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TJ Burnett
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Applicant Information
First Name MI Last Name Date of Birth S.I.N. Marital Status
Current Address City Province Postal Code How Long?
Previous Address (if less then 3 Years) City Province Postal Code How Long?
Email Address Home Phone Work Phone Cell Phone Residential Status
Current Employer Occupation / Title How Long? Pay Type (Select One)
Address Annual Income
Number of dependents Referred By Referred by Other
Co-Applicant Information (Complete if you are married or have a co-applicant)
Co-Applicant on Application?
Yes
No
 
First Name MI Last Name Date of Birth S.I.N. Marital Status
Current Address City Province Postal Code How Long?
Previous Address (if less then 3 Years) City Province Postal Code How Long?
Email Address Home Phone Work Phone Cell Phone Residential Status
Current Employer Occupation / Title How Long? Pay Type (Select One)
Address Annual Income
Number of dependents
Current Mortgage Information
Mortgage Holder Current Value of Property Current Mortgage Amount
Mortgage Interest Rate Current Monthly Payment Property Taxes
Details of Mortgage Loan
Mortgage Purpose: Mortgage Amount: Amortization:
If pre-qualifying, please fill in the following:
What is the purchase price of the home (or max. purchase price you wish to pay)?
How much down payment do you have?
Where is you down payment coming from?
Closing Date (or date of planned purchase)
Liabilities: Please list all outstanding debts, including credit cards, loans, mortgage, car payments, alimony, etc.
Creditor / Description Amount Owed Monthly Payment
Assets: Please list all your assets, including homes, vehicles, RRSP's, Stocks, Bonds, Cash in Bank, etc.
Description Value
Other Comments/Information: Please provide any additional information which could help us approve you.
Are you presently a co-signor on any loan? Yes No
Have you previously declared bankruptcy? Yes No
If yes, please explain.
By submitting this secure online application, I/we hereby authorize TJ Burnett and all affiliated partners to obtain a credit report and make any necessary inquiries regarding my/our mortgage application and to release any of this information to any lender who may be interested in providing funds on my behalf.