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Personal Information

First Name	Last Name
Email
Address	How Long?
City	Postal Code
Res #	Bus #	Cell #
Previous Address (if less than 3 years as current)	City	How Long?
S.I.N.	Date of Birth (mm/dd/yy)
Current Employer	How Long?
Business Address	Business Telephone
Current Position
Are you... SalaryHourlyCommissionSelf Employed
If hourly, what is your hourly rate and number of guaranteed hours per week?
If Salary, what is your income?
Are you Full-time or Part-time
Previous Employer (If less than 3 years as current)	Business Address

Co-Applicant Information

First Name	Last Name
Email
Address	How Long?
City	Postal Code
Res #	Bus #	Cell #
Previous Address (if less than 3 years as current)	City	How Long?
S.I.N.	Date of Birth (mm/dd/yy)
Current Employer	How Long?
Business Address	Business Telephone
Current Position
Are you... SalaryHourlyCommissionSelf Employed
If hourly, what is your hourly rate and number of guaranteed hours per week?
If Salary, what is your income?
Are you Full-time or Part-time
Previous Employer (If less than 3 years as current)	Business Address

Income

What did you each earn in gross income last year?

Applicant

Co-Applicant

What will you each earn in gross income this year?

Applicant

Co-Applicant

Note: If commissioned or self employed, we average your last two years of earnings. Please forward copies of

your last two years Notice of Assessments from Revenue Canada.

Banking Information

Bank Name	Branch Location	Types of Accounts
		ChequingSavings
		ChequingSavings

List of Assets and Approximate Value

Cash	RSPs
Stocks	Bonds
GICs	House
Cottage	Boat(s)

Cars

Year	Make	Model

Any other assets not classified above? Such as a Gift to come from a relative?

Do you own your home? If yes, when was it purchased and for how much?

Please comment here as to what you intend to use for your down payment and how much. (If this is a house purchase)

What

Amount

Address of house to be purchased. (If a purchase)

Do you have a Real Estate Listing for this house? (If a new purchase)
YesNo

If yes, please forward a copy to this office

Liabilities

List approximate balance, payment amount, and name of company.

Credit Cards

Institution	Payment Amount	Balance

Loans

Institution	Payment Amount	Balance

Leases

Institution	Payment Amount	Balance

How much is your current rent?

Existing Mortgages

(Please note if you have more than one Mortgage, please attach a list with the property address and Mortgage information below)

Company Name	Outstanding Amount
Interest Rate	Property Tax Amounts
Current Payments	Maturity Date

By submitting this Electronic Application, I/we declare the above information to be a true and accurate representation of our financial position. I/we authorize Blackburn Financial Services Inc. operating as The Mortgage Professionals to obtain a Credit Report through Equifax Canada and I/we authorize you to exchange credit information and other information as required for the purpose of securing a Mortgage Commitment. Blackburn Financial Services Inc. is a registered Mortgage Broker (1954) through the Ontario Ministry of Financial Institutions.

Any additional comments or questions you may have please provide below:

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