Application Form. Personal Information. Full Name. Full Address. Residential Status Own / Rent Time at Residence. .

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1 Application Form Personal Information Full Name Full Address Residential Status Own / Rent Time at Residence Work Phone Home Phone Cell Phone Fax Number Marital Status Date of Birth # of Children SIN Current Employer Employer Address Time at Job Job Title Annual Income Occupation Employment Type Full Time / Part Time / Contract Self Employed? Have you or your corporation(s) ever filed for bankruptcy? If so, what year? Have you been discharged? Please provide additional comments Has any property that you owned or your corporation(s) owned been in foreclosure? If so, what year? Please provide additional comments 1

2 Are you or any of your corporation(s) subject of any litigation or lawsuits? If so, please explain Spouse Information Full Name Work Phone Cell Phone Date of Birth SIN Current Employer Employer Address Time at Job Job Title Occupation Employment Type Full Time / Part Time / Contract Self Employed? Annual Income $ 2

3 Additional Income Income Type Description Period Amount Income Type Options = Annuity, Bonus, Investment, Salary, Part Time, or Other Period Options = Weekly, Bi-weekly, Monthly, Semi-monthly, Annually, or Other Asset Information Asset Type Description Amount Asset Type Options = Cash, Residence, 2 nd Residence, Rental Property, RRSP, Stocks, Bonds, Other Investment, Vehicle, and Other Liability Information Liability Type Description Value/Limit Balance Monthly Payment Liability Type Options = Residence Mortgage, 2 nd Residence Mortgage, Rental Mortgage, Vehicle Loan, Loan, LOC, Credit Card, Other 3

4 Banking Information Bank Name Bank Address Account Type Account # Requested Mortgage Purpose of Mortgage Mortgage Type First / Second / Third Funding Deadline Mortgage Amount $ Property Value $ Will the Mortgage be in a corporate name? Corporation Name Corporate Address Corporation Directors Note: Please include incorporation docs with application Property Details Property Address Legal Description House Size (sq ft) Appraised Value $ Appraised Date Dwelling Type Dwelling Style Garage Type Attached / Detached Garage Size Single / Double / Triple Annual Taxes $ Taxes Paid Annually / Monthly / By my bank Purchase Price $ Date Purchased Heating Cost $ Condo Fees $ Improvements Value of Improvements $ Is a rental property? 4

5 Rental Details (if a rental) Monthly Income $ Insurance Cost $ Utility Cost $ Management Cost $ 10% Vacancy $ 10% repairs and maintenance $ I/We warrant and confirm that the information given in the mortgage application form is true and complete and that I/we have not withheld or misrepresented any information. I/we understand that it is being used to determine my/our credit responsibility and to evaluate and respond to my/our request for mortgage financing. You are authorized to obtain any information you may require for these purposes from other sources (including, for example, credit bureaus) and each source is hereby authorized to provide you with such information. I/we also understand, acknowledge and agree that the information given in the mortgage application form, as well as other information you obtain or that is provided by me/us in relation to my/our application for financing, may be disclosed to potential mortgage lenders, individual private investors, title insurers, mortgage brokers, appraisers, lawyers, other service providers, organizations providing technological or other support services required in relation to this application and any other parties with whom I/we propose to have a financial relationship. I/we further acknowledge and agree that each potential mortgage lender, individual private investor, title insurer, mortgage broker, appraiser, lawyer, other service provider, organization providing technological or other support services to whom you provide the mortgage application and/or my/our personal information is permitted to receive such application and other information and maintain records relating to me/us and my/our mortgage application and to hold, use, communicate and disclose personal information about me/us, including my/our social insurance number(sin) if I/we provide it, and collect personal information from me/us, you and from third persons including credit bureaus, credit reporting and collection agencies, financial institutions, my/our past and present employers, creditors and tenants, my/our spouse or any other person who has information about me/us for the purposes of recording, evaluating and responding to my/our application for mortgage financing or related activities and I/we specifically consent to the release and disclosure of personal information by such persons to and among you and each potential mortgage lender, individual private investor, title insurer, mortgage broker, appraiser, lawyer, other service provider, organization providing technological or other support services. Westpoint Capital Corporation is authorized to retain the application and credit information, whether or not the application is approved, for a minimum of 3 years. Applicant signature: Date: Co-applicant signature: Date: 5

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