FSCO 1190E.1 (2016-02-01)
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Mortgage Brokerage
Declaration of Compliance
© Queen's Printer for Ontario, 2016
Name of Principal Broker
, on behalf of
Legal Name of Mortgage Brokerage
do hereby declare, that the brokerage will only accept or conduct business with its licensed Mortgage Brokers and
Agents or those persons or businesses that are licensed as Mortgage Brokerages or are exempt from holding a
I acknowledge that it is an offence under section 45 of the Mortgage Brokerages, Lenders and Administrators Act,
2006 to give false or misleading information to the Superintendent or a person designated by the Superintendent
in respect of any matter related to this Act or the regulations.
Date (yyyy-mm-dd)Signature
Principal Broker Name
Mortgage Brokerage Name
Financial Services
of Ontario
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