Registrar of Mortgage Brokers
2800 - 555 West Hastings
Vancouver, BC V6B 4N6
Ph. 604-660-3555 / Toll-free: 1-866-206-3030 (BC)
Facsimile: 604-660-3365
Mortgagebrokers@ficombc.ca
FORM 17
STATUTORY DECLARATION RESPECTING WIND-UP
OF MORTGAGE BROKER
IN THE MATTER OF the Mortgage Brokers Act
I, _________________________, solemnly declare that ______________________________________:
(Director or DI Name)
(Legal name of Mortgage Broker: the “Mortgage Broker”)
has ceased engaging in all registerable mortgage broker activities and has terminated its
mortgage broker registration.
All obligations of the mortgage broker where conditions remain unsatisfied or require the service
of a registered mortgage broker, including the administration of mortgages in the mortgage
broker’s name, have been assigned to
_____________________________________
Name of registered mortgage broker
OR
There are no outstanding obligations of the mortgage broker which require the service of a
registered mortgage broker.
The mortgage broker handles trust monies and attached to this Statutory Declaration are final
financial reports in Forms 14 and 15 from the last year end date to the date of termination.
OR
The mortgage broker does not handle trust money and attached to this Statutory Declaration is a
year-end financial report in Form 12 from the last year end date to the date of termination.
All of the files and records of the mortgage broker shall be kept at the following location:
_________________________________________________________________________________ .
And I make this solemn declaration conscientiously believing it to be true and knowing that it is of the
same legal force and effect as if made under oath and by virtue of the Evidence Act,
DECLARED BEFORE ME AT ____________________ )
In the Province of British Columbia
)
this _____________ day of ____________, 20_____.
)
________________________________
)
Signature
___________________________________________
)
)
A Commissioner for taking Affidavits for British Columbia