Mortgage Refinancing
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Welcome to Mortgage Application Form

Personal Information-applicant 1

Current address
PREVIOUS EMPLOYER (if less than 3 year at present employer)

Personal Information-applicant 2

Current address
PREVIOUS EMPLOYER (if less than 3 year at present employer)

Finanacial Information

Assets Where/finacial Insitution Amount
Cash Saving
Automotive:Present /Value
Value of Present Home(if owned)
Type Where/finacial Insitution Balance Owing Monthly Payment
Credit Card
Amount owing on curent Mortages
finance company Loans And Other Debts
net worth (total Assets - total liabilties) $


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 purpose to have financial relationship.


Client Constent


By signing this form, you acknowledge that you have read and understood the terms and conditions in this document, and you hereby freely consent and agree to: (I) comply with such terms and conditions, and (II) authorize such collection, use and disclosure of your personal information for as long as necessary for the purposes set out herein and/or for any other period prescribed by law, even if you no longer do business with us or obtain any of our products and services. If you have provided information about another person or organization within the scope hereof, you further confirm that you are duly authorized to do so.
    Your privacy is important to us. This document sets out certain privacy practices we follow, including what type of information is collected, how the information is used, and with whom the information is shared.


When you apply for any loan, mortgage credit facility and/or other related products and services that we may offer (the "Products and Services"), you acknowledge and agree that:

1.We may collect personal information from you and/or about you, such as:

  • (a) Your name, address, telephone number, occupation, employer's name, birth date and social insurance number;
  • (b) Identification, such as a valid driver's license or passport;
  • (c) Your annual income, assets, liabilities and credit history:
  • (d) Information about how you intend to use the Products and Services;
  • (e) Information about third parties, such as your spouse, if you are applying forcertain Products and Services, and;
  • (f) Information about beneficial owners, intermediaries and other parties;

2. We may collect your personal information, and use it, and disclose it to any person or organization as often as required for the following purposes:

  • (a) To confirm your identity;
  • (b) To determine your eligibility for our Products and Services, as well as their suitability for you;
  • (c) To share such information with financial institutions in connection with the administration and management of the Products and Services that you have requested; as well as convey the undersigned's credit file to credit reporting and assessment agencies, insurers for credit products or other lenders, as applicable;
  • (d) To verify the accuracy and authenticity of the information that you have provided to us or that we have otherwise obtained about you by any reasonable means (including, for example, verifying any applicable information with your employer or your references);
  • (e) To satisfy legal and regulatory requirements that we believe are applicable to us, including the requirements of any self-regulatory organizations to which we belong;
  • (f) To enable interested persons or companies to carry our due diligence auditsin the event of the sale, disposal or any other transfer of our business orassets or enable the conclusion and execution of any transaction in that
  • (g) Where required by law; authorize Divine Mortgage Group to retain, use and exchange information without the undersigned's consent;
  • (h) To provide you, in an ongoing manner, with the Products and Services that you have requested;

3. We may use your social insurance number to: (I) confirm your identity and (II) verify and report credit information to credit bureaus and credit reporting agencies;

4. We do not directly provide all the Products and Services. For example, we rely on assessment agencies, real estate appraisers, financial institutions, public registers, employers, credit reporting and collection agencies, professionals, our subsidiaries and affiliated companies as well as, other third parties to provide you with the Products and Services (our "Providers). You acknowledge that we may disclose information about you to our Providers in order for us to provide you with the Products and Services;

5. You acknowledge that we and our Providers may contact you (including. but not limited to, via telephone, facsimile, mail and email or other electronic means) on an on going basis to occasionally provide you with information about the Products and Services, news, events and other important messages that might be of interest to you. You agree that Divine Mortgage Group and our Providers can do so even if you may have registered your telephone numbers) in the National Do Not Call Registry;

6. We may receive compensation (in the form of money or other consideration) from our Providers or from third parties which may vary relative to the interest rate and term, or products) and service(s) accepted by you; or volume of business or efficiency ratios we may have with a lender;

7. You will pay all applicable legal, property, appraisal, registration and other fees and other expenses incurred in connection with Products and Services that you have requested, regardless of whether such Products and Services are approved or funded. The consultant will discuss such fees and expenses with you in advance of their occurrence;

8. You will advise us promptly of any changes related to your information so that we may update our files accordingly, and;

9. All of the information that you provide to us is accurate and complete, and that we may rely exclusively on such information for the uses described in this document;

10. You jointly and severally release and indemnify us and save us harmless against and from any claims in damages or otherwise arising from or in connection with the collection, use or disclosures of your personal information.


Subject to our legal, regulatory and contractual requirements, you can withdraw or otherwise amend the consent that you provided above, including your consent with respect to the collection, use and/or disclosure of your information, at any time by contacting our Privacy Officer. Depending on the circumstances, however, any withdrawal or amendment to your consent may prevent us from providing you, or continuing to provide you with: (I) our Products and Services; or (II) information that may be of value to you.

The Mortage Act-Monitoba


This mortgage disclosure must be signed by the Borrower(s) and the Broker, including any Mortgage Salesperson or Authorized Official acting for the Broker prior to the Borrower(s) signing the lender's mortgage commitment.


The mortgage broker's role and obligations to the borrower (you) and the lender will vary depending on the nature of the service relationship between the mortgage brokerage, you and the lender. The disclosure document describes the mortgage broker's role and resulting obligations to you. You are encouraged to discuss this document with your mortgage broker and ask any question that you have.

A mortgage broker will endeavor to obtain the best mortgage for the borrower (you) depending on your qualifying income, credit history, equity, risk tolerance, choice of property and other financial goals that might affect your choice of mortgage product.


The mortgage broker acts as an intermediary between the borrower (you) and lenders who have authorized it to offer their mortgage products to borrowers, in this service relationship, the mortgage broker is authorized to offer the age products of multiple lenders to borrowers who are seeking to secure a mortgage. The mortgage broker is not employed directly or indirectly by any of the lenders for whom it is authorized to offer mortgage products.

The mortgage broker's duties to you, the borrower, are to act competently and honestly and to disclose all relevant information associated with the mortgage.


  • The Brokerage is an affiliate or subsidiary of the lender ......................................................... (Choose One)
  • he brokerage and its representatives have a direct/indirect interest in the transaction ................................. (Choose One)


The mortgage broker may (will) be compensated for this mortgage transaction in the following ways:

  • By way of commission or fee paid by the lender depending on the length of the term and the amount of the mortgage
    and may also include a bonus paid by the lender; .......................................
    (Choose One)
  • By way of renewal commission from the lender and/or ......................................... (Choose One)
  • By way of fee charged to you in the amount of $ ...................................... (Choose One)
  • By way of a cash back offer where the Lender pays % of the mortgage amount to the mortgage
    broker on behalf of the borrower [you]
  • Non-monetary benefits may also be received from the lender;.............................................. (Choose One)


The borrower [you] may be responsible for additional fees, including the following:

  • Property appraisal fees, legal fees, title insurance fees, default mortgage insurance fees home inspection fees, registration fees, lender fees and home owner insurance fees


Your broker/agent has reviewed with you the risks associated with a mortgage commitment. In addition the following terms and conditions associated with the mortgage commitment have been discussed.

  • The right to repay the amount borrowed prior to maturity, if any:
  • The prepayment penalty if paid in full before maturity, if any:
  • Risks and/or benefits of fixed or variable rate mortgage;
  • Other details of this mortgage such as cash back penalty, portability, assumability, transferability.


I/we acknowledge receipt of a copy of this disclosure document

l/we acknowledge that we have reviewed the content of this disclosure.