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
I Type of Mortgage and Terms of Loan
Mortgage Applied for:
Agency Case
Number:
Lender Case Number:
Amount: $
Interest Rate:
No. of
Months:
Amortization Type:
II Property Information and Purpose of Loan
Subject Property Address: Street:
No. of Units:
Legal Description of Subject
Property:
Year Built:
Purpose of Loan:
Property Will Be:
Complete the following if construction
or construction-permanent loan.
Year Lot Acquired:
Original Cost: $
Amount Existing Liens: $
(a) Present Value of Lot: $
(b) Cost of Improvements: $
Total (a+b): $
Complete the following if this is a refinance loan.
Year Acquired:
Original Cost: $
Amount Existing Liens: $
Purpose of Refinance:
Describe Improvements:
Title will be held in what
Name(s):
Manner is which Title will be
held:
Estate will be held in:
Source of Down Payment, Settlement Charges
and/or Subordinate Financing (explain):
III Borrower Information
Borrower Name (include Jr. or Sr. if
applicable):
Social Security Number:
Home Phone (include area
code):
Email:
Age:
Years School:
Marital Status:
Dependents (not listed by
Co-Borrower): No.
Present Address:
Street:
If residing at present address for less than two years, complete
the following:
Former Address1: Street:
Former Address2: Street:
Co-Borrower Name (include Jr. or Sr. if
applicable):
Social Security Number:
Home Phone (include area
code):
Email:
Age:
Years School:
Marital Status:
Dependents (not listed by
Borrower): No.
Present Address: Street:
If residing at present address for less than two years, complete
the following:
Former Address1: Street:
Former Address2: Street:
IV Employment Information
Borrower
Name and Address Employer:
Years on this Job:
Years employed in this line of
work/profession:
Position/Title/Type of
Business:
Business Phone (include area
code):
If employed in current position for less than two years of if
currently employed in more than one position, complete the
following:
Name and Address Employer2:
Dates:
Monthly Income: $
Position/Title/Type of
Business:
Business Phone (include area
code):
Name and Address Employer3:
Dates:
Monthly Income: $
Position/Title/Type of
Business:
Business Phone (include area
code):
Co-Borrower
Name and Address Employer:
Years on this Job:
Years employed in this line of
work/profession:
Position/Title/Type of
Business:
Business Phone (include area
code):
If employed in current position for less than two years of if
currently employed in more than one position, complete the
following:
Name and Address Employer2:
Dates:
Monthly Income: $
Position/Title/Type of
Business:
Business Phone (include area
code):
Name and Address Employer3:
Dates:
Monthly Income: $
Position/Title/Type of
Business:
Business Phone (include area
code):
V Monthly Income and Combined Housing Expense
Information
Gross Monthly Income Borrower Co-Borrower Total
Base Employment Income (Self
Employed Borrower(s) may be required to provide additional documentation such
as tax returns and financial statements.) $ $ $
Overtime $ $ $
Bonuses $ $ $
Commissions $ $ $
Dividends/Interest $ $ $
Net Rental Income $ $ $
Other (before completing see the
notice in "describe other income," below) $ $ $
Total $ $ $
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 Description Monthly Amount
$
$
$
Combined Monthly Housing
Expense Present Proposed
Rent $ $
First Mortgage (P&I) $ $
Other Financing (P&I) $ $
Hazard Insurance $ $
Real Estate Taxes $ $
Mortgage Insurance $ $
Home Owner Assn. Dues $ $
Other $ $
Total $ $
VI Assets and Liabilities
This statement and any applicable supporting
schedules may 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 spouse, this Statement and supporting schedules must be completed about
that spouse also. Completed
Asset Description Cash or Market Value
Cash deposit toward purchase held by: $
List checking and savings accounts
below
Account Number Name and Address of Bank, S&L, or Credit
Union Balance
# $
# $
# $
# $
Asset Company Name, Number &
Description Cash or Market Value
Stocks & Bonds $
Life Insurance Net cash value $
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 (financial statements will need to be provided) $
Automobiles owned (make, year,
and value) Total Value
Other (itemize) Total Value
Total Assets a. $
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 Indicate those liabilities
which will be satisfied upon sale of real estate owned or upon refinancing of
the subject property.
