Confidential Questionnaire
Please print the form, fill out and fax to 250-390-9277.
I
If you have questions on how to fill out the form, enter them in the notes section below. Please fill
out completely. Fields marked with * are required.
|
PERSONAL INFORMATION |
|||
| Consultant | Date | ||
| *Applicant | Co-Applicant | ||
| *Address (street) | Address (street) | ||
| *City | City | ||
| *Province | Province | ||
| *Postal Code | Postal Code | ||
| *SIN | SIN | ||
| *Date of birth | Date of birth | ||
| *Phone (home) | Phone (home) | ||
| Phone (work) | Phone (work) | ||
| Fax Number | Fax Number | ||
| *E-mail address | E-mail address | ||
| Occupation | Occupation | ||
| Employer | Employer | ||
| How long employed | How long employed | ||
| *Is this your residence? |
|
Is this your residence? | Yes No |
| *Is this a revenue property? |
|
Is this a revenue property? | Yes No |
| *Annual Income (gross) | Annual Income (gross) | ||
| Other Income (gross) | Other Income (gross) | ||
| Rental Income (gross) | Rental Income (gross) | ||
| PROPERTY INFORMATION | |||
| Date of home purchase | *Purchase price of home |
|
|
| *Mtg. Balance at purchase | *Open or closed mortgage |
Open Closed |
|
| *Market value of property | *Property taxes annual | ||
| Note: Please enter Principal and Interest (P&I) payment only - not PIT (principal, interest, taxes) | |||
| *1st Mortgage Payment P&I |
|
*Taxes incl. in payment? | Yes No |
| *Payment Frequency | Please select one | *Insurance incl. in payment? | Yes No |
| Important: Be certain that (yes) appears in the correct boxes above, (no) must appear in all non-applicable boxes. | |||
| Taxes and insurance should not be entered as part of the mortgage Principal & Interest payment above! | |||
| *1st mortgage balance | 2nd mortgage balance | ||
| *Interest rate | Interest rate 2nd | ||
| *Original amortization | 2nd Original amortization | ||
| *Years left to pay mtg. | 2nd Years left to pay | ||
| Renewal Date | 2nd mortgage payment | ||
| *Lender 1st mortgage | Lender 2nd mortgage | ||
| Mortgage acct. # (1st) | Mortgage acct. # (2nd) | ||
| *Penalty 1st mortgage | Penalty 2nd mortgage | ||
| LIABILITIES - DEBTS | |||
| Lender/Type of debt | Mo. Payment | Balance | Interest rate |
|
Lines of credit - enter below (if more than two, enter under Lender / Type of debt above) |
|||
| *Cash Flow Requested? | Yes No | Cash flow amount? | |
| *Mtg. payment holiday? | Yes No | For how long? | |
| *Lump sum requested? | Yes No | Lump sum amount? | |
| CREDIT AND SUPPLEMENTARY PERSONAL INFORMATION | |||
| Enter individual applicable answers under each name |
Applicant |
Enter individual applicable answers under each name |
Co-Applicant |
| *Credit rating description: | Credit rating description: | ||
| *Marital status: | Marital status: | ||
| Number of Dependants residing in your domicile | Number of Dependants residing in your domicile | ||
| *Ever been bankrupt ? |
Yes No |
Ever been bankrupt ? |
Yes No |
| If yes, when & discharge date | If yes, when & discharge date | ||
| Purpose of the Lump Sum |
|
||
| PREVIOUS EMPLOYMENT & ADDRESS DETAILS | |||
| If either applicant has been on present job less than 3 years, enter previous job details below: | |||
| Applicant - employer, location, number of years | Co-Applicant - employer, location, number of years | ||
| Income previous employer |
|
Income previous employer | |
| How long residing at present address? (Years) | How long residing at present address? (Years) | ||
| Less than 3 years, give full previous address | Less than 3 years, give full previous address | ||
| PROPERTY DETAILS | |||
| Date re-financed since purchase | Re-financed amount | ||
| *Mortgage payments up to date? | Yes No | *Any liens / judgements? | Yes No |
| PERSONAL PRIORITIES | |||
| *Paying Mtg.: - 1st or 2nd priority? | 1st 2nd | *Debt relief: 1st or 2nd priority? | 1st 2nd |
| PROPERTY PARTICULARS | |||
| Year property was built | Construction | ||
| *Detached home | Yes No | *Semi-detached home | Yes No |
| Lot size: dimensions in feet | Home size: square footage | ||
| Number of Stories | Type of heating | ||
| Total rooms in house (all rooms) | *Owner occupied ( yes or no) | Yes No | |
| Number of bedrooms | Number of bathrooms | ||
| Finished basement | Family room | ||
| Garage (Attached or Detached?) | Garage for how many cars? | ||
| Town House or Condo | Condo fees (monthly) | ||
| Number of fireplaces | Additions made since purchase | ||
| Multi-unit or Apt. building. | No. units / apartments | ||
| Description of property | *Swimming pool | Yes No | |
| Address mortgaged property | |||
| *Mortgage previously CMHC insured? |
Yes No |
If yes, provide CMHC reference number | |
| *Is this a rural property? | Yes No | Well & Septic or Serviced? | |
| Type asset | Value of asset | Maturity date if any | Comment on assets |
| Bank Accounts | |||
| Savings accounts | |||
| RRSP's | |||
| RRSP's | |||
| Term deposits | |||
| Equity funds | |||
| Savings bonds | |||
| Furniture | |||
| Auto (yr/make/Model) | |||
| Auto (yr/make/Model) | |||
| Please add any comments in the NOTES section. (An incomplete questionnaire cannot be processed!) | |||
How did you hear about us?
