11833 MG-2020/04

Page 1 of 2

Customer Consent & Disclosure

1. Quebec residents only: It is the express wish of the parties that this document and any related documents be drawn up in English.
Les parties aux présentes ont expressément demandé que ce document et tous les documents s’y rattachant soient rédigés en anglais.
2. Credit Bureau Consent and Privacy Authorization: By providing CIBC with my personal information in this application, or in
connection with my existing CIBC products and services, I consent to the collection, use, and sharing of my personal information in
accordance with CIBC’s privacy policy called Your Privacy is Protected, which is available at any banking centre or https://www.cibc.com.
I also consent to CIBC, its agents and service providers obtaining my credit report from a credit or consumer reporting agency. During
the course of our relationship, I acknowledge that CIBC, its agents and service providers will also collect my credit, financial and related
personal or business information. CIBC may obtain this information from credit or consumer reporting agencies, or any third party with
whom I have had, or may have, a financial relationship, and CIBC may share that information with these parties. This information may
be used or shared for the following purposes: credit determination and monitoring, product and service qualification, identification,
servicing and fraud protection, product and service updates or promotions and complying with laws. My consent is valid for as long as
I have a product or service with CIBC and for a reasonable time after that. CIBC can provide me with the contact information of the
credit or consumer reporting agency upon request. “Service provider” includes a person or entity that has been engaged in connection
with a) the servicing, origination, insurance, maintenance, collection or operation of the loan, or b) the provision of services or benefits
to me, including loyalty programs.
Including a Social Insurance Number (SIN) in a credit bureau request is the best way to make sure credit bureau information accurately
refers to the right person. However, this is completely voluntary, and I understand that if I choose not to give permission, this by itself
will not prevent me from continuing the application. By checking the “Yes” box below, I give my consent to include my SIN in a credit
bureau request.
3. Borrower Acknowledgement and Consent: I agree that if the loan is granted in whole or in part, or if CMHC or another mortgage
insurer pre-qualifies the loan or agrees to insure the loan: a) the granting, pre-qualification or insurance is not confirmation that I and
any co-applicant(s) have the ability to pay the loan, or confirmation of the value or condition of the property (even if an appraisal or
inspection was performed), and b) all information obtained from or about me and any co-applicant(s) in connection with approving the
loan, including credit bureau information, will be accessible to and may be used by the mortgage insurer for any purpose related to the
provision of mortgage insurance generally. Any information retained by the mortgage insurer in that regard will be subject to federal
access to information and privacy legislation.
4. Referral Sources: I authorize CIBC to notify the referral source involved in this transaction, if any, whether my application has been
approved, of any conditional financing requirements and the amount. I acknowledge that CIBC has advised me of and I consent to
payment by CIBC of a referral fee, where applicable, to the referral source including, but not limited to, real estate brokerage, builder
or developer.
5. Electronic Document Regulation: By checking the “Yes” box below, I agree to receive documents electronically via CIBC secure
email. These documents may include information that the Bank Act or other regulation requires be provided in writing. Depending on
the product I select, the documents may include Borrower Acknowledgement, Disclosure Statement (including Schedule of Non-Interest
Charges), Application for Creditor Insurance, Certificate of Creditor Insurance, Refinance/Replacement Statement and Line of Credit
Fees and Services. I will retain copies of these documents and this consent for my records. CIBC will retain all of these documents for
seven years after my loan is paid off. This consent takes effect immediately. I am responsible for advising CIBC of any changes to my
email address. I may cancel this consent at any time by contacting my Mortgage Advisor.

Social Insurance Number

I give my consent to include my SIN in a credit bureau request. Yes checkbox No checkbox

Electronic Document Delivery

I agree to receive documents electronically via CIBC secure email, as outlined in section 5. Yes checkbox No checkbox

Marketing Messages
I agree that CIBC may send me electronic messages and provide me with information on financing Yes checkbox No checkbox

products through electronic means. I may withdraw consent at any time by contacting CIBC at
1 800 465-CIBC (2422). I will not be refused products or services just because I withdraw my consent
to the use of my information for marketing purposes.

X
Date (mmm/dd/yyyy) Name of Applicant Signature of Applicant (sign within box)
 11833 MG-2020/04
Page 2 of 2

Customer Consent & Disclosure

Social Insurance Number

I give my consent to include my SIN in a credit bureau request. Yescheckbox No checkbox

Electronic Document Delivery

I agree to receive documents electronically via CIBC secure email, as outlined in section 5. Yescheckbox No checkbox

Marketing Messages
I agree that CIBC may send me electronic messages and provide me with information on financing Yescheckbox No checkbox

products through electronic means. I may withdraw consent at any time by contacting CIBC at
1 800 465-CIBC (2422). I will not be refused products or services just because I withdraw my consent
to the use of my information for marketing purposes.

X
Date (mmm/dd/yyyy) Name of Applicant Signature of Applicant (sign within box)

Social Insurance Number

I give my consent to include my SIN in a credit bureau request. Yescheckbox No checkbox

Electronic Document Delivery

I agree to receive documents electronically via CIBC secure email, as outlined in section 5. Yescheckbox No checkbox

Marketing Messages
I agree that CIBC may send me electronic messages and provide me with information on financing Yescheckbox No checkbox

products through electronic means. I may withdraw consent at any time by contacting CIBC at
1 800 465-CIBC (2422). I will not be refused products or services just because I withdraw my consent
to the use of my information for marketing purposes.

X
Date (mmm/dd/yyyy) Name of Applicant Signature of Applicant (sign within box)

CIBC Head Office, Commerce Court, Toronto, Ontario, Canada M5L 1A2; https://www.cibc.com