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Mortgage Application Form


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									        SMR MORTGAGE                                     Toll Free: 1-800-275-5984                   SMR Mortgage
                                                         Toll Free Fax: 1-800-275-5984               http://www.smrmortgage.com
                                                               Applicant                                        Co-Applicant
 Salutation (Mr./Ms/Miss):
 First Name
 Family Name
 S.I.N. #
 Date of Birth
 Marital Status
 City, Province
 Postal Code
 How long at this address
 Home Phone
 Previous Home Address
 Employer (Company)
 Position (Job Title)
 Annual Income
 Address, City, Postal Code
 Work Phone
 How long with this company
 Previous Employer (Company)
 Previous Position
 Years with this company
 Number of Dependants                                                    Referrer/Agent:
Financial Information:
  Money You Have                                    Money You Owe:                                     Monthly Payments
  Cash in Bank ($)                                  Bank Loans ($)
  RRSP         ($)                                  Credit Cards ($)
  Real Estate ($)                                   Mortgages ($)
  Car          ($)                                  Loans        ($)
  Other        ($)                                  Other        ($)
Current Mortgage:
 Current Home Value                                           Date of Purchase
 Current Mortgage Amt ($)                                     Original Amort. (yrs)
 Current Monthly Payment                                      Original Mortgage Term
 Original Purchase Price                                      Original Mortgage Amt ($)
 Mortgage Maturity Date:                                      Current Mortgage Bank

New Mortgage: Variable Rate or Fixed Rate? [                                     ]
 Amt ($)           Rate           Term                                  Closing Date                                Amort (Yrs)

Property Information:
 Address                                    City                      Postal Code
 Property Age           Lot Size            # of Storey               Total Area (sf)
 Property Type Detached?              Semi?           Town house?             Condo?
 Garage Single?               Double?         Builder name (if new home)
 Property Tax ($) per year                    Condo Fee $ (per month)
 SIGNATURE: To the best of my/our knowledge, the information on this application is true. I/we authorize SMR Mortgage to obtain
 information about me/us as permitted by law; to share information about my/our application and credit history with other credit grantors,
 credit bureau, suppliers of services and mortgage insurers; to use it for the express purpose of obtaining a loan and sharing information. If
 I/we receive a matching offer elsewhere after obtaining an approval from SMR Mortgage, I/we undertake to stay with SMR Mortgage for its
 unbiased mortgage service and time spent. I/we authorize the application through electronic transmission.
 Applicant Signature: ____________ Co-Applicant Signature: ____________ Date: ___________

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