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

2

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

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

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

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 $

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.

Form userFile attachment on: 2019/09/27 11:12:12

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