Clone of License # M08010390

Shawn Syed, AMP

License # M08010390
Client Questionnaire (Refinance)
Personal Information

Applicant 1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Social Insurance Number*
Home Number*

Area CodePhone Number
Cell Number

Area CodePhone Number
Marital Status*
Employment Information

Applicant 1
Employer's Name
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Status
Employed Since

MonthDayYear
Designation / Position
Salary type

YearlyHourlyCash
Annual Base Salary*
Personal Information

Applicant 2
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date

MonthDayYear
Social Insurance Number
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
Marital Status
Employment Information

Applicant 2
Employer's Name
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Status
Employed Since

MonthDayYear
Designation / Position
Salary type

YearlyHourlyCash
Annual Base Salary
Property Details
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type of property
Age of property
Garage
Maintenance fee (If any)
Property Tax /Year
Frontage in feet
Depth in feet
Livable / Covered area in Sq.ft
Mortgage Information
Current Value
Purchase Price
Outstanding Mortgage
Purchase Date

MonthDayYear
Down-payment (Equity)
Lender
Product
Interest Rate
Monthly Payment
Maturity Date

MonthDayYear
Monthly Rent (if any)
Closing Date

MonthDayYear
Second Mortgage Details (If any)
Other Properties Owned

If any
Purchase Date
Purchase price
Down-payment paid
Lender
Product
Interest rate
Monthly payment
Current value
Property Tax
Monthly rent (If any)
Credit Bureau Consent: I/We the undersigned, declare the information provided with respect to my/our mortgage application is a true & complete representation of my/our financial situation. I/We understand that it is being used to determine my/our credit responsibility and to evaluate and respond to my/our request for mortgage financing. I/We authorize Mortgage Alliance Company of Canada (hereafter referred to as MAC) to obtain a credit report. I/We also authorize MAC to exchange such credit information for the purpose of securing mortgage financing to potential mortgage lenders, mortgage insurers or service providers. MAC is authorized to retain the application and credit information whether or not the mortgage is approved. I have read, understood, and received a copy of the privacy agreement.
Dated

DayMonthYear
Acknowledged*

Option 1Option 2Option 3
Should be Empty:

Shawn Syed, AMP

Client Questionnaire (Refinance)

Personal Information

Employment Information

Personal Information

Employment Information

Property Details

Mortgage Information

Other Properties Owned