Dominion Lending Centres – White House Mortgages – 104A – 1912 Enterprise Way, Kelowna, BC – PHONE #: 250-878-1541

Type of Loan

Purpose of Loan

Value of home

Mortgage Amount Required

Approx Date Funds Required:

Personal Information - Applicant 1

Identification

First Name:

Last Name:

Initial

Date of Birth:

SIN#

Email Address

Current Living Address

Number

Street Name

Street Type

Street Dir.

Unit

City/Town

Province

Postal Code

Home Phone

Time at this address:

Present Employer

Occupation Type

Name Of Employer

Work Phone

Length of Employment:

Annual Income

Type of Income

Personal Information - Applicant 2

Identification

First Name:

Last Name:

Initial

Date of Birth:

SIN#

Email Address

Current Living Address

Number

Street Name

Street Type

Street Dir.

Unit

City/Town

Province

Postal Code

Home Phone

Time at this address:

Present Employer

Occupation Type

Name Of Employer

Work Phone

Length of Employment:

Annual Income

Type of Income

Financial Information

Assets

Where/Financial Institution(s)

Type

Amount/ Value

Cash savings

Automobile: present value

Value of present home (if owned)

Other

Liabilities

Type

Where/Financial Institution(s)

Balance Owing

Monthly Payment

Credit Cards

Automobile: Loan/Lease

Home Mortgage(s)

Other

Other information

Additional Note for Financial Information: