sylvie@califrs.com 438-494-6894

Personal Report Form

Please complete the attached request as accurately as possible. Then send it back to me signed by email to sylvie@califrs.com. For all other questions, please
contact me at 514-619-5083, and I will be happy to answer you. Be sure that this balance sheet remains confidential.

    Previous address (If less than 3 years)

    [rent text "Rent:"]

    Previous address (If less than 3 years)

    Jobs and Income
    1st Borrower

    Current employer

    If less than 3 years previous employer

    2nd Borrower

    Current employer

    If less than 3 years previous employer

    Active (To have)

    Banking Institution

    Value $

    Bank balance

    Bank balance

    Actions

    Non-RRSP

    Real estate:

    Personal effects:

    R.E.E.R:

    TFSA:

    Automobile:

    Automobile:

    Other

    Creditor (S) (debts)

    Bank

    Deadline

    Nature of the debt

    Balance +/-

    Payment

    Automobile (rental or purchase)

    Mortgage loan

    Personal loan

    Line of credit

    Credit card

    Credit card

    Credit card

    Other:

    Already declared bankrupt? YesNo

    Judgment? YesNo

    Checks without provision? YesNo

    (FOR ADMINISTRATION ONLY) DO NOT COMPLETE:
    REQUIRED READY (1st)

    Kind of loan

    Conventional

    Insured

    Term

    Amortization:

    Goal

    PURCHASE - Property price

    Mobile Home

    REFINANCEMENT: Reason (s)

    Sale-Reason

    Location - Monthly price

    CASH (down payment)

    Rental with option to buy

    DATE OF PURCHASE / SALE / REFINANCING:

    Details relating to the Property for Refinancing / Sale only

    Single-family

    Semi-Comm.

    Age of the building

    Municipal Evaluation

    Semi-detached

    Commercial

    $ For Purchase

    Taxes $

    Condo

    Number of floor (s)

    Date of purchase

    Duplex

    Land area

    Triplex or more

    Living area

    Garage (s)

    Property address:

    Septic tank:

    YesNo

    Well:

    YesNo

    Cadastre number:


    If Income property

    MONTHLY FEES

    REVENUES

    Income (1)

    Income (1)

    Income (2)

    Income (2)

    Rent

    Other

    TOTAL:

    Current mortgage

    Name of current lender

    Balance to date

    Loan maturity date

    Penalty

    Current rate

    Remaining amortization



    I certify that the information provided in this personal report is correct. I accept that Société Immobilière Sylvie Cali-F.R.S, can send this document to any person and / or company related to the execution of this mandate.

    MANDANT 1)

    MANDANT 2)

    In witness whereof I have signed this day