Application

Uniform Residential Loan Application

This application is designed to be completed by the applicant(s) with the Lender’s assistance. Applicants should complete this form as “Borrower” or “Co-Borrower,” as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when

the income or assets of a person other than the Borrower (including the Borrower’s spouse) will be used as a basis for loan qualification or

the income or assets of the Borrower’s spouse or other person who has community property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law and Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

Borrower

Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage

Conventional

Other (explain):

Applied for:

FHA

USDA/Rural

Agency Case Number

Lender Case Number

Amount

Interest Rate

No. of Months

Amortization Type:

Fixed Rate

GPM

Other (explain):

ARM (type)

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Address

Street Address City State / Province / Region ZIP / Postal Code

No. of Units

Legal Description of Subject Property (attach description if necessary)

Year Built

Purpose of Loan

Purchase

Refinance

Construction

Construction-Permanent

Other (explain)

Property will be:

Primary Residence

Secondary Residence

Investment

Complete this line if construction or construction-permanent loan.

Year Lot Acquired

Original Cost

Amount Existing Liens

(a) Present Value of Lot

(b) Cost of Improvements

Total

Complete this line if this is a refinance loan.

Year Acquired

Original Cost

Amount Existing Liens

Purpose of Refinance

Describe Improvements

Untitled

Made

To be Made

Cost: $

Title will be held in what Name(s)

Manner in which Title will be held

Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)

Estate will be held in:

Fee Simple

Leasehold (show expiration date)

Borrower

III. BORROWER INFORMATION

Co-Borrower

Borrower’s Name (include Jr. or Sr. if applicable)

Social Security Number

Home Phone (incl. area code)

Date

Yrs. School

Untitled

Married

Separated

Unmarried (include single, divorced, widowed)

Dependents (not listed by Co-Borrower)

No Ages

Present Address (street, city, state, ZIP)

Street Address City State / Province / Region ZIP / Postal Code

Untitled

Own

Rent

No. Yrs

Mailing Address, if different from Present Address

Former Address (street, city, state, ZIP)

Street Address City State / Province / Region ZIP / Postal Code

Untitled

Own

Rent

No. Yrs

Co-Borrower

Co-Borrower’s Name (include Jr. or Sr. if applicable)

Social Security Number

Home Phone (incl. area code)

Date

Yrs. School

Untitled

Married

Separated

Unmarried (include single, divorced, widowed)

Dependents (not listed by Borrower)

No Ages

Present Address (street, city, state, ZIP)

Street Address City State / Province / Region ZIP / Postal Code

Untitled

Own

Rent

No. Yrs

Mailing Address, if different from Present Address

Former Address (street, city, state, ZIP)

Street Address City State / Province / Region ZIP / Postal Code

Untitled

Own

Rent

No. Yrs

Borrower

IV. EMPLOYMENT INFORMATION

Co-Borrower

Name & Address of Employer

Self Employed

Yrs. on this job

Yrs. employed in this line of work/profession

Position/Title/Type of Business

Business Phone (incl. area code)

Co-Borrower

Name & Address of Employer

Self Employed

Yrs. on this job

Yrs. employed in this line of work/profession

Business Phone (incl. area code)

Borrower

IV. EMPLOYMENT INFORMATION (cont’d)

Co-Borrower

Name & Address of Employer

Self Employed

Dates (from – to)

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code)

Name & Address of Employer

Self Employed

Dates (from – to)

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code)

Co-Borrower

Name & Address of Employer

Self Employed

Dates (from – to)

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code)

Name & Address of Employer

Self Employed

Dates (from – to)

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code)

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Gross Monthly Income

Borrower

Co-Borrower

Total

Base Empl. Income*

number1

Overtime

Number2

Bonuses

Number3

Commissions

Number4

Dividends/Interest

b10

Number5

Net Rental Income

b11

b12

Number6

Other (before completing, see the notice in “describe other income,” below)

b13

b14

Number7

Total

Combined Monthly Housing Expense

Present

Proposed

Rent

bc1

no need

First Mortgage (P&I)

bc2

bc3

Other Financing (P&I)

bc4

bc5

Hazard Insurance

bc6

bc7

Real Estate Taxes

bc8

bc9

Mortgage Insurance

bc10

bc11

Homeowner Assn. Dues

bc12

bc13

Other:

bc14

bc15

Total

bc total1

bc total2

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income

Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

B/C

Monthly Amount

Untitled

Number

Untitled

Number

Untitled

Number

VI. ASSETS AND LIABILITIES

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Completed

Jointly

Not Jointly

ASSETS

Cash or Market Value

Cash deposit toward purchase held by:

List checking and savings accounts below

Name and address of Bank, S&L, or Credit Union

Acct. no

Name and address of Bank, S&L, or Credit Union

Acct. no

Name and address of Bank, S&L, or Credit Union

Acct. no

Liabilities and Pledged Assets. List the creditor’s name, address, and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or upon refinancing of the subject property

LIABILITIES

Monthly Payment & Months Left to Pay

Unpaid Balance

Name and address of Company

$ Payment/Months

Acct. no.

Name and address of Company

$ Payment/Months

Acct. no.

Name and address of Company

$ Payment/Months

Acct. no.

