Loan Application

Applications sent outside of regularly scheduled hours, on weekends or on holidays in which Dakota Community Bank & Trust is not open are considered received on the next business day.

Account Requested Individual Joint - by selecting joint, we affirm our intent to apply for joint credit.

Credit Request is... Home Equity Loan (HELOC) - open end line of credit Collateral Secured Loan Unsecured Personal Loan Ready Reserve

Loan Officer (if known) Branch Amount Requested - If Ready Reserve $400 minimum Interest Rate Requested Term Requested – in months Loan Purpose

Collateral Offered Includes a House

Description of Collateral Offered

Dakota Community Bank & Trust, N.A. Registered Mortgage Loan Originators & NMLS Numbers

Officer name and NMLS #

Applicant

Name (First, Middle, Last) Social Security Number Date of Birth Mother's Maiden Name Place of Birth (City and State) Number of Dependents Ages

Marital Status Married Separated Unmarried (includes single, divorced, and widowed)

Primary Phone Number (###-###-####) Secondary Phone Number (###-###-####) Email Address

Present Address

Mailing Address City State Zip Code

Is your present address your permanent address? Yes No

Permanent Address

Mailing Address City State Zip Code

Nearest Relative

Nearest Relative not living with you Relationship Address Phone Number (###-###-####)

Active Duty

I am a regular or reserve member of the Air Force, Army, Coast Guard, Marine Corps, Navy, or Space Force on active duty or a dependent of a member of the Armed Forces on active duty (a dependent is the member's spouse, member's child under 18 years of age, or an individual for whom the member provides over half their financial support for 180 days immediately preceding today's date). I AM NOT a regular or reserve member of the Air Force, Army, Coast Guard, Marine Corps, Navy, or Space Force on active duty.

Employment / Income Information

Name and Address of Current Employer Gross Annual Salary Full-Time Occupation/Position/Type of Business Work Phone Number (###-###-####)

Years on the job 0-2 Years More than 2 years

Start Date (MM/DD/YYYY)

Name and Address of Previous Employer From (MM/DD/YYYY) To (MM/DD/YYYY) Occupation/Position/Type of Business Work Phone Number (###-###-####)

NOTICE: Alimony, Child Support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying the obligation.

Alimony, child support, or separate maintenance income received under: Court Order Written Agreement Oral Understanding

Other Income Amount Other Income Amount

Co-Applicant

Name (First, Middle, Last) Social Security Number Date of Birth (MM/DD/YYYY) Mother's Maiden Name Place of Birth (City and State) Number of Dependents Ages

Marital Status Married Separated Unmarried (includes single, divorced, and widowed)

Primary Phone Number (###-###-####) Secondary Phone Number (###-###-####) Email Address

Present Address

Mailing Address City State Zip Code

Is your present address your permanent address? Yes No

Permanent Address

Mailing Address City State Zip Code

Nearest Relative

Nearest Relative not living with you Relationship Address Phone Number (###-###-####)

Active Duty

I am a regular or reserve member of the Army, Navy, Marine Corps, Air Force or Coast Guard on active duty or a dependent of a member of the Armed Forces on active duty (a dependent is the member's spouse, member's child under 18 years of age, or an individual for whom the member provides over half their financial support for 180 days immediately preceding today's date). I AM NOT a regular or reserve member of the Army, Navy, Marine Corps, Air Force or Coast Guard on active duty.

Employment / Income Information

Name and Address of Current Employer Gross Annual Salary Full-Time Occupation/Position/Type of Business Work Phone Number (###-###-####)

Years on the job 0-2 Years More than 2 years

Start Date (MM/DD/YYYY)

Name and Address of Previous Employer From (MM/DD/YYYY) To (MM/DD/YYYY) Occupation/Position/Type of Business Work Phone Number (###-###-####)

NOTICE: Alimony, Child Support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying the obligation.

