Personal Information Applicant
Name and Last Name: *
Date of Birth (mm/dd/yyyy): *
Social Insurance Number (no spaces): *
Home Address: *
City: *
Postal Code: *
Contact Number: *
Current Employment Applicant
Employer: *
Occupation: *
Employer’s Address: *
Employer’s Tel. #  
Annual Income: *
Hourly, Salary, Self Employed:  
Assets Applicant
Down Payment: ($)  
Savings:  
RRSP:  
GIC:  
Credit Authorization

I/We undersigned, declare the information provided with respect to my/our mortgage application is a true & complete representation of my/our financial situation. I/We authorize THE MORTGAGE CENTRE / I direct MORTGAGES INC. to obtain a credit report & I/we authorize THE MORTGAGE CENTRE / I direct MORTGAGES INC. to exchange credit & other information as required for the purpose of securing a commitment for mortgage financing. THE MORTGAGE CENTRE CANADA / I direct MORTGAGES INC. confirms it is a registered Mortgage Broker through the Ontario Ministry of Financial Institutions.
Agency Agreement
I/We understand THE MORTGAGE / I direct MORTGAGES INC. a is prepared to work on my/our behalf as my/our agent & as such, I/we now appoint THE MORTGAGE CENTRE / I direct MORTGAGES INC. as my/our agent to secure this mortgage. I/We acknowledge and understand that THE MORTGAGE CENTRE / I direct MORTGAGES INC. may receive a finders fee from the lending institution for the placement of this mortgage and THE MORTGAGE CENTRE / I direct MORTGAGES INC. will furnish complete details of such fee, upon request.
Applicant Signature: Date: