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Amount applied for
Purpose
Residential Phone
Name
Date of Birth
S.I.N.
Business Phone
Ext.
Spouse's Name
Date of Birth
S.I.N.
Business Phone
Ext.
Marital Status
How Long?
Yrs. Mths.
# of Dependants
# of Dependants Working
Present Address (Number, Street, Apt/Suite, City, Province, Postal Code)
Date of Res.
Amount
Buy Rent
Landlord or Mortgage Holder - Name and address
Previous Address (Number, Street, Apt/Suite, City, Province, Postal Code)
How long?
Yrs. Mths.

EMPLOYMENT
     
     
Gross
Mthly Inc
Net
Mthly Inc
Present Employer
Address of Employer
Position
Date of Employ
Mth. Yr.
Gross Salary
Wage Rate
 
Per Mth.
Per Wk.
Per Hr.
Pay Days
 
Former Employer
Address of Employer
Position
How long?
Mths. Yrs .
Spouse's Employer
Address of Employer
Position
Date of Employ
Mth. Yr.
Spouse's Former Employer
Address of Employer
Position
How long?
Mths. Yrs.
Other Sources of Income (P/T Jobs - Family Allowance - Pensions - Etc.) Explain
     
Totals:


FINANCIAL INFORMATION
ASSETS Institution / Details Bal/Value LIABILITIES Institution Monthly
Payment
Bal/Value
Cash/GICS: Bank Loans:
   
RRSPS: Finance Co.
Loans:
   
Stocks: Charge Acct/
Credit Cards:
   
Auto: Auto:
   
Other
(Boat, Trailer):
Other Debts:
   
   
Real Estate: Mortgage:
   
   
             
Name and Address of Banking Institution

Cheq.
Sav.
Account #
Name and Address of Banking Institution

Cheq.
Sav.
Account #
Name and Address of Banking Institution

Cheq.
Sav.
Account #
Solicitor's Name and Address
  Solicitor's Fee
Name and Address of Appraiser

  Appraiser's Fee

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By submitting this electronic application to Doni Realty Ltd. / Family Group Sudbury Inc., I/We hereby apply for a loan, mortgage, or line of credit and certify that the information given above is complete and correct, and acknowledge that you are relying on this information. Authorization is hereby given to Doni Realty Ltd. / Family Group Sudbury Inc. (1) to obtain such factual investigative, credit and personal information regarding me/us from others as permitted by law. (2) to furnish other credit grantors and personal or consumer reporting agencies particulars of this credit application and such factual investigative, credit and personal information regarding me/us as may be in its possession and (3) to retain this application.




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