Alimony, child support, or separate maintenance income received under: Court Order Written Agreement Oral Understanding

Other Income Amount Other Income Amount

Asset

Description of Asset Value Subject to Debt Name(s) of Owner(s)

Housing Debt

Landlord/Mortgage Holder Rent Payment Mortgage Original Debt Present Value Monthly Payment Name in which Acct Carried

Outstanding Debt

Description of Debt Original Debt Present Value Monthly Payment Name in which Acct Carried

Endorsement

I certify that everything I have stated in this application is correct. The Lender, its servicers, successors or assings may keep any paper record and/or electronic record of this application whether or not the loan is approved. By signing below, I authorize you to check my credit and employment history and to answer questions about your credit experience with me. I understand that I must update credit information at your request if my financial condition changes. If this application is created as or converted into an electronic application, I consent to the use of electronic records and signatures as defined by the federal and/or state electronic transaction laws. I agree if the application is delived to the Lender as an electronic record or facsimile transmission with my electronic signature, it will be as effective, enforceable and valid as if a paper version of the application were delivered and signed by me in writing.

Signed by (Applicant) Date Signed (MM/DD/YYYY)

Signed by (Joint Applicant) Date Signed (MM/DD/YYYY)

Insurance Disclosure for Credit Application

Purpose:

You have submitted an application for a loan. In connection with your loan application, Dakota Community Bank & Trust, N.A. (Lender) may be soliciting, offering to sell, or will sell you an insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.

Credit Disclosures:

Lender, as a condition of granting you a loan, cannot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffiliated entity.

Acknowledgment:

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, RECEIVED AND UNDERSTAND THIS INSURANCE DISCLOSURE.

Signed by (Applicant) Date Signed Signed by (Joint Applicant) Date Signed

Consumer Dwelling Secured Loan Application

Dakota Community Bank & Trust, N.A. NMLS# 520334

Property Address Securing Loan Property Value Estimate

Occupancy Principal Residence Second Residence Investment Property

Lien Position

Property Type One-to-Four Family Multifamily Manufactured Housing

Purchase Price

Loan Purpose Purchase Other (Home Equity) Home Improvement Construction Only Refinance Construction to Permanent

Year Built

Is this loan application secured by the house you are living in? Yes No

Are the loan proceeds to purchase a house you are planning to live in as your primary dwelling? Yes No Not Applicable

Are the loan proceeds to refinance the house you are currently living in as your primary dwelling? Yes No Not Applicable

Applicant Demographic Information

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled.

For residential mortgage lending, Federal law required that we ask applicants for their demographic information (ethniciity, race, and sex) in order to monitor our compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not requried to provide this information, but are encouraged to do so.

You may select one or more designations for "Ethnicity" and one or more designations for "Race". The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person Federal regulations require us to note your ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to provide some or all of this information, please check below.

I wish to furnish this information. I do not wish to furnish this information.

Ethnicity Hispanic or Latino Non Hispanic or Latino Information not Provided (mail, internet, or phone application) N/A - Not a natural person

Hispanic or Latino Ethnicity Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin

Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Information not Provided (mail, internet, or phone application) N/A - Not a natural person

Print name of enrolled or principal tribe

Asian Race Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Origin

Native Hawaiian or Other Pacific Islander Race Native Hawaiian Guanmanian or Chamorro Samoan Other Pacific Islander

Print Origin

Sex Female Male Information not Provided (mail, internet, or phone application) N/A - Not a natural person Both Male and Female

Co-Applicant Demographic Information

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled.

I wish to furnish this information. I do not wish to furnish this information.

Ethnicity Hispanic or Latino Non Hispanic or Latino Information not Provided (mail, internet, or phone application) N/A - Not a natural person

Hispanic or Latino Ethnicity Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin

Print name of enrolled or principal tribe

Asian Race Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Origin

Native Hawaiian or Other Pacific Islander Race Native Hawaiian Guanmanian or Chamorro Samoan Other Pacific Islander

Print Origin

Sex Female Male Information not Provided (mail, internet, or phone application) N/A - Not a natural person Both Male and Female