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HEBREW FREE LOAN ASSOCIATION

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									                                              HEBREW FREE LOAN ASSOCIATION
                     6525 Décarie Blvd., Suite 202, Montreal, Quebec H3W 3E3 – Tel.: 733-7128 / Fax: 733-3698

                                                             ENDORSER’S FORM

I. PERSONAL

Last Name                                       First Name                                    Maiden Name

Social Ins. #                                   Home Phone #                                  Marital Status

# Dependent Children                 Your Birth Date (mo./day/yr.)                            Medicare #

Driver’s License #                                       Country of Origin                            Year Arrived in Canada

Relationship to applicant

Home Address

Address                                                            Apt. #            City                       Province

Country                              Postal Code                             E-mail Address

Financial

Home (own/rent)                      Mo. Payment $                                  Mtge. Balance $

II. WORK

Firm                                                                                                  Owner (yes/no)

Position                                                                                      Start Date

Address                                                                                                         Suite #

City                                 Province                      Country                            Postal Code

Phone #                                         Cel. #/Pagette #                                      Fax #

If less than 3 years with present / last firm, complete below:

Firm                                                                                                  Owner (yes/no)

Position                                                 Start Date                                   End Date

III. SPOUSE

Name                                                     Maiden Name                                  Social Ins. #

Work

Firm                                                                                                  Owner (yes/no)

Position                                                                                      Start Date

Address                                                                                                         Suite #

City                                 Province                      Country                            Postal Code

Phone #                                         Cel. #/Pagette #                                      Fax #

IV. BANKING

Bank                                            Branch                                                Contact

Phone #                     Fax #                        Acct. #                              Acct. Type



1. Please provide us with a copy of your latest bank statement or last 2 pages of your bankbook.

2. An endorser and his/her spouse may not request a loan within 6 months of signing.


Oct-03

								
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