MORTGAGE VERIFICATION FORM
Date: ______________________________________ Please address replies to: _________________________________
Mortgage Co.: ______________________________ Name: _________________________________________________
Address: __________________________________ Company: ______________________________________________
Mortgage No.: ______________________________ Address: _______________________________________________
Fax No.: ___________________________________
RE: Name: _____________________________
Address: ___________________________ Telephone: ____________________ Fax: __________________
I/We hereby authorize you to provide _______________________________________with the mortgage information listed
below and any other pertinent information they may require. Would you please return this form to the above address as soon
as possible. Thank you.
________________________________________________
Owners’ Signature
1. The current mortgage balance of $ __________________________________________
2. Does this include accrued interest? _________________________ How much accrued interest? $_______________________
3. Mortgage Payment $ __________________________________ P.I. or P.I.T. (excluding life insurance) per _______________
4. Arrears if any $ ___________________________________________Date of last payment _____________________________
5. If applicable, what is the tax account balance? $ _______________________________________________________________
6. Interest rate of mortgage ________________________%. Term renewal date _______________________________________
7. Is this an insured mortgage? (i.e. CMHC, GEMICO) ___________________________________________________________
8. What is the remaining amortization of the mortgage? ___________________________________________________________
9. Can the mortgage be paid out? ______________________________________________________________________________
10. If, so, how much would the payout penalty be? ________________________________________________________________
11. Can the mortgage be paid out and remortgaged with your company? _____________________________________________
12. The payout penalty, if any? ________________________________________________________________________________
13. Can this mortgage be assumed without qualifying? ____________________________________________________________
14. Do you have a copy of the Survey Certification or the Real Property Report? ______________________________________
If yes, please enclose a photocopy for the benefit of your client.
Confirmed by: ________________________________________________ Title: ______________________________________
Date: ______________________________________
Form Made Fillable by eForms
15. Please indicate if there are any other special terms or prepayment privileges of this mortgage.
____________________________________________________________________________________________________________
I, the undersigned below, confirm that the above stated information is correct.
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