Line of Credit and Mortgage Application

Purpose: $______________________ Amount: $_______________________

Primary Applicant
Name: __________________________ SIN: ______________ DOB: _______________
Address______________________________________________________________________________
Rent: $______________________ Own: $_____________________ Taxes: $_____________
Other: $_____________________ Years at Current Address: _______________________________
Home Phone #: _______________ Fax #: _________________ Mobile #: ___________________
Name of Employer: _____________________ Occupation: ____________________________________
Time at Present Employment: _________
Annual Gross Salary: $___________________
Work Phone #: _______________________ Income per Self-Employed Income: $___________
Work Fax #: _________________________ Matrix Other Income: $__________________

Spouse / Co-Applicant
Name: __________________________ SIN: ______________ DOB: _______________
Address______________________________________________________________________________
Rent: $______________________ Own: $_____________________ Taxes: $_____________
Other: $_____________________ Years at Current Address: _______________________________
Home Phone #: _______________ Fax #: _________________ Mobile #: ___________________
Name of Employer: _____________________ Occupation: ____________________________________
Time at Present Employment: _________
Annual Gross Salary: $___________________
Work Phone #: _______________________ Income per Self-Employed Income: $___________
Work Fax #: _________________________ Matrix Other Income: $__________________

Assets
Residence Registered Owners(s): _________________
Owned Vehicle(s):
Yr: __________ Make: ___________ Model: ___________
Yr: __________ Make: ___________ Model: ___________
Stocks / Bonds & Mutual Funds: ____________
RSP Investments: ________________________
Term Deposits or CSBs:___________________
Estimated Value: $________________
Estimated Value: $________________
Estimated Value: $________________
Estimated Value: $________________
Estimated Value: $________________
Estimated Value: $________________
Estimated Value: $________________

Bank Information
Name & Location
_____________________
_____________________
_____________________
Fax Number Account Type Balance
________________ ________________ _________________
________________ ________________ _________________
________________ ________________ ________________
Liabilities: Mortgage(s)
Holder Name / Address Balance Payments Matures
1. _____________________ _____________ _____________ __________
2. _____________________ _____________ _____________ __________
3. _____________________ _____________ _____________ __________

Liabilities: Loans / Credit Cards / Lines of Credit

Brand Vendor Limit Balance Monthly Payment
Mastercard

VISA

Amex
Other

Line of Credit

Loan(s)

Release and Disclaimer

Please read and sign: The Bank and Clarity Mortgage Inc. may obtain credit information about the
borrower and or the spouse from their employer, and any credit bureau of any of their dealings with
the bank. Each asset is shown at its present fair market value and I / we own all such assets.

I / we are not being sued and there are no judgments or executions against me/us. I/We certify that
the information is true and correct to the best of my / our knowledge.

____________________________________ ____________________________
Signature of Applicant Date

____________________________________ ____________________________
Signature of Spouse / Co-Applicant Date