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Broker License Application

By Dorothy Crawford,2014-04-07 21:06
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Broker License Application

    VERICO Financial Group Inc.

    P: 1.866.983.7426

    F: 1.877.983.7426

     ?The information contained in this application will help our Broker Licensing Committee assess your request to be granted a VERICO License. The submission of this information places no continuing obligation on either party. The information contained in the application will be held in confidence.

Personal Information

    Date: Email: Name: Fax #: Home telephone #: Work#: Home address:

     (Street)

     (City) (Province) (Postal Code)

    Date of Birth: Driver's License Number: Social Insurance Number:

Former residence:

    Address:

     (Street)

     (City) (Province) (Postal Code)

Previous Broker Experience

    1) Company:

     Address:

     Position: Employed from to

     Describe responsibilities:

    2) Company:

     Address:

     Position: Employed from to

     Describe responsibilities:

    3) Company:

     Address:

     Position: Employed from to

     Describe responsibilities:

Business Analysis

1) Do you plan to spend full-time in this business? ; Yes ; No

    If no, please explain your other obligations ______________________________________

    2) Are you presently a Realtor ; Lawyer ; Financial Planner ; Insurance Broker ;

3) Are you a member of CAAMP ; Yes ; No

    4) Are you a member of MBABC, AMBA, or IMBA ; Yes ; No ; Other

5) Have you obtained your AMP designation ; Yes ; No

    6 What was your loan volume for the most recent 12 months?

    7) How many closed loans did you have in the most recent 12 months?

    8) What was your gross commission for the most recent 12 months?

    9) How many, if any, mortgage agents are presently employed by you?

Business Ownership

    ; Sole Proprietorship ; Partnership ; Corporation

     If corporation, corporation name

    State partners' or shareholders' names and percentage of ownership: (All partners and officers must also complete an application.)

    Name Home Address No. of shares %

The following individual will be the responsible broker:

    Name: Broker License #: Address: Proposed location:

     (Street address

     (City) (Province) (Postal Code)

    Is the proposed location a:

    ;Store Front Location ;Office Space ;Home Office

Do you have an ownership interest in any other mortgage brokerage business?

    ; Yes ; No

Please complete the following, have you ever:

     Been Convicted of a felony No ? Yes ? If Yes please provide details:

     Had your Mortgage broker license suspended or listed on probation No ? Yes ? If Yes

    please provide details:

     Had legal action filed against you or your company within the last five years No ? Yes

    ? If Yes please provide details:

     Had legal action initiated by you or your office within the last five years No ? Yes ? If

    Yes please provide details:

     Filed for bankruptcy No ? Yes ? If Yes please provide details:

    Breached a mortgage act regulation on any of the CAAMP Ethics of Best Practices

    Standards No ? Yes ? If Yes please provide details:

     To the best of your knowledge past or present employed an agent that has been

    accused or committed a breach of mortgage, criminal or privacy laws No ? Yes ? If

    Yes please provide details:

    Do you currently have Errors & Omissions Insurance No ? Yes ? If Yes please provide

    amounts and provider:

     Do you currently have a privacy policy and procedure standards in compliance with all

    applicable privacy laws Yes ? No ? If no please provide details:

    Fellow Mortgage Brokers / Originators / Lenders 1) Contact:

     Address: Telephone:

2) Contact:

     Address: Telephone:

3) Contact:

     Address: Telephone:

Mortgage Lender References

Has any lender refused to do business with you or your firm or any agent employed by you

    either past or present for any reason?

    ; Yes ; No

If Yes Please Provide Explanation

    ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

    As part of the VERICO membership due diligence program please authorize VERICO to check your references with the following lenders. All inquiries are strictly confidential.

; Yes I authorize VERICO to contact these lenders

TD Canada Trust Street Capital Firstline Mortgage

    Scotia Bank National Bank HSBC

    First National Merix MCAP

    Resmor Maple Trust Home Trust

    ING Direct Maquarie Other

    As part of the VERICO membership due diligence program please authorize VERICO to contact the following sources to perform background checks

; Provincial Licensing &/or regulatory authority

    ; REDX

    ; Equifax

Please indicate your annual loan volumes **Strictly Confidential**

For Calendar Year _________

    TD Canada Trust $ # Street Capital $ # Scotia $ # Firstline $ # First National $ # MCAP $ # HSBC $ # National Bank $ # Maple Trust $ # Merix $ # ING $ # Maquarie $ # Resmor $ # Home Trust $ # Bridgewater $ # HSBC $ # Household $ # Credit Unions $ # Other $ #

    $ #

Please provide a listing of your agents: (if more space required please attach)

     ?1) Explain briefly your interest in affiliating with the VERICO Network.

    It is understood that by completing this application you confirm you are in the position to be able to form a relationship with Verico Financial Group Inc. For further clarification, you confirm you are currently not in a legal binding contract that would not allow you to approach Verico Financial Group Inc at this time. You agree that you have approached Verico Financial Group Inc on your own merit with the purpose of pursuing potential membership with Verico Financial Group Inc. and have not been solicited by Verico Financial Group Inc The purpose of this application is for information only, and it is in no way binding upon either VERICO Financial Group Inc. or the applicant. It is, however, understood that the applicant supplies the information contained herein to the best of his/her knowledge and ability and that VERICO Financial Group Inc. relies on the contents herein in making a meaningful evaluation of applicant’s qualifications. In order to assess applicant’s qualifications to join the VERICO network, VERICO Financial Group Inc. may conduct certain background investigations, including but not limited, to credit bureau reports and the applicant hereby authorizes VERICO Financial Group Inc. to conduct such investigations during the application process and, if membership is granted, from time to time thereafter as it may deem necessary.

Submitted this day of , .

By

    (Signature of Applicant)

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