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Registrar of Mortgage Brokers Number:
1200 – 13450 102nd Avenue
Surrey, BC V3T 5X3
INVESTOR/LENDER DISCLOSURE STATEMENT
FORM 9- Section 17.1
Neither the Registrar of Mortgage Brokers nor any other authority of the government of the Province of British Columbia has in
any way passed on the merits of the matters dealt with in this information statement. This information statement has not been
filed with the Registrar of Mortgage Brokers and the registrar has not determined whether or not it complies with Part 2 of the
Mortgage Brokers Act.
Please write or print clearly. If additional information is required, reference and attach a schedule to this form.
A - CAUTIONS
1. All mortgage investments carry risk. There is a relationship 5. You should be satisfied with the borrower’s ability to meet
between risk and return. You should very carefully assess the payments required under the terms of this mortgage.
the risk of the transaction described in this Investor/Lender 6. A mortgage broker must not administer, or arrange for
Disclosure Statement and in the supporting documentation another person to administer, a mortgage on your behalf
before making a commitment. unless the mortgage broker has a written agreement with
2. You are advised to obtain independent legal advice you that covers matters set out in the Mortgage Brokers Act.
regarding your decision to invest. 7. This Investor/Lender Disclosure Statement and the attached
3. If you are one of several investors in this mortgage, you documents are not intended to provide a comprehensive list
may not be able to enforce repayments of your investment of factors to consider in making a decision concerning this
on your own if the borrower defaults. investment. You should satisfy yourself regarding all factors
4. You should ensure you have sufficient documentation to relevant to this investment before you commit to invest.
support the property valuation quoted in this Investor/Lender
B – BORROWER / GUARANTOR / CONVENANTOR INFORMATION
FULL NAME OF BORROWER: FULL NAME OF GUARANTOR/CONVENANTOR (if applicable):
ADDRESS - include postal code ADDRESS – include postal code
C – OTHER PARTIES TO THE TRANSACTION REPRESENTED BY THE MORTGAGE BROKER
The Mortgage Broker does not represent other parties to the transaction.
The Mortgage Broker does represent other parties to the transaction, who are:
Syndicate mortgage lenders:
(attach list if more space
Other – please describe:
MBA F9 01/2009
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D – PRE-EXISTING OR EXISTING MORTGAGE IN DEFAULT
Will the lender/investor be acquiring an interest in a currently registered mortgage?
If yes, please explain any defaults by the borrower over the past 12 months:
If the mortgage is new, was there a previous mortgage registered against title by the same borrower?
If yes, please explain any defaults by the borrower with the previous mortgage over the past 12 months:
E – REGISTERED INTEREST
Your interest as a lender will be directly registered on the mortgage document filed at the Land Title Office ; or
________________________________ will act as a trustee or nominee and will hold a registered interest in the mortgage in
trust for you as beneficial owner; or
Your interest in the mortgage will be secured under the following arrangements:
F – PROPERTY TO BE MORTGAGED
Legal and Municipal address of the property: Property taxes
Annual Property taxes: $ ____________________________
Are taxes in arrears?
If yes, amount in arrears: $ ____________________________
Type of Property Zoning
Property with existing buildings If mortgage proceeds are to be used for construction financing,
Single family residential is the zoning on the property appropriate for the proposed
Two-to-four unit multifamily use?
Five or more unit multifamily
Other: If no, details:
Vacant land, development or construction project. Appraisal
Detail of project/proposed use:
Date of appraisal:
Name and address of appraiser:
Current value of property based on appraisal:
Projected or future value of property based on appraisal:
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G – MORTGAGE PARTICULARS
Type of Mortgage Terms of the Mortgage
Your investment represents: Amount of your investment: $ _______________________
the entire mortgage
OR Face value of the mortgage: $ _______________________
a portion of the mortgage
Your portion represents _____________ % of the total. Interest rate is fixed at __________ % per annum
______ other parties have an interest in this mortgage.
Interest rate is variable. Explain:
Trust Funds Compounding Period: ______________________________
Will the funds be held in trust pending execution of the Payment Frequency: _______________________________
Yes Payments by Borrower: $ ____________________________
If yes, please indicate the party that will hold the funds in trust: Term: ___________ Amortization: _____________________
Maturity date: ______________________________________
Administered Mortgage Balance on maturity: $ ______________________
Will the mortgage be administered for you? Borrowers first payment due: _______________________
If “yes”, name and address of administrator:
Loan to value ratio (according to information from
Rank of Mortgage borrower)
The mortgage will rank: a) Total of prior encumbrances: $ _____________________
first second third other: ___________
Prior encumbrances (existing or anticipated) b) Amount of this mortgage: $ _____________________
c) Total amount of mortgages: 0.00
OR (a + b)
Priority: ____ Amount Owing $ _______________ d) Appraised “as is” value: 0.00
In default? Yes No (from Part F)
Lender/Charge Holder__________________________ e) Loan to “as is” value: NaN
(c/d x 100)
Priority: ____ Amount Owing $ _______________ f) Projected value: $ ____________________
In default? Yes No (where appropriate)
Lender/Charge Holder__________________________ NaN
g) Loan to “projected value” ratio: __________________%
(c/f x 100)
Priority: ____ Amount Owing $ _______________
In default? Yes No
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H – FEES CHARGED TO THE INVESTOR
Mortgage broker fee $ ______________________
Administration fees (where applicable): $ ______________________
Any other charges: $ ______________________
I – ATTACHED DOCUMENTS
Important: You should review the following documents carefully and assess the risks of this investment before
committing to invest. The following documents are attached:
1. A copy of any existing mortgage on the property;
2. A copy of the appraisal;
3. A copy of any purchase and sale contract entered into by borrower for the purchase of the property;
4. Documentary evidence respecting the borrower’s ability to meet the mortgage payments, such as a credit bureau
report or a letter from an employer disclosing the borrower’s earnings.
5. A copy of the borrower’s application for a mortgage.
6. If the mortgage is a new mortgage, documentary evidence of any down payment made by the borrower for the
purchase of the property.
7. A copy of any agreement that you may be asked to enter into with the mortgage broker or other administrator.
8. A copy of the Cost of Credit Disclosure provided to the borrower.
J – CERTIFICATION
This Investor/Lender Disclosure Statement has been completed by:
Name and address of Mortgage Broker
I have fully completed the above Investor/Lender Disclosure Statement in accordance with the Mortgage Brokers Act and
regulations and declare it to be accurate in every respect.
Date: ______________________________________ _________________________________________________
Signature of Mortgage Broker, or of a person authorized
to sign on behalf of the mortgage broker
Print name of person signing
K – ACKNOWLEDGEMENT
I, ________________________________________________, of _________________________________________________
Print name Address
acknowledge receipt of this Investor/Lender Disclosure Statement, signed by the mortgage broker.
Date: ________________________________________ Signature: _________________________________________
Dated by Lender
One copy of this form must be provided to the prospective investor,
and one copy must be retained by the mortgage broker.
MBA F9 01/2009