Revised March 2015
RESIDENTIAL TITLE INSURANCE POLICY ORDER FORM
Ontario
Please note that Chicago Title does not title insure Indian/Aboriginal/Native Lands
To:
Chicago Title Insurance Company
Date:
Attention:
Residential Title Services
Fax No.: Toll Free: 1-866-214-1953
Tel No:
(289) 816-4465 /Toll Free: 1-888-868-4853
Email: ResidentialTitle@ctic.ca
Click here to enter a date.
Please refer to our website www.chicagotitle.ca for our “Privacy Statement”.
Law Firm Information
Solicitor:
Click here to enter text.
Law Firm:
Click here to enter text.
Address:
Click here to enter text.
Tel.:
Click here to enter text.
Your Firm represents: ☐ Purchaser
Contact: Click here to enter text.
Email: Click here to enter text.
☐ Vendor
☐ Lender
Additional Law Firm involved in the transaction
Solicitor:
Click here to enter text.
Law Firm:
Tel.:
Click here to enter text.
Email: Click here to enter text.
This Firm represents:☐ Purchaser
☐ Vendor
Click here to enter text.
☐ Lender
Policies Information:
☐Loan Policy
Closing Date: Click here to enter a date.
☐Owner Policy
☐Existing Owner Policy (Single family residence only)
Original Transfer Date: Click here to enter a date.
Purchase price or current assessed value:
$Click here to enter text.
☐Transaction Protection Coverage for: ☐Owner ☐ Lender 1 ☐ Lender 2
(Note: This coverage is not available for Private Mortgages, Existing Owners or Mortgage enforcement
proceedings Transactions)
Tax Service Required:
No ☐ Yes ☐
($20 per parcel, plus disbursements)
Please note that a separate invoice will be sent by Tax Services
Please provide the Assessment Roll No.
Click here to enter text.
Transaction Information
☐Purchase / Purchase Price: $ Click here to enter text.
Click here to enter text.New Mortgage / Mortgage Refinancing (the borrower owns the Land)
☐Other (Please provide details): Click here to enter text.
Purchaser / Mortgagor Information
Name: Click here to enter text.

