PERSONAL CLIENT-(PSOA)-PERSONAL STATEMENT OF …



|BRANCH: |Acct. Officer Code: |NEG FEES: |DATE (YYYY/MM/DD): |

|      |      |      |      |

|AMT OF LOAN REQ.: |PURPOSE OF LOAN: |

|      |      |

|VISA ACCT NO.: |CUSTOMER MASTER NO.: |NATIONAL INSURANCE NO./NATIONAL I.D.: |MASTERCARD ACCT NO.: |

|      |      |      |      |

|DRIVER’S LICENSE NO.: |EXPIRY DATE (YYYY/MM/DD): |PASSPORT NO.: |EXPIRY DATE (YYYY/MM/DD): |

|      |      |      |      |

|personal information |

|NAME (PLEASE PRINT) |DATE OF BIRTH (YYYY/MM/DD) |AGE |MARTIAL STATUS |NO. OF DEPENDENTS |

|      |      |    | |(INCL SPOUSE)      |

|HOME ADDRESS – NUMBER, STREET, CITY |POSTAL BOX |SINCE (YEAR) |TELEPHONE NUMBERS |SPOUSE’S NAME |DATE OF BIRTH |

|      | | |Home:       Cell:       | |(YYYY/MM/DD) |

| |      |     |Work:       |      |      |

|NAME & ADDRESS OF LANDLORD (IF RENTING) |PREVIOUS ADDRESS |YEARS THERE |

|      |      | |

| | |     |

|NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED |ADDRESS – STREET, CITY, P.O. BOX |TELEPHONE NUMBERS |RELATIONSHIP |

|      |      |Home:       Cell:       | |

| | |Work:       |      |

|NAME OF PERSONAL REFERENCE – IMMEDIATE FAMILY PREFERRED |ADDRESS – STREET, CITY, P.O. BOX |TELEPHONE NUMBERS |RELATIONSHIP |

|      |      |Home:       Cell:       | |

| | |Work:       |      |

|NAME OF BANK OR FINANCIAL INSTITUTION |HAVE YOU ANY JUDGEMENTS OR | YES |IF YES, SEE PAGE 2 |INDIRECT LIABILITIES (GUARANTEES | YES |

|  |LEGAL PROCEEDINGS AGAINST YOU? |NO |(FOR DETAILS ( |OR ENDORSEMENTS FOR OTHERS) |NO |

|HAVE YOU EVER BORROWED |IF YES, WHERE AND WHEN |AMOUNT |HAVE YOU HAD ANY PREVIOUS LOANS |IF YES, WHERE AND WHEN |AMOUNT |

|BEFORE FROM ANY SOURCE? |      | |FROM THE ROYAL BANK? |      | |

|YES NO | |      |YES NO | |      |

|employment information |

|NAME & ADDRESS OF EMPLOYER |TELEPHONE |EMPLOYMENT DATE |PRESENT ANNUAL SALARY OR WAGES |      |

|      | |(yyyy/mm/dd) | | |

| |      |      | | |

|OCCUPATION |POSITION |EMPLOYEE NO. |RENT: 50% 75%       |      |

|      |      |      | | |

|PREVIOUS EMPLOYER |EMPLOYMENT DATE |other |      |      |

|      |(yyyy/mm/dd) |income |(source) | |

| |      | | | |

|NAME & ADDRESS OF SPOUSE’S EMPLOYER |TELEPHONE |EMPLOYMENT DATE |SPOUSE’S ANNUAL SALARY OR WAGES |      |

|      | |(yyyy/mm/dd) | | |

| |      |      | | |

|OCCUPATION |POSITION |EMPLOYEE NO. |TOTAL ANNUAL INCOME |$ 0.00 |

|      |      |      | | |

|PREVIOUS EMPLOYER |EMPLOYMENT DATE |TOTAL MONTHLY INCOME( |$ 0.00 |

|      |(yyyy/mm/dd) | | |

| |      | | |

|financial information |

|asset |amount |liabilities |amount |monthly pmt |

|CASH (ROYAL BANK)       |      |(loans, mortgages, credit cards. all other | | |

| | |debts) | | |

|CASH (OTHER)       |      |MORTGAGE |RENEWAL DATE (YYYY/MM/DD) |      |      |

| | |      |      | | |

|LIQUID INVESTMENTS (STOCKS, BONDS, ETC.) | |BANK LOANS – ROYAL       |      |      |

|      |      |BANK LOANS – OTHER       |      |      |

|LIFE INSURANCE –       | |LOANS – CREDIT UNION       |      |      |

|FACE AMOUNT |PAYABLE TO |      |LOANS – INSURANCE CO.       |      |      |

|      |      |csv | | | |

|OTHER LIQUID ASSETS (SPECIFY) | |CREDIT CARDS – VISA ROYAL – LIMIT $      |      |      |

|      |      |CREDIT CARDS – OTHER – LIMIT $      |      |      |

|REAL ESTATE | | |OTHER DEBTS (SPECIFY) | | |

|      |      |      |      |      |

|AUTOMOBILE | | |      |      |      |

|year and make |      |      |      |      |      |

|year and make |      |      |      |      |      |

|FURNITURE |      |      |      |      |      |

|OTHER |      |      |MONTHLY RENT (IF APPLICABLE) | |      |

|OTHER |      |      |      |SUBTOTAL |$ 0.00 |

|REAL ESTATE OWNED - LOCATION |REGISTERED - OWNER |YR PURCHASED |PURCHASE PRICE |VALUE |EQUITY |FIRE INS |

|      |      |     |      |      |      |     |

|      |      |     |      |      |      |     |

|      |      |     |      |      |      |     |

|APPLICABLE LOAN TYPE |INTEREST RATE VALID UNTIL | ROYAL BANK PRIME PLUS      % |PAYMENT |TERM |AMORTIZATION |

| | |ROYAL BANK PERSONAL LOAN BASE RATE PLUS      % | | | |

| |   /      /    |FIXED      % |      |      |      |

|I/We warrant and confirm the information given herein is true and correct and I/We understand it is being |PAYMENT IN MONTHLY INSTALLMENTS |

