Loan Application

PERSONAL FINANCIAL STATEMENT
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Have you been at this address for more than 2 years?*
- Yes
- No
Own or Rent?*
- Own
- Rent
Previous Address (If less than two years at current address)
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
At this address since:
MM
DD
YYYY
Own or Rent?
- Own
- Rent
Phone
Marital Status*
- Married
- Single
- Widowed
Date of Birth*
MM
DD
YYYY
Number of Dependents*
Social Insurance Number
Email
Employer Name*
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Length of employment with current employer
Spouse's Full Name
First Last
Spouse's Date of Birth
MM
DD
YYYY
Spouse's Social Insurance Number
Spouse's Occupation
Spouse's Employer's Name
First Last
Spouse's employer's address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Spouse's length of employment with current employer

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STATEMENT OF PERSONAL ASSETS AND LIABILITIES
Leave blank if not applicable
ASSETS (own)
Cash (Indicate where assets are held)
Cash Amount $
RRSP’s (self) (Describe and Indicate where assets are held)
RRSP’s (self) Amount $
RRSP’s (spouse) (Describe and Indicate where assets are held)
RRSP’s (spouse) Amount $
Stocks, Bonds, Mutual Funds (Describe and Indicate where assets are held)
Amount $
Real Estate Property (1) - Address – Year purchased & amount purchased – Date appraised
Amount $
Real Estate Property (2) - Address – Year purchased & amount purchased – Date appraised
Amount $
Vehicle (1) - Year, make, model
Amount $
Vehicle (2) - Year, make, model
Amount $
Other assets (Describe)
Amount $
Total Amount $
Personal Loans or LOC (Bank, Address)
Amount $
Mortgage (1) - Property address, mortgage company, branch
Amount $
Mortgage (2) - Property address, mortgage company, branch
Amount $
Vehicle Loan or Lease (1) - Motor co., Bank, term of lease or loan
Amount $
Vehicle Loan or Lease (2) - Motor co., Bank, term of lease or loan
Amount $
Credit Cards Visa & M/C (list cards)
Amount $
Credit Cards (other) - List company names
Amount $
Other (Describe)
Amount $
TOTAL LIABILITIES
Total Amount $
Calculate – Your Net Worth = (Total Assets minus Total Liabilities)
Net Worth $
STATEMENT OF INCOME AND EXPENDITURES (ANNUALLY)
INCOME
Salaries, Wages - (self) (before taxes)
Annually $
Salaries, Wages - (spouse) (before taxes)
Annually $
Rental Income
Annually $
Other Income: EI, CPP
Annually $
Other child support, child tax benefit, pensions,
Annually $
TOTAL INCOME
Total Annual Income $
EXPENDITURES
Mortgage / Rent / Property tax (Monthly)
Annually $
Income Taxes, CPP, EI, RRSP’s (Monthly)
Annually $
Total Loan Payments (Monthly)
Annually $
Total Credit Card Payments (Monthly)
Annually $
Estimated Living Expenses: Utilities, food, recreation, gas, daycare, medical, telephone, cable, insurance (Monthly)
Annually $
TOTAL EXPENDITURES (Monthly)
TOTAL EXPENDITURES (Annually)
Calculate – Your Disposable Annual Income = (Total Annual Income minus Total Annual Expenditures) This information must be consistent with "Personal Expenses" in the Cash Flow Forecast Tool
Disposable Annual Income

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To: Enterprise Brant I/We certify the above statement of my property and debts, including information contained in the appropriate schedules, are true. I/We declare that neither my spouse nor any other person has any claim in or to the assets shown above except as set out therein. The whole of my/our property is shown at a fair valuation. I am not being sued and there are no executions against me, neither do I owe anything except as reported above. I/We hereby authorize Enterprise Brant to at any time obtain such factual and investigate information regarding me/us from any credit bureau, chartered bank, or any other person in connection with advisory, consultative, administrative or financing services as permitted by law to furnish other consumer credit grantors and credit bureau with particulars of the credit application and subsequent credit experience, if applicable and to retain this application for the Enterprise Brant records. I/We acknowledge that the Federal Development Agency for Southern Ontario or their successor may have access to the records of the business at any time.

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Step 1 of 4

PERSONAL FINANCIAL STATEMENT

STATEMENT OF PERSONAL ASSETS AND LIABILITIES

STATEMENT OF INCOME AND EXPENDITURES (ANNUALLY)

Loan Request Summary

Other Information