For Corporate Purchaser/Mortgagor: Corporate Profile and Borrowing Resolution for the Borrower, if Corporate
Borrower
☐Obtained ☐ Not yet, but will be obtained before closing
Interest Held
☐Fee Simple
☐Leasehold
Lease by:Click here to enter text. in favour of:
Click here to enter text.
Registration No. :Click here to enter text.
Registered on: Click here to enter a date.
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☐Other (Please provide details): Click here to enter text.
SELECT ONLY THOSE ITEMS THAT APPLY TO THIS TRANSACTION:
☐Non arm’s-lengh transaction (i.e. parties are related to each other)
 Please explain the nature of the relationship:
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 If applicable, please provide current tax assessment:
Click here to enter text.
☐ Power of Sale/Mortgage enforcement proceedings transaction
 Please provide a copy of the Parcel Register
☐ Another Title Insurer refused to insure this transaction
 If applicable, please provide details:
Click here to enter text.
☐ Not acted for any of the parties before this transaction
 Please confirm that you have personally examined and kept copies of valid photo IDs: Yes ☐ No☐
☐Recent Activity (purchase/Mortgage/Discharge within the last 12 months)
 Please provide a copy of the PIN including Deleted Instrument.
☐Power of Attorney is being used by one of the parties to the transaction – Please complete the questionnaire attached
to this order form as Schedule 1.
☐No Existing Mortgage to be paid out and discharged on closing
 Are any of the funds being directed to a party other than the Owner/Borrower/Vendor’s solicitor:
Yes ☐ No
 If yes, please provide details:
☐
Property Information:
Municipal Address of the Land:
Click here to enter text.
Legal Description of the Property being insured: P.I.N./PID:
Described as:
Click here to enter text. (LT)☐ (R)☐
Click here to enter text. (Please provide a copy of last deed or a copy of Reference/Boundary Plan, if applicable)
☐ Waterfront property
☐ Water supplied by a private well
☐ Water supplied other than municipal or private well, please provide details:
Click here to enter text.
☐ Private septic system
Was a use permit issued by the proper authority? Yes ☐ No ☐
If no, please provide details:
Click here to enter text.
If more than one property is being insured, please provide the above information for each property as a schedule
to this Order Form.
Property Type:
☐ Single family dwelling
enter text.
☐ Vacant Land
☐ New Home from a Builder
☐ Other:
Click here to
☐ Multi Family Residence
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Legal number of units revealed by the Zoning search:Click here to enter text.
Zoning is in compliance:
Yes ☐ No ☐ If No, please provide details:
Fire Code is in compliance:
Yes ☐ No ☐ If No, please provide details:
All work orders clear:
Yes ☐ No ☐ If No, please provide details:
Click here to enter text.
Click here to enter text.
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☐ Condominium
The Status certificate is clear or will be clear on closing: Yes ☐ No ☐ If No, please provide details: Click here to
enter text.
☐ Mobile Home (if yes, please confirm if affixed to the Land: Yes ☐ No☐)
☐ Farm
Is the land over 2 acres?
Yes ☐ No ☐
Is the farm income generating? Yes ☐ No ☐
Mortgage Information
Mortgagee:
Click here to enter text.
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Mortgage Amount:
Priority:
☐1st
$Click here to enter text.
☐ 2nd
☐ 3rd
Mortgage Ref. No.:
Click here to enter text.
☐ Other, please provide details: Click here to enter text.
☐Private Lender
Please state the appraised value of the property: Click here to enter text.
If there are prior mortgages on Title, please indicate the balance owing under each mortgage: Click here to enter
text.
Provide details on any title insurance claims submitted by this Private Lender: Click here to enter text.
☐This Private Lender never submitted a title insurance claim.
Please state the proposed use of the funds: Click here to enter text.
☐Blanket Mortgage (Number of Properties being mortgaged: Click here to enter text. )
(If applicable, please provide details for all properties being mortgaged)
☐Construction Loan
☐Vendor Take-Back Mortgage
Are the proceeds of the Mortgage being paid directly to the Registered Owner or paying out existing encumbrances?
☐ Yes ☐ No
(If no, please provide details): Click here to enter text.
Title Information
Existing Mortgages:
(Please note that Private Mortgages must be discharged prior to or on closing)
☐To be discharged
☐Remaining on title
☐Other Click here to enter text.
The following is to be completed when requesting a Loan Policy for a 2nd or 3rd priority mortgage:
Mortgagee:
Click here to enter text.
Date of Registration:
Click here to enter a date.
Instrument No.: Click here to enter text.
Original Principal:
$Click here to enter text. Priority:
☐1st
☐ 2nd
☐ 3rd
Real Estate taxes Information
☐Paid to date ☐Arrears to be paid from closing funds
☐Taxes not assessed, but an undertaking to readjust has been obtained
☐Other (Please provide details) Click here to enter text.
Off Title Information

Writs of Execution (Mortgagor only)
☐Clear Certificate
☐Execution(s) against current parties being paid out and lifted.
☐Other (Please provide details):

Click here to enter text.
Borrowing Resolution for the Borrower, if Corporate Borrower
☐Obtained ☐ Not yet, but will be obtained before closing

Current Certificate of Status / Corporate Profile for the Borrower, if Corporate Borrower
☐ Obtained ☐ Not yet, but will be obtained before closing
Purchase Transaction Information (if applicable)

Current Vendor/Seller’s name: Click here to enter text.

Does the vendor own any abutting land? Yes ☐ No ☐
If yes, does this transaction comply with the Planning Act: Yes ☐ No ☐

Will the vendor sign a Declaration of Possession or Statutory Declaration? Yes ☐ No ☐
Please send a copy for our review, if applicable.

