On-line application form

Please complete the following mortgage application in as much detail as you can (required information has been highlighted), then click Submit to have it submitted to Andrea, your Mortgage Specialist. Andrea will review the information, then contact you to discuss your application, answer any questions you might have, and explain next steps.

Please note that you are about to voluntarily provide personal information. We are committed to protecting all the information you give us. For a full explanation of how we�ll treat this information, click here.
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) (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 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 Dominion Lending Centre. The words, "Dominion Lending Centre Specialist" means the independent mortgage broker to whom Dominion Lending Centre 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 Dominion Lending 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 Dominion Lending Centre Specialist as soon as possible. I understand that in submitting my application to my Dominion Lending 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 Dominion Lending 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 Dominion Lending 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 Dominion Lending 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 Dominion Lending 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 Dominion Lending Centre Specialist is an independently owned and operated Dominion Lending Centre franchisee of Dominion Lending Centre 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 Dominion Lending Centre Specialist and Dominion Lending Centre 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 Dominion Lending Centre Specialist and Dominion Lending Centre 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 Dominion Lending 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 Dominion Lending 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.

By clicking Submit, you Accept the terms of the Mortgage Application