Real Estate Mortgage Intake Form

ABOUT YOUR CLOSING

What kind of property are you mortgaging?* Single Family HomeResidential CondoCommercial CondoResidential: 2 or more unitsPre-construction/New build homeCommercialVacant LandFarmCottageLuxury PropertyOther

What is the closing date?

What is the street address of the property being mortgaged?*

City/Region*

Postal Code*

Name of Lender*

Mortgage Reference/Policy Number (if applicable)

Address

Phone Number (if applicable)

Mortgage Representative Name

Mortgage Representative Phone Number

MORTGAGES (If applicable)

If there are one or more mortgages currently on the property, please provide the following information:

First Mortgage Lender (name of company or person)

First Mortgage Reference Number

First Mortgage Lender Phone Number

First Mortgage Lender Address

Second Mortgage Lender (name of company or person)

Second Mortgage Reference Number

Second Mortgage Lender Phone Number

Second Mortgage Lender Address

PARTY ONE

Please indicate your full name as it appears on your government-issued photo ID:*

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth*

Phone number*

Email address

Employer/Business name

Employer/Business address

Are you acting on behalf of a corporation?*

If you are acting on behalf of a corporation, what is the corporation's name?

If you are acting on behalf of a corporation, what is the corporation's address?

Is the property being mortgaged the same as your current residence?* YesNo

If the property being mortgaged is NOT the same as your current residence, what will your address be after closing?

City/Region

Postal Code

Please specify your current spousal status.* SingleMarriedCommon LawSeparatedDivorcedWidowed

If you are married, separated or in a common-law relationship, and your spouse is NOT on title to the property, please provide the following information:

Non-title spouse's full name as it appears on their government-issued photo ID:

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth of non-title spouse

Phone number of non-title spouse

Email address of non-title spouse

Employer/Business of non-title spouse

PARTY TWO

Please indicate your full name as it appears on your government-issued photo ID:*

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth*

Phone number*

Email address

Employer/Business name

Employer/Business address

Are you acting on behalf of a corporation?*

If you are acting on behalf of a corporation, what is the corporation's name?

If you are acting on behalf of a corporation, what is the corporation's address?

Is the property being mortgaged the same as your current residence?* YesNo

If the property being mortgaged is NOT the same as your current residence, what will your address be after closing?

City/Region

Postal Code

Please specify your current spousal status.* SingleMarriedCommon LawSeparatedDivorcedWidowed

If you are married, separated or in a common-law relationship, and your spouse is NOT on title to the property, please provide the following information:

Non-title spouse's full name as it appears on their government-issued photo ID:

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth of non-title spouse

Phone number of non-title spouse

Email address of non-title spouse

Employer/Business of non-title spouse

PARTY THREE

Please indicate your full name as it appears on your government-issued photo ID:*

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth*

Phone number*

Email address

Employer/Business name

Employer/Business address

Are you acting on behalf of a corporation?*

If you are acting on behalf of a corporation, what is the corporation's name?

If you are acting on behalf of a corporation, what is the corporation's address?

Is the property being mortgaged the same as your current residence?* YesNo

If the property being mortgaged is NOT the same as your current residence, what will your address be after closing?

City/Region

Postal Code

Please specify your current spousal status.* SingleMarriedCommon LawSeparatedDivorcedWidowed

If you are married, separated or in a common-law relationship, and your spouse is NOT on title to the property, please provide the following information:

Non-title spouse's full name as it appears on their government-issued photo ID:

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth of non-title spouse

Phone number of non-title spouse

Email address of non-title spouse

Employer/Business of non-title spouse

PARTY FOUR

Please indicate your full name as it appears on your government-issued photo ID:*

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth*

Phone number*

Email address

Employer/Business name

Employer/Business address

Are you acting on behalf of a corporation?*

If you are acting on behalf of a corporation, what is the corporation's name?

If you are acting on behalf of a corporation, what is the corporation's address?

Is the property being mortgaged the same as your current residence?* YesNo

If the property being mortgaged is NOT the same as your current residence, what will your address be after closing?

City/Region

Postal Code

Please specify your current spousal status.* SingleMarriedCommon LawSeparatedDivorcedWidowed

If you are married, separated or in a common-law relationship, and your spouse is NOT on title to the property, please provide the following information:

Non-title spouse's full name as it appears on their government-issued photo ID:

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth of non-title spouse

Phone number of non-title spouse

Email address of non-title spouse

Employer/Business of non-title spouse

PARTY FIVE

Please indicate your full name as it appears on your government-issued photo ID:*

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth*

Phone number*

Email address

Employer/Business name

Employer/Business address

Are you acting on behalf of a corporation?*

If you are acting on behalf of a corporation, what is the corporation's name?

If you are acting on behalf of a corporation, what is the corporation's address?

Is the property being mortgaged the same as your current residence?* YesNo

If the property being mortgaged is NOT the same as your current residence, what will your address be after closing?

City/Region

Postal Code

Please specify your current spousal status.* SingleMarriedCommon LawSeparatedDivorcedWidowed

If you are married, separated or in a common-law relationship, and your spouse is NOT on title to the property, please provide the following information:

Non-title spouse's full name as it appears on their government-issued photo ID:

Please attach photocopies of the front and back of two pieces of government-issued photo ID. Health Cards are not accepted. (Note: we are required by law to obtain this ID, but you may provide it to us in person when we meet you.)

Date of birth of non-title spouse

Phone number of non-title spouse

Email address of non-title spouse

Employer/Business of non-title spouse

FIRE INSURANCE

Please provide details of your fire insurance coverage for the property you are mortgaging. Please note that fire insurance is usually required by lenders when obtaining a mortgage.

Name of Insurance Company

Name of the Insurance Agent/Broker/Rep

Policy # (if applicable)

Email address of Agent/Broker/Rep

Phone number of Agent/Broker/Rep

SILENT OWNERS

Other than a spouse, does any other person or corporation have an ownership interest in the property?* YesNo

Silent owner's full name as it appears on their government-issued photo ID:

What is the silent owner's relationship to the parties on title?

Date of birth of silent owner

Phone number of silent owner

Email address of silent owner

Employer/Business of silent owner

OTHER DETAILS

If there are any other details about your sale not covered in this intake form, please let us know below!