Personal Information

Prefix Mr Mrs Ms Miss Dr Rev Sr Last Name First Name S.I.N.(optional) Birthdate // (yyyy/mm/dd)

Home Phone Email Marital Status Single Married Separated Divorced Widowed Common Law Gender Male Female

 

Current Address Housing Own principal residence Rent principal residence With Parents/Relatives Room & Board Employer provides Military housing Own Mobile/Owns Property Own Mobile/Rents Property Street Number Apt. Street Name Street Type Avenue Blvd Circle Crescent Court Drive Lane Parkway Place Road Street Terrace Direction N S E W NE NW SE SW N/A City Province AB BC LB MB NB NF NS NT ON PE PQ SK YT Postal Code Since / (yyyy/mm)

Previous Address (if less than 2 years at current address) Housing Own principal residence Rent principal residence With Parents/Relatives Room & Board Employer provides Military housing Own Mobile/Owns Property Own Mobile/Rents Property Street Number Apt. Street Name Street Type Avenue Blvd Circle Crescent Court Drive Lane Parkway Place Road Street Terrace Direction N S E W NE NW SE SW N/A City Province AB BC LB MB NB NF NS NT ON PE PQ SK YT Postal Code How Long - (yy-mm)

 

Current Employer Employment Type Employed Self employed Retired Student At Home Unemployed Employer Name Phone - Ext: Occupation Production Driver Trades Sales Clerical Office Labourer Outside Law Security/Postal Service Manager Owner Semi-Professional Professional Executive Military-Non Military-Comiss. Creative/Arts Entertainment Other Status Full Time Full Time-Probation Part Time-Regular Part Time-Casual Temporary Seasonal Contract Temporary Layoff On strike Disability Employed since / (yyyy/mm) Position Income $ (annual gross)

Previous Employer (if less than 3 years with current employer) Employment Type Employed Self employed Retired Student At Home Unemployed Employer Name Phone - Ext: Occupation Production Driver Trades Sales Clerical Office Labourer Outside Law Security/Postal Service Manager Owner Semi-Professional Professional Executive Military-Non Military-Comiss. Creative/Arts Entertainment Other Status Full Time Full Time-Probation Part Time-Regular Part Time-Casual Temporary Seasonal Contract Temporary Layoff On strike Disability Since - (yyyy-mm) Position

Spouse Information

Prefix Mr Mrs Ms Miss Dr Rev Sr Last Name First Name S.I.N.(optional)

Birthdate (yyyy/mm/dd) // Royal Bank Customer Yes No Customer Since /(yyyy/mm)

 

Current Employer Employment Type Employed Self employed Retired Student At Home Unemployed Employer Name Phone - Ext: Occupation Production Driver Trades Sales Clerical Office Labourer Outside Law Security/Postal Service Manager Owner Semi-Professional Professional Executive Military-Non Military-Comiss. Creative/Arts Entertainment Other Status Full Time Full Time-Probation Part Time-Regular Part Time-Casual Temporary Seasonal Contract Temporary Layoff On strike Disability Employed since / (yyyy/mm) Position Income $ (annual gross)

Previous Employer (if less than 3 years with current employer) Employment Type Employed Self employed Retired Student At Home Unemployed Employer Name Phone - Ext: Occupation Production Driver Trades Sales Clerical Office Labourer Outside Law Security/Postal Service Manager Owner Semi-Professional Professional Executive Military-Non Military-Comiss. Creative/Arts Entertainment Other Status Full Time Full Time-Probation Part Time-Regular Part Time-Casual Temporary Seasonal Contract Temporary Layoff On strike Disability Since - (yyyy-mm) Position

Assets (including those of your spouse)

Home/Properties

Estimated Value Address 1. $ Street Name/Number: Apt.: City: Province/State: AB BC LB MB NB NF NS NT ON PE PQ SK YT AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MN MO MS MT NE NC NH NJ NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY Postal/ZIP Code: Country: Canada USA Other 2. $ Street Name/Number: Apt.: City: Province/State: AB BC LB MB NB NF NS NT ON PE PQ SK YT AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MN MO MS MT NE NC NH NJ NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY Postal/ZIP Code: Country: Canada USA Other 3. $ Street Name/Number: Apt.: City: Province/State: AB BC LB MB NB NF NS NT ON PE PQ SK YT AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MN MO MS MT NE NC NH NJ NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY Postal/ZIP Code: Country: Canada USA Other

Automobile(s)

Estimated Value Description Model Year 1. $ 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 2. $ 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 3. $ 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988

Investments/RRSP's

Amount Description 1. $ 2. $ 3. $

Liabilities  (including those of your spouse)

What You Owe	Amount Owing	Monthly Payment	Creditor	Corresponding Property
Existing Mortgage(s) excluding taxes and condo fees	$	$		1 2 3
	$	$		2 3 1
	$	$		3 1 2
What You Owe	Amount Owing	Monthly Payment	Creditor	Refinanced (Yes or No)
Car loan(s)	$	$		No Yes
	$	$		No Yes
	$	$		No Yes
Personal loan(s)	$	$		No Yes
	$	$		No Yes
	$	$		No Yes
What You Owe	Amount Owing	Credit Limit	Creditor	Refinanced (Yes or No)
Personal Line(s) of credit	$	$		No Yes
	$	$		No Yes
	$	$		No Yes
Credit card(s)	$	$		No Yes
	$	$		No Yes
	$	$		No Yes
	$	$		No Yes
	$	$		No Yes

Other Income | Other Expenses

Income	Amount	Payment Frequency	Expenses	Amount	Payment Frequency
Child support/Alimony	$	Monthly Annually	Child support/Alimony	$	Monthly Annually
Pension(s)	$	Monthly Annually	Auto lease	$	Monthly Annually
Interest/dividends	$	Monthly Annually	Rent (if applicable)	$	Monthly Annually
Other income (e.g. tips, rent)	$	Monthly Annually	Heat	$	Monthly Annually
			Property taxes	$	Monthly Annually
			Other expenses (e.g. condo fees)	$	Monthly Annually

 

 

 

Please indicate how you want us to communicate our decision back to you.

E-MAIL - My address is:
Telephone - My number is:

 

Best Time of the day to reach me is:

Comments:

Credit

 

. Judgement or collection in the last 7 years: PLEASE CHOOSE No Yes $0-$1000 Yes $1000 - $2000 Yes $2000 or greater . Lateness of credit cards, loans: PLEASE CHOOSE Never Occasionally Usually/Frequently . Current mortgage payments up-to-date: PLEASE CHOOSE Yes No . Lateness of mortgage payments: PLEASE CHOOSE Never Occasionally Usually/Frequently Years since bankruptcy discharged: (0=Never Bankrupt)