AFFIDAVIT OF STATUS

Appendix A – Mortgage Amending Agreement (F.25800-SAP-012) – Newfoundland and Labrador only

CANADA

PROVINCE OF Newfoundland and Labrador

TO WIT:

I [Name], of , Province of Newfoundland and Labrador, make oath and say as follows:

1.  THAT I am the person executing the Mortgage Amending Agreement and, as such, have personal knowledge of the facts (sworn below).

2.  THAT the words “Spouse”, “Matrimonial Home”, “Marriage Contract”, “Cohabitation Agreement” and “Separation Agreement” as used below have the same meanings as defined in the Family Law Act, R.S.N.L. 1990, c. F-2 (the “Act”).

3.  THAT at the time of the execution of the Mortgage Amending Agreement:

(a)  I was at least nineteen years of age;

(b)  I was not a Spouse;

(c)  The property being mortgaged under the Mortgage Amending Agreement was not a Matrimonial Home;

(d)  No other person had any right to or unregistered interest in the property being mortgaged under the Mortgage Amending Agreement;

(e)  I had not entered into a Cohabitation Agreement, Separation Agreement, or Marriage Contract nor entered a designation pursuant to Section 9 of the Act in respect of the property being mortgaged under the Mortgage Amending Agreement; and

(f)  I was not and will continue not to be liable for any tax imposed under the School Tax Authorities Winding Up Act, S.N.L. 1992, c. s-10.1 at least until the registration of the Mortgage Amending Agreement.

4.  THAT I have not at any time owned or operated a commercial venture required to collect, pay or remit a Newfoundland and Labrador tax or royalty.

5.  THAT I am not liable for, or in arrears of, any tax or other debt imposed under the Revenue Administration Act, S.N.L. 2009,
c. R-15.01.

6.  THAT I am presently a resident of Canada within the meaning and intent of the Income Tax Act, R.S.C. 1985, c. 1.

7.  THAT to the best of my knowledge, information and belief, at this date there are no statutory liens of any kind whatsoever charging or encumbering my assets and specifically the property being mortgaged under the Mortgage Amending Agreement.

8.  THAT there are no leased chattels affixed to the property being mortgaged under the Mortgage Amending Agreement.

9.  THAT I am not an employer as defined under either of the Labour Standards Act, R.S.N.L. 1990, c. L-2 or the Workplace Health, Safety and Compensation Act, R.S.N.L. 1990, c. W-11.

10.  THAT I have not made an assignment in Bankruptcy pursuant to the Bankruptcy and Insolvency Act, R.S.C., 1985, c. B-3 as amended.

11.  THAT I acknowledge it is an offence to give false information in an Affidavit.

SWORN/AFFIRMED before me at / , in the Province of / Newfoundland and Labrador / ,
this / day of / , 20 / .
Barrister, Commissioner of Oaths or Notary Public in and for the Province of Newfoundland and Labrador (affix seal) / [Name of Mortgagor]

National Bank is a trademark used by National Bank of Canada.

25800-SAP-012 (2013-11-04) Page 2 of 2

National Bank is a trademark used by National Bank of Canada.

25800-SAP-012 (2013-11-04) Page 3 of 3