License # 10464

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January 1

Ontario

Ontario Ontario

Ontario

January 1

Mr. Mr.

Tell Us About Your EmploymentBORROWER C0-BORROWER

CURRENT EMPLOYER: __________________________________________________ CURRENT EMPLOYER: ________________________________________________

ADDRESS / DEPARTMENT: ______________________________________________ ADDRESS / DEPARTMENT: ____________________________________________

CITY / PROVINCE: ______________________________________________________ CITY / PROVINCE: ____________________________________________________

JOB TITLE / POSITION: __________________________________________________ JOB TITLE / POSITION: ________________________________________________

YEARS THERE: ______ FULLTIME ________ PART TIME ______ SEASONAL ______ YEARS THERE: ______ FULLTIME ________ PART TIME ______ SEASONAL____

HOW MANY YEARS IN THIS LINE OF BUSINESS? ____________________________ HOW MANY YEARS IN THIS LINE OF BUSINESS? __________________________

GROSS ANNUAL INCOME (BEFORE TAXES): ________________________________ GROSS ANNUAL INCOME (BEFORE TAXES): ______________________________

DO YOU COLLECT / EARN OTHER INCOME? DETAILS:______________________ DID YOU COLLECT / EARN OTHER INCOME? DETAILS: ____________________

IF LESS THAN THREE YEARS, WHERE DID YOU WORK PREVIOUSLY? IF LESS THAN THREE YEARS, WHERE DID YOU WORK PREVIOUSLY?

PREVIOUS EMPLOYER: __________________________________________________ PREVIOUS EMPLOYER: ________________________________________________

GROSS ANNUAL INCOME:________________________________________________ GROSS ANNUAL INCOME: ______________________________________________

JOB TITLE / POSITION: __________________________ YEARS THERE: ________ JOB TITLE / POSITION: ________________________ YEARS THERE: ________

Tell Us About Your FinancesASSETS (MARKET VALUE) LIABILITIES FINANCIAL PAYMENT/MO. TOTAL DEBT

INSTITUTION

PRINCIPAL RESIDENCE ____________________ CURRENT MORTGAGE ______________________ ______________________ ____________________

CASH / SAVINGS ____________________ PERSONAL LOANS ______________________ ______________________ ____________________

STOCKS / BONDS ____________________ LINE OF CREDIT ______________________ ______________________ ____________________

AUTO (YR., MAKE, MODEL) ____________________ CAR PAYMENT ______________________ ______________________ ____________________

AUTO (YR., MAKE, MODEL) ____________________ CAR PAYMENT ______________________ ______________________ ____________________

RRSP’S (AMT. & INSTITUTION) ____________________ RRSP LOAN ______________________ ______________________ ____________________

OTHER REAL ESTATE ____________________ OTHER MORTGAGE ______________________ ______________________ ____________________

PERSONAL EFFECTS ____________________ CREDIT CARDS ______________________ ______________________ ____________________

We Need Your AuthorizationBy signing below you affirm that the information you have given in this Application is true and complete and that you have not withheld any information. We will rely on the information you have given to decide on your Application. You also agree to the terms below.

Date Applicant Signature Co-Applicant’s Signature

CONSENT TO COLLECT AND USE PERSONAL INFORMATION

When you apply for a mortgage with us, you agree that:1) We may collect and use personal information from you and about you for the following purposes: (a) to understand your needs

(b) to determine the suitability of our products and services for you (c) to determine your eligibility for our products and services(d) to establish, manage and offer products and services that meet your needs (e) to provide on-going service and (f) to meet ourlegal and regulatory requirements.

2) We may use, give to, obtain, verify, share and exchange credit and other information about you with others including credit bureaus,mortgage insurers, credit insurers, registries and other persons with whom you may have financial dealings, as well as any otherperson as may be permitted or required by law. You also authorize any person whom we contact in this regard to provide suchinformation to us.

We may ask you for your Social Insurance Number to use in verifying and reporting credit information to credit bureaus and credit reportingagencies. You may refuse to consent to its use or disclosure for these purposes.

EMPLOYMENT

FINANCIAL

SIGNATURE