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TYPE OF MORTGAGE AND TERMS OF LOAN |
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Complete this row if construction or construction-permanent loan. |
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Complete this line if this is a refinance loan. |
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BORROWER INFORMATION |
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If residing at present address for less than two years, complete the following: |
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EMPLOYMENT INFORMATION |
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If employed in current position for less than two years or if currently employed in more than one position, complete the following: |
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MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION |
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* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. |
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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. |
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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 spouse, this Statement and supporting schedules must be a completed about that spouse also. |
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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
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Name and address of Company
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Acct. no. |
$ Payment / Months
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$ |
Alimony/Child Support/ Separate Maintenance Payments Owed to:
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$ |
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Job-Related Expenses (child care, union dues, etc.) |
$ |
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Total Monthly Payments |
$ |
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Total Liabilities b. |
$ |
Net Worth (a minus b) |
$ |
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ASSETS AND LIABILITIES (cont.) |
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.) |
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List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s): |
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DETAILS OF TRANSACTION |
a. |
Purchase price |
$ |
b. |
Alterations, improvements, repairs |
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c. |
Land (if acquired separately) |
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d. |
Refinance (incl. debts to be paid off) |
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e. |
Estimated prepaid items |
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f. |
Estimated closing costs |
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g. |
PMI, MIP, Funding Fee |
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h. |
Discount (if Borrower will pay) |
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i. |
Total costs (add items a through h) |
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j. |
Subordinate financing |
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k. |
Borrower's closing costs paid by Seller |
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l. |
Other Credits (explain) |
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m. |
Loan amount (exclude PMI, MIP, Funding Fee financed) |
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n. |
PMI, MIP, Funding Fee financed |
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o. |
Loan amount (add m & n) |
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p. |
Cash from/to Borrower (subtract j, k, l & o from i) |
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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? |
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b. |
Have you been declared bankrupt within the past 7 years? |
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c. |
Have you had property foreclosed upon or given title or deed in lien thereof in the last 7 years? |
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d. |
Are you a party to a lawsuit? |
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e. |
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of 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.) |
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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. |
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g. |
Are you obligated to pay alimony, child support, or separate maintenance? |
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h. |
Is any part of the down payment borrowed? |
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i. |
Are you a co-maker or endorser on a note? |
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j. |
Are you a U.S. citizen? |
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k. |
Are you a permanent resident alien? |
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l. |
Do you intend to occupy the property as your primary residence? If "Yes", complete question m below. |
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m. |
Have you had an ownership interest in a property in the last three years? |
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(1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)? |
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(2) How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (o)? |
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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 herein; (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 herein; (6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not 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 owner or servicer of the Loan 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. |
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INFORMATION FOR GOVERNMENT MONITORING PURPOSES |
To be Completed by Loan Originator |
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The purpose of collecting this information is to help ensure that all borrowers are treated fairly and that the housing needs of communities and
neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask borrowers for their demographic information
(ethnicity, race, and sex) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You
are not required 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. The law also provides that we may not discriminate on the basis of age or
marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below. |
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Borrower |
Ethnicity |
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Example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc. |
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Sex |
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Race |
- |
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Example: Hmong, Laotian, Thai, Pakistani, Cambodian, etc. |
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Example: Fijian, Tongan, etc. |
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Co-Borrower |
Ethnicity |
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- |
Example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc. |
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Sex |
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Race |
- |
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Example: Hmong, Laotian, Thai, Pakistani, Cambodian, etc. |
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- |
Example: Fijian, Tongan, etc. |
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