTATE ____________________ OTHER MORTGAGE ______________________ ______________________ ____________________
L PERSONAL EFFECTS ____________________ CREDIT CARDS ______________________ ______________________ ____________________
We Need Your Authorization
S
I Consent to collect and use personal information
G 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. You are authorized to obtain any
N information you may require relative to this application from any sources to which you may apply and each such
source is hereby authorized to provide you with such information. You are furthermore authorized to disclose, in
A response to direct enquiries from any other lender or credit bureau, such information on my loaning account as
you consider appropriate, and I agree to indemnify you against and save you harm from any and all claims in
T 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.
U
R
___________________________________________________________________________________________
E Date Applicant's Signature Co-applicant's signature
Corporate Office: 200, 2005 Sheppard Ave E, Toronto ON, M2J 5B4 Phone: 1-877-366-3487

3. If you know the details and type of mortgage
you are looking for please tell us ...
M
Loan Type: Term Requested: Interest Rate:
T
%
Ì First Mortgage Ì (6 months to 25 years)
Ì Second Mortgage Ì Closed Ì Open
Purpose of Mortgage Funds Ì Fixed Rate Ì Variable Rate G
Ì Purchase of new property Ì Cash Back Ì Free Down Payment
Amortization: ____________ (5 to 25 years)
Property Taxes:
Ì Renewal/Switch of existing mortgage
NOTE: If Renewal/Switch, the remaining Ì Include with mortgage payment
Ì Debt Consolidation
amortization on your existing mortgage will Ì Paid directly by borrower T
Ì Equity Takeout/Investment be used.
Most lenders insist that property taxes be
House Ì Townhouse Ì Condo Ì Payment Frequency: included with your mortgage payment if the
Y
Ì Weekly Ì Monthly mortgage is high-ratio insured.
Year Purchased________________________ Ì Bi-Weekly Ì Semi-Monthly P
(26 payments/year) (24 payments/year)
Purchase Price ________________________ Ì Accelerated
E
We’re Listening
With regards to your financing, please tell us anything that is important to you so we can serve you better.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Are you working with any other real estate professionals? (e.g. realtor, lawyer) If so, please provide their contact information. If not, we would be
M
happy to offer any recommendations to people we have used in the past.
T
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________ G
Do you know anyone else interested in a mortgage? Please provide us with their contact information.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________ I
Please gather the following documents to help us get you the best mortgage possible.
Employment Letter Current Pay Stub Bank/RRSP Statements NOA N
H.O. Insurance Prop Tax Assess. Prop Tax Receipt Mortgage Statement
F
O
Tell us about your property
Building Type ____________________________ # of Bedrooms ____________________________ # of Fireplaces __________________________
Water Supply ____________________________ Basement ________________________________ MLS # __________________________________
Sewer Type ____________________________ Square Footage____________________________ Property Taxes __________________________
Year Built ______________________________ # of Bathrooms____________________________ Strata Fees ______________________________
P
If you own rental properties, please provide us with details R
MONTHLY INCOME MONTHLY INCOME
O
Address: ____________________________________________
Gross Income ________________ Mortgage Payment ________ P
Ì Condo Ì Townhouse Ì House
Can you provide a residential Property Taxes ________ E
Purchase Price & Date: ________________________________ tenancy agreement to verify Insurance ________
your property’s rental income?
Current Value: ________________________________________ Utilities ________
R
Ì Yes Ì No
Can you provide a mortgage
Mortgage Balance: ____________________________________
Can you provide a recent property
statement to verify your
T
tax assessment or property
property’s mortgage balance
Maturity Date:________________ Interest Rate: __________
appraisal to verify your
property’s value? and payment amount?
Y
Financial Institution: __________________________________ Ì Yes Ì No Ì Yes Ì No
Corporate Office: 200, 2005 Sheppard Ave E, Toronto ON, M2J 5B4 Phone: 1-877-366-3487