Your Mortgage Centre Specialist:  Michael Wang - Mortgage Professionals Inc.
Phone: 905-889-9990 Fax:905-889-9199
The Mortgage Centre Administration
The Mortgage Centre - Apply For A Mortgage
To get lenders fighting for your business, please complete the following mortgage application in as much detail as you wish. In order to submit your mortgage application a minimum amount of information is required. For your convenience, this information has been highlighted on the application form. Once completed, your application is electronically forwarded to your local Mortgage Centre Specialist who contacts you for a personalized evaluation of your needs and he/she will explain the next steps in the mortgage application process. It's that simple!

Please note that you are about to voluntarily provide personal information to us. We are committed to protecting all of the information you give us. A full explanation of how we will treat this information is available through our website at http://www.mortgagecentres.net.

WHO REFERRED YOU TO THE MORTGAGE CENTRE?
Name of Company
 Representative
PURPOSE OF NEW MORTGAGE
Pre-Approval Purchase Refinance Consolidate Debt
WHO YOU ARE
Full Name Birth Date
yyyy-mm-dd		 S.I.N. Marital Status Dependents
Applicant  (required) (required)  
Co-Applicant
HOW TO CONTACT YOU
Home Phone Work Phone Fax Number Email Address
Applicant  (required) (required)   (required)
Co-Applicant
WHERE YOU LIVE - (3 Year History)
Street Address City, Province, PC, Country How Long (Yrs) Status
Present
Previous
Previous
WHERE YOU WORK - (3 Year History)
Employer Address Position How Long (Yrs) Income/Year
Applicant
$
$
Co-Applicant
$
$
YOUR NET WORTH
Assets Outstanding Debts
Description Value Description Balance Payment
Savings $ $ $
Checking $ $ $
Bonds $ $ $
R.R.S.P.'s $ $ $
Vehicle Type Loans
$ $ $
$ $ $
Life Insurance (csv) $ $ $
Other Asset $ $ $
Other Asset $ $ $
YOUR PRESENT HOME
LandLord/Mortgage Holder Monthly Payment Mortgage Balance Home Value
$ $ $
NEW PROPERTY INFORMATION
Property Address Property
Type		 Purchase
Price		 Down Payment /
Equity		 Closing Date
yyyy-mm-dd
$ $
 
LEGAL INFORMATION
Solicitor's Firm Solicitor's Name
Address City, Province, PC Phone Number Fax Number
BANKING INFORMATION
Institution Branch Type of Accounts
Currently a Co-Signer on another loan? Yes No 
Have you Declared Bankruptcy within the past 7 Years?Yes No 
Reason For Bankruptcy Amount Date Discharged
yyyy-mm-dd
$
ADDITIONAL COMMENTS REGARDING YOUR MORTGAGE APPLICATION
APPLICATION AUTHORIZATION
 The words "I", "me" and "my" mean the person who submits this application by clicking the "I Consent/Submit Application" button below. The word "you" means Mortgage Centre Canada. The words, "Mortgage Centre Specialist" means the independent mortgage broker to whom Mortgage Centre Canada will refer my application.

If I have included information in this application in respect of any other person, including a co-applicant, I hereby confirm that such other person(s) has fully authorized me to release their personal information to you and to my Mortgage Centre Specialist and that such other person(s) consent to all of the terms set-out herein. The word "Information" means personal information about me and any other person(s) identified in this application, obtained from this application or other sources.

I request that this application be submitted to my Mortgage Centre Specialist as soon as possible. I understand that in submitting my application to my Mortgage Centre Specialist, 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 you and my Mortgage Centre Specialist 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 Mortgage Centre Specialist 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, credit the Information by contacting such third parties.

I hereby consent to and agree that my Mortgage Centre Specialist may retain the Information after the last mortgage application made on my behalf, or the end of the term of the mortgage, whichever is later and that my Mortgage Centre Specialist may retain and use my personal information for the purposes listed above after the last mortgage application made on my behalf.

I hereby acknowledge that I have been advised that Mortgage Life/Creditor Insurance may be available to me through a lender, insurance company or broker and take sole responsibility to investigate and secure such coverage if desired.

I acknowledge that my Mortgage Centre Specialist is an independently owned and operated Mortgage Centre franchisee of Mortgage Centre Canada and that it is not acting as my agent. I, in consideration of the receipt of $1.00, agree to release and forever discharge my Mortgage Centre Specialist and Mortgage Centre Canada from any claim which I may have as a result of the loan not being advanced or from fluctuations in the market either before or after my application is submitted and to indemnify and save harmless my Mortgage Centre Specialist and Mortgage Centre Canada from any claim over relief by any party against whom I may make a claim, whether or not a mortgage commitment is supplied to me by a lender(s). I further acknowledge that my Mortgage Centre Specialist and you have no obligation to locate a lender and no responsibility or liability for any acts or omissions of any lender.

I hereby acknowledge that my Mortgage Centre Specialist and you may receive consideration from a lender, and that consideration may vary with the mortgage interest rate and mortgage terms accepted by me. Such consideration may include monetary fees, or goods and services having value to the recipient.

The parties hereto confirm that it is their wish that this Agreement, as well as all other documents relating hereto, including notices, have been and shall be drawn up in the English language only. Les parties aux presentes confirment leur volonte que cette convention, de meme que cette convention, de mem que tous les documents, y compris tout avis qui s'y rattache, soient rediges en langue anglaise.

I hereby certify that the information given in my application is complete and correct and is given for the purpose of obtaining the mortgage loan and/or financial services applied for.