Name and Address of Company Monthly Payments & Months Left to
Pay Unpaid Balance
$ $
Account #
$ $
Account #
$ $
Account #
$ $
Account #
$ $
Account #
$ $
Account #
$ $
Account #
Alimony/Child Support/Separate
Maintenance Payments: Owed to
Amount $
Job Related Expense (child care,
union dues, etc.) $
Total Liabilities b. $
Net Worth (a-b) $
Schedule of Real Estate Owned
Property Address Select One:
Sold
Pending Sale
Rental
Type of Property
Property Address Select One:
Sold
Pending Sale
Rental
Type of Property
Property Address Select One:
Sold
Pending Sale
Rental
Type of Property
Present Market Value Amount of Mortgages &
Liens Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes &
Misc. Net Rental Income
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
Totals
$ $ $ $ $ $
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
#
#
VII Details of Transaction
a. Purchase Price $
b. Alterations, improvements, repairs $
c. Land (if acquired separately $
d. Refinance (include 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) $
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) $
p. 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 Comments Box below for explanation
Questions Borrower Co-Borrower
a. Are there any outstanding judgements against you?
Select One
Yes
No
Select One
Yes
No
b. Have you been declared bankrupt within the past 7
years?
Select One
Yes
No
Select One
Yes
No
c. Have you had property foreclosed upon or given title or deed in
lieu thereof in the last 7 years?
Select One
Yes
No
Select One
Yes
No
d. Are you a party to a lawsuit?
Select One
Yes
No
Select One
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
judgement? (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.)
Select One
Yes
No
Select One
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.)
Select One
Yes
No
Select One
Yes
No
g. Are you obligated to pay alimony, child support, or separate
maintenance?
Select One
Yes
No
Select One
Yes
No
h. Is any part of the down payment borrowed?
Select One
Yes
No
Select One
Yes
No
i. Are you a comaker or endorser on a note?
Select One
Yes
No
Select One
Yes
No
j. are you a U.S. citizen?
Select One
Yes
No
Select One
Yes
No
k. are you a permanent resident alien?
Select One
Yes
No
Select One
Yes
No
l. Do you intend to occupy the property as your primary residence?
( If "Yes" complete question m below.)
Select One
Yes
No
Select One
Yes
No
m. Have you had an ownership interest in a property in the last three
years?
Select One
Yes
No
Select One
Yes
No
(1) What type of property did you own?
Select One
Principal
Residence
Second Home
Investment
Property
Select One
Principal
Residence
Second Home
Investment
Property
(2) How did you hold title to the home?
Select One
Soley by yourself
Jointly with
spouse
Jointly
Other
Select One
Soley by yourself
Jointly with
spouse
Jointly
Other
Comments
IX Acknowledgment and
Agreement
By clicking on the "Send Now" button below
you are specifically acknowledging and agreeing that: (1) the loan requested by
this application will be secured by a first mortgage or deed of trust on the
property described herein; (2) the property will not be used for any illegal or
prohibited purpose or use; (3) all statements made in this application are made
for the purpose of obtaining the loan indicated herein; (4) occupation of the
property will be as indicated above; (5) verification or reverification of any
information contained in the application may be made at any time by the Lender,
its agents, successors and assigns, either directly or through a credit
reporting agency, from any source named in this application, and the original
copy of this application will be retained by the Lender, even if the loan is
not approved; (6) the Lender, its agents, successors and assigns will rely on
the information contained in the application and I/we have represented have a
continuing obligation to amend and/or supplement the information provided in
this application if any of the material facts which I/we have represented
herein should change prior to closing; (7) in the event my/our payments on the
loan indicated in this application become delinquent, the Lender, its agents,
successors and assigns, may, in addition to all their other rights and
remedies, report my/our name(s) and account information to a credit reporting
agency; (8) ownership of the loan may be transferred to an agent, successor or
assign of the Lender without notice to me; (9) the Lender, its agents,
successors and assigns make no representations or warranties, express or
implied, to the Borrower(s) regarding the property, the condition of the
property, or the value of the property.Certification: I/we
certify that the information provided in this application is true and correct
as of the date set forth opposite my/our name below and acknowledge my/our
understanding that any intentional or negligent misrepresentation(s) of the
information contained in this application may result in civil liability and/or
criminal penalties including, but not limited to, fine or imprisonment or both
under the provisions of Title 18, United States Code, Section 1001, et seq. and
liability for monetary damages to the Lender, its agents, successors and
assigns, insurers and any other person who may suffer any loss due to reliance
upon any misrepresentation which i/we have made on this
application,
Borrower Co-Borrower
X Information for Government Monitoring
Purposes
The following information is requested by the
Federal Government for certain types of loans related to a dwelling, 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 provides that a Lender may
neither discriminate on the basis of this information, nor on whether you
choose to furnish it. However, if you choose not to furnish it, under Federal
regulations this Lender is required to note race and sex on the basis of visual
observation or surname. If you do not wish to furnish this information, please
check the box below. (Lender must review the material to assure that the
disclosure satisfy all requirements to which the Lender is subject under
applicable state law for the particular type of loan applied for.
Borrower Co-Borrower
Race or National Origin: Race or National Origin:
Sex: Sex:
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