603-04-061E (11/18/2013)
This form authorizes B2B Bank to release information on my B2B Bank Broker Mortgage to my mortgage broker.
Please return this form to:
B2B Bank, Broker Mortgages
199 Bay Street, Suite 600
PO Box 279 STN Commerce Court
Toronto ON M5L 0A2
Fax: 1.866.947.7405
The purpose of this form is to (please select one)
authorize the mortgage broker (this authorization cancels any previous authorization)
cancel the existing authorization of the mortgage broker
Client information
Last name First name Last name First name
Last name First name Last name First name
Property address (street no. & name, apt. no.) City Province Postal code
Mortgage reference number Phone number
( )
Mortgage broker information
Broker name Phone number
( )
Address (street no. & name, apt. no.) City Province Postal code
Client authorization
This Client Consent Form is for mortgage information purpose ONLY, and does not authorize my broker to request
or complete any changes to my mortgage on my behalf.
The information to be provided on my B2B Bank mortgage is limited to the following:
• Information regarding the Mortgage interest rate and how interest is changed
• Mortgage payment frequency, mortgage payment due date and payment amount
• Principal balance
• Mortgage early prepayment privileges
• Terms and features (privileges) of the mortgage
• Whether B2B Bank remits property taxes on my behalf
• Whether the mortgage has creditor insurance
Once signed and submitted to B2B Bank at the above address, this authorization will be in place until such time as a
separate form is received to cancel this authorization.
Client signature
Date (mm/dd/yyyy)
Client signature
Date (mm/dd/yyyy)
Client signature
Date (mm/dd/yyyy)
Client signature
Date (mm/dd/yyyy)
Client Consent Form
