MDC Mortgage Direct Canada Corp.- Dealing directly with qualified lenders, White Rock, BC

PRIMARY APPLICANT

First Name:
Middle Initial:
Last Name:
Maritial Status:
Sex:
Age:
Date of Birth:
S.I.N.:
Telephone:
Number of Dependants:

PRESENT ADDRESS:

Address:
City/Town:
Province:
Postal Code:
How Long?:

PREVIOUS ADDRESS:

Address:
City/Town:
Province:
Postal Code:
How Long?:

APPLICANT'S EMPLOYER:

Employer:
Work Phone:
Position:
How Long?:
Gross Income:

CO-APPLICANT: (if applicable)

First Name:
Middle Initial:
Last Name:
Maritial Status:
Sex:
Age:
Date of Birth:
S.I.N.:
Telephone:

CO-APPLICANT'S EMPLOYER: (if applicable)

Co-Applicants Employer:
Work Phone:
Position:
How Long?:
Gross Income:

BANK INFORMATION:

Bank (Branch & Address):
Account #:
Balance:
Bank (Branch & Address):
Account #:
Balance:

PRIMARY SECURITY INFORMATION:

Home Address:
City:
Province:
Postal Code:
Estimated Value:
Appraised Value
Appraiser:
Assessed Value:
Listing Price:
Listing REALTOR:

First Mortgage Holder:
Branch & Address:
Rate:
Due Date:
Balance:
Payment:
PIT:

Second Mortgage Holder:
Branch & Address:
Rate:
Due Date:
Balance:
Payment:
PIT:

Third Mortgage Holder:
Branch & Address
Rate:
Due Date:
Balance:
Payment:
PIT:

ADDITIONAL SECURITY:

LIABILITIES:

CREDITOR	ACCOUNT#	BALANCE	PAYMENT

PURPOSE OF LOAN:

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. I / WE AFFIRM THAT THE INFORMATION IS TRUE AND THAT THE DEBT LISTED IS OUR TOTAL DEBT. I / WE ARE AWARE THAT YOU (THE LENDER/BROKER) ARE RELYING ON THE ACCURACY OF THE ABOVE INFORMATION. Consent is hereby given pursuant to s.12 of the "Credit Reporting Act", R.S.B.C. 1996, Chapter 81. BROKER AND LENDER FEES MAY APPLY

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Mortgage Direct Canada Corp. Privacy Statement

As Mortgage Professionals, we are committed to keeping your privacy protected.

Information we collect is used and disclosed for a variety of reasons:

To provide you with financial services;
To identify you and verify any information you give us
To determine what products or services you are eligible for
To determine your financial situation
To present your mortgage application and information to various lenders for the purpose of securing a mortgage for you
To protect us both from error and fraud
To meet legal, regulatory requirements;

MDC Mortgage Direct Canada Corp. (MDC) is committed to safeguarding confidentiality of personal information sent to us online from misuse and unauthorized access. Any information you supply to MDC online will be held with extreme care and will not be used in any ways that you have not consented to. Data sent over the Internet is secured by using firewalls and SSL (Secure Socket Layer) encryption. Internally stored data is password protected and access to this information is restricted to select employees that are aware of our privacy policy. Even though we take extensive measures to protect the security of data it cannot be guaranteed to be 100% secure. If you have concerns about the security of information being sent we encourage you to contact us.

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