Malvern Bank, National Association Home Equity Loan Application

Home Equity Installment Loan Application
Loan Information
Loan Amount: Term: Purpose:		Loan Type: Individual Joint
(If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit.)
I/We desire automatic payment from Malvern Bank, National Association checking account number
Applicant (Income verification will be required)
First Name M.I.		Last Name
Birth Date Social Security No.		Number of dependents, excluding self
Home Street Address
City	State Zip
Home Phone (include area code)	How long at this address? Yrs. Mos.
Name of current mortgage holder or landlord
Balance owed (if mortgaged) $	Monthly mortgage or rent payment $
Does mortgage payment include taxes & insurance? YesNo	If no, list annual amount for taxes & insurance $
Name of business/employer
Business phone (include area code)	How long employed there? Yrs. Mos.
Position held	Gross monthly salary $ Self-employed Retired
Other income (Applicant & Co-Applicant) Alimony, child support or separate maintenance need not be revealed if Borrower or Co-Borrower does not choose to have it considered for repaying this loan.
Gross monthly amount $ Name & address of source
Co-Applicant (Income Verification will be required)
First Name M.I.	Last Name
Birth Date	Social Security No.
Home Street Address (if different from applicant’s)
City	State Zip
Home Phone (include area code)	How long at this address? Yrs. Mos.
Name of current mortgage holder or landlord
Name of business/employer
Business phone (include area code)	How long employed there? Yrs. Mos.
Position held	Gross monthly salary $ Self-employed Retired
Property Information (Copy of homeowner’s policy will be required)
Estimated value of home $ Purchase price $ Date Purchased:
Annual Amount of Taxes & Insurance if not included in Mortgage Payment $
Name of insurance agent	Insurance agent phone (include area code)
Customer Certification Please read the following before signing and submitting your application: This application is submitted to obtain credit. I/we agree that Malvern Bank, National Association may make inquiries and obtain credit reports to verify information I/we provided. I/we also authorize Malvern Bank, National Association to provide credit and account information to and respond to requests for information from others. If this is a joint application, the applicant and co-applicant shall be jointly and severally liable for any and all credit extended from time to time. Lender or anyone authorized by lender may inspect the property for the sole purpose of determining value. The lender or anyone authorized by the lender may obtain or verify any employment, credit or other information relating to my/our application for a home equity installment loan. The lender may retain this application even if the loan is not granted. By signing and submitting this application, I/we certify that all information herein is true and correct as of the date submitted and acknowledge my/our understanding that nay 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 Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm this information. The information you provide is protected by our privacy policy and federal law.
Applicant Signature Date	Co-Applicant Signature Date

Addendum to Application

The below information is to be completed if applying for a Home Equity Installment Loan whose purpose is one of the following: Home Improvement Refinance of existing Home Equity loan on the property being used as collateral Proceeds are being used to purchase a subject property or another dwelling 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 whether you choose to furnish it. If you furnish this information, please provide both ethnicity and race. For race, you make 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 had made this application in person. If you do not wish to furnish the above 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	CO-BORROWER
I do not wish to furnish this information	I do not wish to furnish this information
Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Asian White Black or African American Sex: Female Male	Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Asian White Black or African American Sex: Female Male