Become a memberWe value and support a cooperative spirit Personal Information Form Step 1 of 2 50% Personal informationApplicant's Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Work PhoneFaxEmail* SIN #* Birthdate* Month Day Year Employer Employer's Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Employer PhoneEmployer FaxEmployer Email Number of years employed Position Status Full Time Part Time Spouse's Name First Last Spouse's employer Number of dependants Your Annual IncomeSpouse's IncomeOther IncomeYears at present address Do you Own Rent Monthly Fee Landlord's Name First Last Landlord's PhoneName of Bank Branch Account type Account number Have you borrowed before Yes No Where from? Do you have any loans or credit card balances outstanding? Yes No If yesplease give details and amounts owing: AssetsVehiclesDescriptionMarket Value EquipmentDescriptionMarket Value BuildingsDescriptionMarket Value Cash, bonds, Securities, RRSPs etcDescriptionMarket Value OtherDescriptionMarket Value Net WorthIncome + Assets – Liabilities (amount owed) =I certify that all the information in this statement is true and complete and understand that it will be used by Kitikmeot Community Futures Inc. (KCFI) to determine my creditworthiness. I agree that the KCFI may also give to, receive from and share with others, including credit bureaux, and persons and organizations with whom I have or may have financial dealings, credit and other information about me.Applicant Signature (please type full name)Date Month Day Year Click here to download the Word Document version.
