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, city, state, & ZIP):*

No. of Units:*

Legal Description of Subject Property (attach description if necessary):*

Year Built:*

Purpose of Loan:*

Property will be:*

Complete this line if construction or construction-permanent loan.

Complete this line if construction or construction-permanent loan.

Complete this line if this is a refinance loan

Complete this line if construction or construction-permanent loan.

Title will be held in what Name(s):*

Manner in which Title will be held:*

Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain):*

Estate will be held in:*

Fee Simple

Leasehold

III. BORROWER INFORMATION

Borrower

Borrower's Name (include Jr. or Sr. if applicable):*

Social Security Number:*

Home Phone (incl. area code):*

DOB (MM/DD/YYYY):*

Yrs. School:*

Married

Separated

Unmarried (include single, divorced, widowed)

Present Address (street, city, state, ZIP):*

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):*

III. BORROWER INFORMATION

Co-Borrower

Co-Borrower's Name (include Jr. or Sr. if applicable):*

Social Security Number:*

Home Phone (incl. area code):*

DOB (MM/DD/YYYY):*

Yrs. School:*

Married

Separated

Unmarried (include single, divorced, widowed)

Present Address (street, city, state, ZIP):*

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):*

IV. EMPLOYMENT INFORMATION

Borrower

Name & Address of Employer:*

Yrs. on this job:*

Yrs. employed in this line of work/profession: *

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:*

Dates (from – to):*

Monthly Income $: *

Position/Title/Type of Business: *

Business Phone (incl. area code): *

Name & Address of Employer:*

Dates (from – to):*

Monthly Income $: *

Position/Title/Type of Business: *

Business Phone (incl. area code): *

IV. EMPLOYMENT INFORMATION

Co-Borrower

Name & Address of Employer:*

Yrs. on this job:*

Yrs. employed in this line of work/profession: *

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:*

Dates (from – to):*

Monthly Income $: *

Position/Title/Type of Business: *

Business Phone (incl. area code): *

Name & Address of Employer:*

Dates (from – to):*

Monthly Income $: *

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 Employment Income*				Rent
Overtime				First Mortgage (P&I)
Bonuses				Rent
Commissions				Hazard Insurance
Dividends/Interest				Real Estate Taxes
Net Rental Income				Mortgage Insurance
Other (specify)				Other Expenses
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 spouse, this Statement and supporting schedules must be completed about that spouse also

ASSETS Description	Cash or Market Value
List checking and savings accounts below
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).
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 upon refinancing of the subject property.

LIABILITIES	Monthly Payment & Months Left to Pay	Unpaid Balance
Net Worth (a minus b ) ➡		Total Liabilities b. ➡

VI. ASSETS AND LIABILITIES (cont.)

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. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. 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) Explanation Here	Other Credits Cost
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 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.)
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?
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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 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 fascimile 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

Borrower’s Signature

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Co-Borrower’s Signature

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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 discriminate neither 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 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 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 Black or African American Native Hawaiian or Other Pacific Islander White	Race: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex: Female Male	Sex: Female Male

To be Completed by Interviewer This application was taken by: Face-to-face interview Mail Telephone Internet

Interviewer’s Signature

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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

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.

Borrower’s Signature

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Co-Borrower’s Signature

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