Syndicate Mortgages Inc. A Canadian based mortgage brokerage

Secured Online Loan Application
*Mandatory field.
Mortgage Agent	If no agent applicable leave blank
Mortgage Details
Type of Loan: *	Purpose of Loan: *	Value of Home: *

Mortgage Amount Required:*	Approx Date Funds Required:

Personal Information - Applicant 1
Identification
First Name:*	Last Name:*	Initial:

Date of Birth: (MMDDYYYY)*	SIN#:	E-Mail Address:*

Current Living Address
Number:*	Street Name:*	Unit:

City/Town :*	Province: *	Postal Code:*

Home Ph.#:* (incl. area code)	Time at this address:(YYMM)* (eg. 4 years & 2 months = 0402)

Present Employer
Occupation Type:*	Name of Employer:*	Work Ph.#:* (incl. area code)

Length of Employment: (YYMM)* (eg. 4 years & 2 months = 0402)	Annual Income: *	Type of Income: *

Personal Information - Applicant 2
Identification
First Name:	Last Name:	Initial:

Date of Birth: (MMDDYYYY)	SIN#:	E-Mail Address:

Current Living Address

Number:	Street Name:	Unit:

City/Town :	Province:	Postal Code:

Home Ph.#: (incl. area code)	Time at this address:(YYMM) (eg. 4 years & 2 months = 0402)

Present Employer (Applicant 2)
Occupation Type:	Name of Employer:	Work Ph.#: (incl. area code)

Length of Employment: (YYMM) (eg. 4 years & 2 months = 0402)	Annual Income:	Type of Income:

Financial Information
Assets Type	Where/Financial Institution(s)	Amount/ Value
Cash savings		$
Automobile: present value		$
Value of present home (if owned)		$
Other		$
Total		$

Liabilities
Type	Where/Financial Institution(s)	Balance Owing		Monthly Payment
Debts / Loans		$		$
Credit Cards		$		$
Amount owing on current mortgage(s)		$		$
Finance company loans and other debts		$		$
Total		$		$
Net Worth (Total Assets - Total Liabilities) =		$
Other Information
Additional Note for Financial Information: (Max. 500 Characters)

I/we warrant and confirm that the information given in the mortgage application form is true and correct and I/we understand that it is being used to determine my/our credit responsibility. You are authorized to obtain any information you may require for these purposes from other sources (including, for example, credit bureau) and each such source is hereby authorized to provide you with such information. I/we also understand that the information given in the mortgage application form as well as other information you obtain in relation to my credit history may be disclosed to potential mortgage lenders, financial intermediary and mortgage insurers, 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.
Online Applications
Please read the paragraph above prior to sending completed application. By transmitting the online mortgage application you are accepting the terms of the paragraph noted above.
			Secure Certificate