VI. ASSETS AND LIABILITIES (cont’d)

Name and address of Bank, S&L, or Credit Union

Acct. no.

Stocks & Bonds (Company name/ number & description)

Life insurance net cash value

Face amount: $

Subtotal Liquid Assets

Real estate owned (enter market value from schedule of real estate owned)

Vested interest in retirement fund

Net worth of business(es) owned (attach financial statement)

Automobiles owned (make and year)

Other Assets (itemize)

Total Assets a

Number

Name and address of Company

$ Payment/Months

Acct. no.

Name and address of Company

$ Payment/Months

Acct. no.

Name and address of Company

$ Payment/Months

Acct. no.

Alimony/Child Support/Separate Maintenance Payments Owed to:

Job-Related Expense (child care, union dues, etc.)

Total Monthly Payments

Net Worth (a minus b)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Property Address (enter S if sold, PS if pending sale or R if rental being held for income)

▼

Type of Property

Untitled

Present Market Value

Amount of Mortgages & Liens

Gross Rental Income

Number

Mortgage Payments

Insurance, Maintenance, Taxes & Misc

Net Rental Income

Number

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name

Creditor Name

Account Number

Untitled

VII. DETAILS OF TRANSACTION

a. Purchase price

b. Alterations, improvements, repairs

c. Land (if acquired separately)

d. Refinance (incl. debts to be paid off)

e. Estimated prepaid items

f. Estimated closing costs

g. PMI, MIP, Funding Fee

h. Discount (if Borrower will pay)

i. Total costs (add items a through h)

Number

VIII. DECLARATIONS

If you answer “Yes” to any questions a through i, please use continuation sheet for explanation.

Borrower

Yes/No

Co-Borrower

Yes/No

a. Are there any outstanding judgments against you?

Untitled

Yes

No

b. Have you been declared bankrupt within the past 7 years?

Untitled

Yes

No

c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Untitled

Yes

No

d. Are you a party to a lawsuit?

Untitled

Yes

No

e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?

Untitled

Yes

No

(This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If “Yes,” provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action.)

VII. DETAILS OF TRANSACTION

j. Subordinate financing

k. Borrower’s closing costs paid by Seller

l. Other Credits (explain)

m. Loan amount (exclude PMI, MIP, Funding Fee financed)

n. PMI, MIP, Funding Fee financed

o. Loan amount (add m & n)

Number

Cash from/to Borrower (subtract j, k, l & o from i)

VIII. DECLARATIONS

If you answer “Yes” to any questions a through i, please use continuation sheet for explanation.

Borrower

Yes/No

Co-Borrower

Yes/No

f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If “Yes,” give details as described in the preceding question.

Untitled

Yes

No

g. Are you obligated to pay alimony, child support, or separate maintenance?

Untitled

Yes

No

h. Is any part of the down payment borrowed?

Untitled

Yes

No

i. Are you a co-maker or endorser on a note?

Untitled

Yes

No

j. Are you a U.S. citizen?

Untitled

Yes

No

k. Are you a permanent resident alien?

Untitled

Yes

No

l. Do you intend to occupy the property as your primary residence? If “Yes,” complete question m below.

Untitled

Yes

No

m. Have you had an ownership interest in a property in the last three years?

Untitled

Yes

No

(1) What type of property did you own—principal residence (PR), second home (SH), or investment property (IP)?

Untitled

(2) How did you hold title to the home—solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

Untitled

IX. ACKNOWLEDGEMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Borrower’s Signature

Date
MM slash DD slash YYYY

Co-Borrower’s Signature

Date
MM slash DD slash YYYY

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

BORROWER

I do not wish to furnish this information

CO-BORROWER

I do not wish to furnish this information

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Race:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Sex:

Female

Male

To be Completed by Interviewer

Interviewer’s Name (print or type)

Name and Address of Interviewer’s Employer

This application was taken by:
Face-to-face interview
Mail
Telephone
Internet

Interviewer’s Signature

Date
MM slash DD slash YYYY

Interviewer’s Phone Number (incl. area code)

CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION

Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B f or Borrower or C for Co-Borrower.

Borrower:

Agency Case Number:

Co-Borrower:

Lender Case Number

Untitled

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.

Borrower’s Signature

Date
MM slash DD slash YYYY

Co-Borrower’s Signature

Date
MM slash DD slash YYYY

Uniform Residential Loan Application

Name

Email

Phone

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Application

Uniform Residential Loan Application

I. TYPE OF MORTGAGE AND TERMS OF LOAN

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Borrower

III. BORROWER INFORMATION

Co-Borrower

Co-Borrower

Borrower

IV. EMPLOYMENT INFORMATION

Co-Borrower

Co-Borrower

Borrower

IV. EMPLOYMENT INFORMATION (cont’d)

Co-Borrower

Co-Borrower

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

VI. ASSETS AND LIABILITIES

VI. ASSETS AND LIABILITIES (cont’d)

VII. DETAILS OF TRANSACTION

VIII. DECLARATIONS

VII. DETAILS OF TRANSACTION

VIII. DECLARATIONS

IX. ACKNOWLEDGEMENT AND AGREEMENT

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION

Uniform Residential Loan Application

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