Does a physical inspection of the property reveal any person in possession or using any portion of the Land?
(i.e. unregistered leases, rights of way in favour of other lands) Yes☐
No ☐
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Please provide details and attach documentation for our review, if applicable:

Was a real estate agent involved? Yes ☐
Click here to enter text.
No ☐
Name: Click here to enter text. Phone Number:
Click here to enter text.
(if no agent, please send a copy of the Agreement of Purchase and Sale)

Was any portion of the deposit paid directly to the vendor (other than in the vendor’s lawyer’s trust account)?
Yes ☐ No ☐

Do you have a survey? Yes☐ No ☐
Does the survey disclose any defects or are you aware of any changes made to the property since the
survey date? Yes ☐ No ☐ - If Yes, please provide details: Click here to enter text.
If a survey, certificate of location or real property report is available, please forward a copy by email or by
fax for our review.
List any other matters that would otherwise qualify your opinion (including but not limited to title matters, judgments,
liens, etc.)
Click here to enter text.
REPORT ON TITLE
I am a solicitor in good standing and I have investigated title to the property insured by this policy in accordance with, at a
minimum, the search requirements set out by Chicago Title Insurance Company Canada. By submitting this order, I
confirm the following to Chicago Title Insurance Company:
1.
2.
3.
4.
5.
6.
I have performed the due diligence necessary to provide the information and make the statement included with
this order;
I will advise Chicago Title Insurance Company of any changes to the information provided, including additional
registrations or material changes to the state of title or the priority of the insured’s interest, prior to closing;
For all loan transactions: (a) I will comply with any and all instructions of the mortgage lender prior to funding,
and (b) I will make the proceeds of the mortgage payable to all registered owner(s) of the property, or a secured
or unsecured credit for which there is evidence of a debt; and
I have disclosed all title matters which would otherwise qualify my opinion on title;
I will advise each named insured that no coverage will be provided with respect to those exceptions included on
Schedule 'B' attached to the policy and confirm that I will conclude this transaction only where each named
insured has instructed me to do so notwithstanding said exceptions.
I will receive the signature of the purchaser(s) on the "Acknowledgment by Purchaser ‘ form delivered with the
policy and will retain a signed copy in my file, which I acknowledge is a requirement for Chicago Title Insurance
Company to issue the Transaction Protection endorsement and which I will produce for delivery to Chicago Title
Insurance Company upon request. (Applicable where Transaction Protection coverage has been requested for a
Purchase Transaction Owner Policy.)
Chicago Title Insurance Company reserves the right to amend its commitment or policy of title insurance based on
additional information provided or obtained.
Dated: Click here to enter a date.
____________________________________
Lawyer signature
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Schedule 1
Power of Attorney Questionnaire
Please provide a copy of the power of attorney and a current copy of the title search to Chicago Title
for review at residentialtitle@ctic.ca
Please provide the following information with regards to the Power of Attorney being used to close the
transaction:
1. Which party is signing by way of a power of attorney: Click here to enter text.
2. Reason why a power of attorney is being used for this transaction: Click here to enter text.
3. Relationship between the donor and the attorney:
Click here to enter text.
4. The power of attorney has been reviewed and is valid and enforceable: Yes ☐ No ☐
5. The Donor has been contacted and the consequenses of using a power of attorney were explained to
him/her: Yes ☐ No ☐
If No, please provide details: Click here to enter text.
6. The Lender is aware that a power of attorney is being used for this transaction?
(if applicable) Yes ☐ No ☐
7. I have prepared the power of attorney: Yes ☐ No ☐
If Yes, please answer the following questions. If No, please see section below.
a. Do you know the person giving the power of attorney? Yes ☐ No ☐
b. Valid photo ID was obtained: Yes ☐ No ☐
c. The signature on the power of attorney matches the photo ID obtained: Yes ☐ No ☐
If you have answered «No» for any of the above, please provide more information: Click here to enter text.
 If the power of attorney was prepared by someone other than yourself, please contact the person who
prepared the document and validate the following information:
a. The person who prepared the document knows the person giving the power of attorney?
Yes ☐ No ☐
b. Valid photo ID was obtained : Yes ☐ No ☐
c. Confirmation that the signature on the power of attorney matches the photo ID obtained:
Yes ☐ No ☐
If the answer is «No» to any of the above, please request and provide more information:
Click here to
enter text.
8. Please indicate any additional information with regards to the power of attorney: Click here to enter text.
___________________________________
Lawyer Signature
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Date
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Print Name
If you are completing this form electronically, please type your name above lawyer signature and we will accept
that as your signature.
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