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.


Borrower

Co-Borrower
Are you applying for joint credit? Yes No

 

Uniform Residential Loan Application

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage Applied for: VA FHA Conventional USDA/Rural Housing Service Other
Amortization Type: Fixed Rate GPM Conventional ARM Other
Amount $ Interest Rate%     Number of Months

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address (street, city, state, ZIP)
No. of Units
Legal Description of Subject Property (Tax Township/Lot/Block)
Year Built:
Purpose of Loan:
Purchase Refinance Construction Construction - Permanent Other (explain):
Property is:
Primary Residence Secondary Residence Investment
Complete this line for construction, construction-permanent loans.
Year Lot
Acquired
Original Cost
Amount Existing Liens
a) Present Value of lot
b) Cost of Improvements
$
                      Total (a + b):$
Complete this line if this is a refinance loan.
Year
Acquired
Original Cost
Amount Existing Liens
Purpose of Refinance
Describe Improvements:   made to be made Cost:$
Title is held in what Name(s):
Manner in which title is held:
(Individual/Joint/Joint-Survivorship)
Estate is held in:
Fee Simple
Leasehold (show Expiration Date)
Source of Down Payment
Settlement Charges and/or subordinate financing (explain)

III. BORROWER INFORMATION

Borrower Co-Borrower
Borrower’s Name (include Jr. or Sr. if applicable)
Co-Borrower’s Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone
(incl. area code)
DOB
(MM/DD/YYYY)
Yrs. School
Social Security Number
Home Phone
(incl. area code)
DOB
(MM/DD/YYYY)
Yrs. School
Married Separated
Unmarried
(Include Single, Divorced, Widowed)
Dependents
(not listed by Co-Borrower)
Married Separated
Unmarried
(Include Single, Divorced, Widowed)
Dependents
(not listed by Co-Borrower)
No: Ages: No: Ages:
Present Address (street, city, state, ZIP) Own Rent   No Yrs.
Present Address (street, city, state, ZIP) Own Rent   No. Yrs.
Mailing Address, if different from Present Address
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent   No Yrs.
Former Address (street, city, state, ZIP) Own Rent   No Yrs.

IV. EMPLOYMENT INFORMATION

Borrower Co-Borrower
Name & Address of Employer
Self Employed
Yrs. on this job
Name & Address of Employer
Self Employed
Yrs. on this job
Yrs. employed in this
line of work/profession
Yrs. employed in this
line of work/profession
Position/Title/Type of Business
Business Phone (incl. area code)
Position/Title/Type of Business
Business Phone (incl. area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
Dates (from – to)
Name & Address of Employer
Self Employed
Dates (from – to)
Monthly Income
$
Monthly Income
$
Position/Title/Type of Business
Business Phone (incl. area code)
Position/Title/Type of Business
Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from – to)
Name & Address of Employer
Self Employed
Dates (from – to)
Monthly Income
$
Monthly Income
$
Position/Title/Type of Business
Business Phone (incl. area code)
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 Combined Monthly
Housing Expense
Present Proposed
Base Empl. Income* $ $ $ Rent $
Overtime $ $ $ First Mortgage (P&I) $ $
Bonuses $ $ $ Other Financing (P&I) $ $
Commissions $ $ $ Hazard Insurance $ $
Dividends/Interest $ $ $ Real Estate Taxes $ $
Net Rental Income $ $ $ Mortgage Insurance $ $
Other (before, completing, see the notice in "describe other income," below) $ $ $ Homeowner Assn. Dues $ $
Other: $ $
Total $ $ $ Total $ $
* 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
$  
$
$

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
Description
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. $
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 Assts (itemize)
$
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 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 Unpaid Balance
Name and address of Company
$

Months left to pay


$
Acct. no.
Name and address of Company
$ $
Acct. no.
Name and address of Company
$ $
Acct. no.
Name and address of Company
$ $
Acct. no.
Name and address of Company
$ $
Acct. no.
Name and address of Company
$ $
Acct. no.
Name and address of Company
$ $
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)
$ Total Liabilities 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 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. Alerations, improvements, repairs $
c. Land (if acquired separately) $
d. Refinance (incl. debits to be paid off) $
e. Estimated prepaid items $
f. Estimate 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 continuation sheet for explanation. Borrower Co-Borrower
    Yes No Yes No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment?
(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.)
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.
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
       
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
If "Yes", complete question m below.
m. Have you had an ownership interest in a property in the last three years?
  (1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?
  (2) How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

IX. ACKNOWLEDGMENT 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 services, 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 credit 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
Co-Borrower's Signature
Date

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 neither discriminate on the basis of this information, nor 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 or surname. If you do not wish to furnish the information, please check the appropriate box. (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 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 Ethnicity: Hispanic or Latino Not Hispanic or Latino
Race: American Indian or Alaska Native Asian White
Black or African American Native Hawaiian or Pacific Islander
Race: American Indian or Alaska Native Asian White
Black or African American Native Hawaiian or Pacific Islander
Sex: Female Male Sex: Female Male

To be completed by Loan Originator
This information was provided:
In a face-to-face interview
In a telephone interview
By the applicant and submitted by fax or mail
By the applicant and submitted via e-mail or the Internet
Loan Originator's Name
Loan Originator Indentifier
Loan Originator's Phone Number (including area code)
Loan Originator Company's Name
Loan Originator Company Indentifier
Loan Origination Company's Address

Continuation Sheet/Residential Loan Application

Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower. Borrower: Agency Case Number:
Co-Borrower: Lender Case Number:
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.
 
Type your name in the box below to represent your electronic signature
Borrower's Signature
Date
Co-Borrower's Signature
Date
 
Please check here to indicate that all information provided is accurate and you are ready to submit this application.
    
Member FDIC Equal Housing Lender
© The Citizens National Bank 2010