Application

If at current address less than 1 year, provide previous address

If less than 3 years:

If less than 3 years:

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Attach rider if space insufficient

SIGNATURES COLLECTION, USE AND DISCLOSURE OF INFORMATION

By signing below, I/we hereby authorize The Mortgage Centre-YourMortgageYourWay.ca hereinafter referred to as the agent to arrange on my/our behalf the loan described above and certify that the above information which is furnished with the intent that it be relied upon by the broker to obtain said credit, is true and correct and I am not in arrears on my present mortgage. The above information includes all my/our debts and that we have no current unsatisfied judgments against us and that I/we have not declared bankruptcy in the last six years and that all my/our outstanding credit are current and in good standing. I/we acknowledge that the agent may also be receiving a finders fee in respect to the arranging of this loan, and I/we hereby waive any right to deny or dispute the agent from receiving said finder fee. 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 agencies and to retain this application for the agent's records.