Disclosure To Borrower Page 2
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2The Lender is an affiliated or related company of the brokerage and the brokerage will receive a commission and
may receive contingent commissions from the Lender.
Bonus
The Brokerage may receive a bonus or contingent commission from the Lender. Contingent commissions may be
based on factors such as the volume of business placed with the Lender, or a certain percentage of growth in the
placement of business over a previous period.
Other Compensation
The Lender involved in this transaction may provide the brokerage fees or incentives dependant on the interest rate
and the term(s) accepted by the Borrower. The brokerage may retain the fees and incentives or may use them for
the benefit of another of the brokerage’s clients.
Referral – No Referral Fee Paid
The Borrower was referred to the brokerage, and no referral fee is being paid to the referring party.
Referral – Referral Fee Paid
The Borrower was referred to the brokerage, and a referral fee is being paid to _____________________________.
Other conflict not described above
___________________________________________________________________________________________
Information on Brokerage:
The Brokerage is representing _________________________ in this transaction.
The Brokerage has placed over 50% of their business with __________________, during the previous fiscal year.
The Brokerage has acted for ______ lenders during the previous fiscal year.
The Brokerage has acted as a lender in the previous fiscal year.
Name and Address of Brokerage: ____________________________________________. Licence #: _________
________________________________________________________________________
Name of Authorized Person signing on behalf of Brokerage: _______________________, Licence #: __________
Date:___________________________ Authorized Signature:___________________________________________
Disclosure of Material Risks:
The brokerage has reviewed with the borrower the general risks associated with a mortgage commitment. These
risks include: risk of falling arrears, default and foreclosure, prepayment penalties, etc.
In addition, the following specific risks associated with this particular mortgage transaction have been
discussed:_________________________________________________________________________________
Acknowledgement
I / we acknowledge receipt of a copy of this form, and corresponding Amortization Schedule and that I / we have
reviewed the information.
I / we waive the 2 business days requirement for this disclosure. Initials:___________
Date:__________________________________ Borrower:______________________________________________
Date:__________________________________ Borrower:______________________________________________
This form is provided “as-is” and Filogix Limited Partnership (“Filogix”) makes no representations, warranties or conditions with regard to this form. Without limiting the
generality of the foregoing, Filogix does not warrant that this form complies with any applicable legislation and/or regulation. To the maximum extent permitted by applicable
law, Filogix disclaims all warranties and conditions implied or statutory, including, but not limited to, any warranties or conditions of merchantability, fitness for a particular
purpose, and non-infringement.
Disclosure to Borrower: Cost of Borrowing & Conflict of Interest
Filogix LP
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