REQUEST TO OBTAIN MY CREDIT HISTORY REPORT
PLEASE PRINT
Name:
LAST NAME
FIRST NAME
INITIAL
SUFFIX (Sr, Jr, etc.)
Current Address:
STREET ADDRESS
APT.
CITY
PROVINCE
POSTAL CODE
PREVIOUS ADDRESS(ES) (within last 5 years)
Previous Address:
STREET ADDRESS
APT.
CITY
PROVINCE
POSTAL CODE
STREET ADDRESS
APT.
CITY
PROVINCE POSTAL CODE
Date of Birth:
Social Insurance Number:
MONTH DAY YEAR
(OPTIONAL)
The name and last 4 digits of a major credit card:
WERE YOU DENIED CREDIT? NO [ ] YES [ ] BY WHICH INSTITUTION? ___________________________________ WHEN? ______________________
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* We will require two (2) pieces of personal identification to process your request. (Example: driver’s
licence, bank account statement, gas, phone, electricity or cable bill). If your current address has changed
within the last 90 days, a confirmation of address must be attached with your request in order to be
processed. (Example: gas, phone, electricity or cable bill, bank account statement, driver’s license).
** You can expect to receive a copy of your personal credit report via regular mail within 5 to 10 days. If you
have any further inquiries about delivery, please contact us using our toll-free number below.
*** Please note that if any corrections are necessary, you must complete the credit report update form
enclosed with the credit report sent to you. This form - Consumer Credit Report Update Form – can also
be found on-line at www.equifax.ca
SIGNATURE
DATE
National Consumer Relations