personal information form - mty...
TRANSCRIPT
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PERSONAL INFORMATION FORM
Name
Date
Please attach your curriculum vitae
http://www.mtygroup.com
VALENTINEVANELLIS
VIE & NAM
BIG SMOKE BURGER CAFÉ DEPOT
COUNTRY STYLE CULTURES
DAGWOODS EXTREME PITA
JUGO JUICE KORYO KOREAN
KIMCHI KOYA JAPAN
LA BOITE VERTE LA CRÉMIÈRE
LA DIPERIE MANCHU WOK
MMMUFFINSMR SOUVLAKI
MR. SUBMUCHO BURRITO
MUFFIN PLUS SOUTH ST. BURGER
SUKIYAKISUSHI GO
SUSHIMANSUSHI SHOP
TACO TIME TANDORI
TCBY CANADA THAÏ EXPRESS
THAIZONETHE WORKS
TIKI MING TIMOTHY'S
TOSTO TUTTI FRUTTI
VALENTINE VANELLIS
CAFÉ VAN HOUTTE VIE&NAM
AU VIEUX DULUTH VILLA MADINA
WASABIYUZU SUSHI
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PERSONAL INFORMATION
Name Occupation
Address
City Prov.
Cell phone
Postal Code
E-mail
Date of Birth S.I.N. Marital Status
Spouse’s Name Occupation
Have you personally, or any company in which you were a partner, declared bankruptcy? Yes No
Explain
Actual health status Excellent Good Acceptable Weak
Explain if Weak or Acceptable
Education Level
Degree(s) obtained
Spoken Language(s) Excellent Good Acceptable WeakFrench English Other:
GENERAL INFORMATION
How much capital do you want to invest?
Do you have a partner? Yes No
If yes, name of partner
Address
City Prov. Postal Code
Gender
FRANCHISE
All the information will be treated confidentially. This form is not an agreement and does not bind M.T.Y. Group nor the person herein
mentioned in any way. Each partner shall fill in the present form.(Please print or type)
Do you have a financing source? Yes No
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3
BUSINESS EXPERIENCEName of present employer
Address
City Prov. Postal Code
Position or responsibilities
Duration of employment from to
Name of previous employer
Address
City Prov. Postal Code
Position or responsibilities
Duration of employment from to
Have you already owned or operated a business? Yes No
Which type of business? Please describe
BANKING INFORMATION
List all bank / trust company accounts in which you have accounts or credits.
ACCOUNTS, NOTES & LOANS RECEIVABLE
$
$
$
$
$
$
$
$
Due dateLoansBalance of accountName and bank branch and/or trust
$
$
$
$
Due dateLoan typeAmountName and address of debtor
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4
STOCKS, BONDS & SECURITY
LIFE INSURANCE
REAL ESTATE
All the rights and legal titles of any real estate listed below are completely owned by the undersigned.
Past Year IncomeActual Market Value CostValue and Number Description Registered in the name of
Name of insured person
Name of beneficiary
Insurance Company Type of policy Book value
Amount borrowedon the policy
Purchase date
Description &address Size Improvements
Amount ofmortgages
Installment date
Duedate
Actual value
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5
PERSONAL BALANCE SHEET
In date of
ANNUAL INCOME CONTINGENT LIABILITIES
Cash on hand unrestricted (section A) $ Notes payable (section A) $
Accounts & loans receivable (section B) $ Credit card balances $
Stock, bonds & security (section C) $ Accounts & bills due $
Life insurance (indicate surrender value) (section D) $ Loans against insurance (section D) $
Real estate (section E) $ Real estate mortgages (section E) $
Automobiles in your name $ Other liabilities (indicate) $
Other assets (indicate) $ $
$ $
$ TOTAL LIABILITIES (2) $
TOTAL ASSETS (1) $ NET WORTH (3)(= (1) - (2)) $
Salary $ As endorser or guarantor $
Bonus & commissions $ On leases or contracts $
Dividends & interests $ Legal claims $
Real estate income $ Provisions for income tax $
Other income (indicate) $ Other liabilities $
$ $
TOTAL $ TOTAL $
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6
REFERENCES (OTHER THAN FAMILY)
NAME/ADDRESS KNOWN SINCE EMAIL
1
2
3
PREFERRED LOCATION(S)
First choice
Brand Area
Second choice
Brand Area
Third choice
Brand Area
Are you willing to relocate? Yes No
Name Signature
TELEPHONE
Date
The undersigned hereby certifies that the information given in the foregoing statement is true and accurate and that no unfavorable information known to the undersigned or called for herein has been omitted. M.T.Y. Group is hereby authorised to obtain such information as it may require concerning said statement, which at all times shall remain the property of M.T.Y. Group., and to procure consumer reports from credit reporting agencies and obtain personal and credit information from persons other than consumer reporting agencies. I hereby waive any responsibility from any person giving or receiving such information. It is understood that all information provided in this form and obtained pertaining to same will be treated confidentially by M.T.Y. Group.
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Form userFile attachment on: 2019/09/27 11:12:12
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