Mortgage Application

I AM APPLYING FOR

(please check all appropriate boxes below)

MORTGAGE

LINE OF CREDIT

ASSUMPTION OF MORTGAGE

PURCHASE

REFINANCE

LOAN

OTHER

PERSONAL INFORMATION

APPLICANT

Mr.

Mrs.

Miss

Ms.

* Full Name

* Social Insurance Number

* Personal Phone

Business Phone

* Date of Birth

Day

Month

Year

* Marital Status

Single

Married

Divorced

Separated

* Number of Dependents

* Years at Present Address

* Rent/Mortgage Payment

* Street Address

* City

* Postal Code

Own

Rent

Other

Previous Address

How Long?

* Applicant's Present Employer

* Present Employer's Address

* Years with Company

* Job Title

* Type of Business

* Gross Monthly Income

Applicant's Previous Employer

Previous Employer's Address

Years with Previous Employer

Other Source of Income

Other Monthly Income

* Banking Institution

* Your Branch Address

* Account Number

CO-APPLICANT

Mr.

Mrs.

Miss

Ms.

Full Name

Social Insurance Number

Personal Phone

Business Phone

Date of Birth

Day

Month

Year

Co-Applicant's Present Employer

Present Employer's Address

Years with Company

Job Title

Type of Business

Gross Monthly Income

Co-Applicant's Previous Employer

Previous Employer's Address

Years with Previous Employer

Other Source of Income

Other Monthly Income

FINANCIAL STATEMENT - ASSETS & LIABILITIES

Asset 1

Asset Value (in $)

Liability (in $)

Monthly Payment (in $)

Asset 2

Asset Value (in $)

Liability (in $)

Monthly Payment (in $)

Asset 3

Asset Value (in $)

Liability (in $)

Monthly Payment (in $)

Asset 4

Asset Value (in $)

Liability (in $)

Monthly Payment (in $)

Asset 5

Asset Value (in $)

Liability (in $)

Monthly Payment (in $)

By checking this box I/We hereby authorize NVR Mortgages - Brokerage License 11055, hereinafter referred to as "the Broker" to arrange on my/our behalf the loans described above and certify that the above information which is furnished with the intent that it be relied upon by the Broker to obtain said credit, is true and correct and:

Agree (if this application is for a loan to be secured by a mortgage) that the evaluation inspection and legal expenses incidental to this application will be paid by me/us and that I am not in arrears on my present mortgage.
The above information includes all my/our debts and that we have no current unsatisfied judgements and that I/we have not declared bankruptcy in the last six years and that all my/our outstanding credits are current and in good standing.
I/we also acknowledge that the Broker may also be receiving a fee in respect to the arranging of this loan and I/we hereby waive any right to deny or dispute the Broker from receiving said fee.
In connection with my application for credit, I/we hereby take notice that you may be procuring and may be referring to a consumer report respecting me/us containing personal information and I/we hereby consent thereto and to the disclosure of such information to other credit grantors or consumer reporting agency and to retain this application for the Brokers records.

* Calculate 4

4 =

Green Moolaa. Buy, Sell, Trade & Pawn

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APPLICANT

CO-APPLICANT

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