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Mortgage Type(Required)

Number Of Applicants(Required)

Do You have an existing Property?(Required)

Do You have an Existing Mortgage?(Required)

Applicant 1 Information

Full Name(Required)

First Middle Last

Date of Birth(Required)

SIN Number (###-###-###)

Marital Status(Required)

No. of Dependents(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

How long have you lived here(Required)

Status(Required)

Savings and Investments(Required)

Applicant 1 Employment Information

Are you Self-Employed?(Required)

Current Employer(Required)

Employer Phone Number(Required)

Employer Address(Required)

Street Address Address Line 2 City Province Postal Code

How long have you worked here(Required)

Position/Title(Required)

Yearly income(Required)

Type of Income(Required)

Applicant 2 Information

Full Name(Required)

First Middle Last

Date of Birth(Required)

SIN Number (###-###-###)

Marital Status(Required)

No. of Dependents(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

How long have you lived here(Required)

Status(Required)

Savings and Investments(Required)

Applicant 2 Employment Information

Are you Self-Employed?(Required)

Current Employer(Required)

Employer Phone Number(Required)

Employer Address(Required)

Street Address Address Line 2 City Province Postal Code

How long have you worked here(Required)

Position/Title(Required)

Yearly income(Required)

Type of Income(Required)

Existing Property Details

Type of Property(Required)

Current Value(Required)

Yearly Property Taxes(Required)

Monthly Condo/Maintenance Fees(Required)

Are Property Taxes up to date?(Required)

Are Property Taxes included in your mortgage payments?(Required)

Existing First Mortgage

Lender(Required)

Current Balance(Required)

Payments(Required)

Payment Frequency(Required)

Interest Rate(Required)

When did current term begin(Required)

Renewal Date(Required)

Are payments up to date(Required)

Existing Second Mortgage

Lender(Required)

Current Balance(Required)

Payments(Required)

Payment Frequency(Required)

Interest Rate(Required)

When did current term begin(Required)

Renewal Date(Required)

Are payments up to date(Required)

How Did You Hear About Me?

Comments

Consent

Applicant 1 signature (typing acts as signature) *(Required)

First Last

Date(Required)

Applicant 2 signature (typing acts as signature)(Required)

First Last

Date(Required)

I/we confirm that the personal information provided by myself to Verico – Fair Mortgage Solutions Inc. is true and correct. I/we understand that this information is being used for the purposes of determining my/our credit history in order to arrange mortgage financing. I acknowledge that I have provided Verico – Fair Mortgage Solutions Inc. with my SIN and I/we authorize Verico – Fair Mortgage Solutions Inc. to obtain my personal and confidential information, including my credit bureau.

I/We acknowledge that the information provided to Verico – Fair Mortgage Solutions Inc., including my SIN and credit bureau, may be shared with other parties, such as lenders, mortgage insurers, or any other parties that require my personal information exclusively for the purposes of potentially financing my mortgage.

Applicant 1 Information

Applicant 1 Employment Information

Applicant 2 Information

Applicant 2 Employment Information

Existing Property Details

Existing First Mortgage

Existing Second Mortgage

How Did You Hear About Me?

Consent

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