|used to determine My/Our credit responsibility. I/We further confirm that no information, which might affect| |

|the Bank's decision to make the loan, has been withheld. I/We hereby authorize and consent to the Bank |BEGINNING ONE MONTH FROM DATE OF NOTE / AGREEMENT |

|receiving and exchanging any financial and other information which it may have in it's possession about |BEGINNING -    /      /    |

|Me/Us with any of it's subsidiaries, agents, third party assignees, other financial institutions, Credit |MATURITY DATE -    /      /    |

|Bureaus or other person of Corporation or with whom I/We may have or propose to have financial dealings from| |

|time to time. I/We indemnify the Bank against any loss, claims, damages, liabilities, actions and | |

|proceedings, legal and or other expense which may be directly and reasonably incurred as a consequence of | |

|the disclosure of the financial information. My/Our deposit account may be charged with the monthly payments| |

|as they mature and I/We agree to pay your customary assessment for any notices of overdue installments. | |

| | | |

|APPLICANT’S SIGNATURE | |CO-SIGNOR (SPOUSE ONLY) |

|SOURCE OF BUSINESS | | | | | | |

|NEW |REFINANCE |FORMER |NEWSPAPER |RADIO |TV |OTHER (SPECIFY) |

|MAIL DROP |DIRECT MAIL |WALK IN |SIGN |STAFF REFERRAL |CLIENT REFERRAL |      |

|JUDGEMENTS OR LEGAL PROCEEDINGS (PARTICULARS) |

|      |

|INDIRECT LIABILITIES (PARTICULARS) |

|      |

|investigation |

|EMPLOYER CONFIRMS |SALARY VERIFICATION/CONFIRMATION DETAILS: |

|POSITION INCOME SERVICE |      |

|PREVIOUS EMPLOYER CONFIRMS | |

|POSITION INCOME SERVICE | |

|SPOUSE’S EMPLOYER CONFIRMS | |

|POSITION INCOME SERVICE | |

|LANDLORD / MORTGAGE HOLDER | |

|MO. PAYMENT YEARS THERE PAYING HABITS – GOOD / SLOW | |

| LIFE INSURANCE APPRAISAL | |

|existing creditors (Verify standing of account with all creditors.) |

|NAME OF COMPANY / BANK |TELEPHONE |DATE ACCT OPENED |HIGH CREDIT |TERMS |BALANCE |RATING |OTHER INFORMATION OBTAINED |

|      |      |   /      /    |      |      |      |      |      |

|      |      |   /      /    |      |      |      |      |      |

|record particulars of last check completed |

|GENERAL INFORMATION |CONFIRMATION |REFERENCE CHECKED |DATE ACCT OPENED |HIGH CREDIT |TERMS |PRESENT BALANCE |RATING |

| |YES |NO | | | | | | |

|AGE | | |      |   /      /    |      |      |      |      |

|      | | | | | | | | |

|ADDRESS | | |      |   /      /    |      |      |      |      |

|      | | | | | | | | |

|EMPLOYER | | |      |   /      /    |      |      |      |      |

|      | | | | | | | | |

|SALARY | | |      |   /      /    |      |      |      |      |

|      | | | | | | | | |

|INVESTIGATOR’S REMARKS |NO. OF YEARS RBC|

|      |CUSTOMER |

| |     |

|COLLATERAL SECURITY | |      |INITIALS |

|HELD TO BE OBTAINED BEING SENT |} | | |

|SHOW FULL PARTICULARS FORM NO. AND | | |      |

|DESCRIPTION OF SECURITY. | | | |

| | | | |

|ENDORSEMENT(S) AND/OR CO-SIGNER(S) (ATTACHED S.O.A.) |

|INSERT NAME(S) AND THE DEGREE OF|} |      |

|PROTECTION AFFORDED SUCH AS NET | | |

|WORTH, ETC. | | |

|TOTAL DEBT SERVICE RATIO |TOTAL MONTHLY PAYMENTS INCLUDING NEW LOAN |      |X 100 =       % (should not exceed 40%) |

|(SPOUSE MUST CO-SIGN IF INCOME BEING USED) |GROSS MONTHLY INCOME |      | |

| | | | |

| | | | |

| | | | |

|INFORMATION CHECK LIST | AUTOMOBILE INSURANCE VERIFIED | REGISTERED CHATTEL MORTGAGE | SALARY ASSIGNMENT |

| |CHATTEL MORTGAGE ON MOTOR VEHICLE TAKEN / BILL OF SALE|SPOUSE’S COVENANT HELD |SALARY DEDUCTION - |

| |ON MOTOR VEHICLE TAKEN | | |

| | | | |

|REFINANCE LOAN #      TRANSIT #:       LOAN NOTE DATE -    /      /    | LOAN #      TRANSIT #:       |

| CREDIT A/C #      TRANSIT #:       | DEBIT A/C #      TRANSIT #:       |

| |

|CREDIT BUREAU RESULTS: |

|      |

| |      |      |APPROVING |

| | | |OFFICER |

| | | |      |

| |CREDIT POLICY EXCEPTIONS |NAME AND SIGNATURE | |

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