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Questionaire
RBLCAPITAL CORP                                                                                                      APPLICATION Personal InformationApplicant 1                                                                     Applicant 2
First Name   First Name  
Last Name   Last Name  
Date of Birth   Date of Birth  
SIN   SIN  
Marital Status   Marital Status  
# of Dependents   # of Dependents  
Home Phone #   Home Phone #  
Cell   Cell  
Fax #   Fax #  
Email   Relationship to Applicant 1  
 How do you prefer to be contacted by me?                                                                Address Information – Applicant 1
Current Address
Time at Residence (yrs/mths)  Own/Rent/Live with Parents  Monthly Rent  
   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code  
Previous Address (if less than 3 years at current)
Time at Residence (yrs/mths)  Own/Rent/Live with Parents     
#             Street Name      Street Ext (ex. Road)              City                     Province            Postal Code 
 Address Information – Applicant 2
Current Address - same as applicant 1 q
Time at Residence (yrs/mths)  Own/Rent/Live with Parents  Monthly Rent  
   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code 
Previous Address (if less than 3 years at current) - same as applicant 1 q
Time at Residence (yrs/mths)  Own/Rent/Live with Parents     
#             Street Name      Street Ext (ex. Road)              City                     Province            Postal Code 
 
 Employment Information – Applicant 1
Do you have your 2007 and 2006 Notice of Assessment?  
Do you owe any income tax?  
 
Current Employer’s Name -
Time with Current Employer (yrs/mths)  Full time/Part time/Contract/Self Employed
Address of Employer#   Street Name   Street Ext (ex.road)         City                    Province               Postal Code 
Phone: Fax: Email:  
Job Title Annual Income
Income Type (salary/hourly/commission/self employed) – indicate one
 Employment Information – Applicant 2
Do you have your 2007 and 2006 Notice of Assessment?  
Do you owe any income tax?  
 
Current Employer’s Name -
Time with Current Employer (yrs/mths)  Full time/Part time/Contract/Self Employed
Address of Employer#   Street Name   Street Ext (ex.road)         City                    Province               Postal Code 
Phone: Fax: Email:  
Job Title Annual Income
Income Type (salary/hourly/commission/self employed) – indicate one
 Other Income
Interest  Child Support  Pension  Alimony  Other (specify) 
  Assets
Type Description Value
Savings    
RRSP    
Vehicle    
Vehicle    
Stock/Bonds    
Household Goods    
Other    
Other    
 Liabilities
Type Description Balance
Credit Card    
Credit Card    
Credit Card    
Line of Credit    
Line of Credit    
Car Lease    
Other    
 
Current Mortgages/Properties Owned
Address                       Owner Occupied   Rental   Second Home  ______________________________________________________________________________________   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code
Property Value  Original Purchase Date  Original Purchase Price 
Annual Taxes  Condo Fees  Mortgage Payment Rental Income
Mortgage Holder Balance on Mortgage Interest Rate  Mortgage Maturity Date 
Address                       Owner Occupied   Rental   Second Home  ______________________________________________________________________________________   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code
Property Value  Original Purchase Date  Original Purchase Price 
Annual Taxes  Condo Fees  Mortgage Payment Rental Income
Mortgage Holder Balance on Mortgage Interest Rate  Mortgage Maturity Date 
Address                       Owner Occupied   Rental   Second Home  ______________________________________________________________________________________   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code
Property Value  Original Purchase Date  Original Purchase Price 
Annual Taxes  Condo Fees  Mortgage Payment Rental Income
Mortgage Holder Balance on Mortgage Interest Rate  Mortgage Maturity Date 
Address                       Owner Occupied   Rental   Second Home  ______________________________________________________________________________________   #          Street Name      Street Ext (ex. Road)              City                     Province            Postal Code
Property Value  Original Purchase Date  Original Purchase Price 
Annual Taxes  Condo Fees  Mortgage Payment Rental Income
Mortgage Holder Balance on Mortgage Interest Rate  Mortgage Maturity Date 
 In submitting this application, I/we warrant and confirm that the information given in this application is true and correct and I/we understand that it is being used to determine my/our credit responsibility.  I/we authorize Dominion Lending Centres to obtain and/or exchange personal information with any personal information agent towards establishing or verifying my financial standing.  You are furthermore authorized to disclose, in response to direct enquiries from any other lender or credit bureau, such information on my loaning account as you consider appropriate and I agree to indemnify you against and save you harm from any and all claims in damages or otherwise arising from such disclosure on your part.  You are also authorized to retain the application whether or not the relative mortgage is approved.