Client Information Form (Real Estate)

Contact 1 First Name:  (as appears on your identification) Home Telephone#:  Last Name:  (as appears on your identification) Business Telephone#:  Date of Birth:  Mobile Telephone#:  S.I.N.:  Fax Telephone #:  Email Address:    Occupation:    Business Address:  Present Address:  New Address:    Resident of Canada     First Time Home Buyer?YesNo     Add Contact (e.g. spouse) Remove Contact

Spousal Status

MarriedCommon LawSingleSeperatedDivorcedWidowed

Agent/Broker Contact Information
Present Address:		Business Address:
New Address (if applicable):
Real Estate Agent Name:		Real Estate Agent Telephone:
Mortgage Broker or Bank Manager:

Property Status

PurchaseSaleMortgage

Property Address (if different from above): Closing Date: < September 2010 > Sun Mon Tue Wed Thu Fri Sat 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9

Referral Information

New ClientExisting Client

Retainer

We hereby retain Gardiner Miller Arnold LLP ("GMA"), confirm that we have reviewed GMA's standard retainer posted on GMA's website, agree to be bound by said retainer and understand that the retainer will not become effective until accepted by GMA.

Law Society Verification Requirements (please select the option applicable to you)

I am an individual. If I am submitting this form to GMA electronically I promise to provide GMA with a copy of an original government issued identification that is valid and has not expired, including a driver’s licence, birth certificate, provincial or territorial health card (if such use of the card is not prohibited by the applicable provincial or territorial law), passport or similar record within 14 days of electronic submission of this form. This may be done by sending a copy of the above described identification by fax, email or regular lettermail to GMA and I acknowledge that GMA has the right to examine the original of the submitted identification.

I am an organization such as a corporation or society that is created or registered pursuant to legislative authority. If I am submitting this form to GMA electronically I promise to provide GMA with a copy of a written confirmation from a government registry as to the existence, name and address of the organization, which includes the names of the organization’s directors, if applicable, such as, a certificate of corporate status issued by a public body, a copy obtained from a public body of a record that the organization is required to file annually under applicable legislation, or a copy of a similar record obtained from a public body that confirms the organization’s existence, within 60 days of electronic submission of this form. This may be done by sending a copy of the above described identification by fax, email or regular lettermail to GMA and I acknowledge that GMA has the right to examine the original of the submitted identification.

I am an organization other than a corporation or society (e.g. a trust or partnership which is not registered in any government registry). If I am submitting this form to GMA electronically, I promise to provide GMA with a copy of the organization’s constating documents, such as a trust or partnership agreement, articles of association or any other similar record that confirms its existence as an organization within 14 days of electronic submission of this form. This may be done by sending a copy of the above described identification by fax, email or regular lettermail to GMA and I acknowledge that GMA has the right to examine the original of the submitted identification.

Please note that we will be following up on our introductory letter that contains a section on frequently asked questions (for purchases only). A letter will also request more specific information.

A note on collection of personal information: GMA uses and discloses your personal information only for the purposes it was collected. GMA does not sell or rent personal information to any organization or person for any reason. GMA acknowledges that any information collected in this form is governed by applicable privacy legislation.

 

  This information will be sent directly to Patricia Malcangi or Cathy Veal, and one of them will be in contact with you shortly.