Important Information About Procedures For
Obtaining A Mortgage Loan
To help the government fight the funding of terrorism and money
laundering activities, Federal law requires all mortgage bankers to obtain,
verify, and record information that identifies each person who applies for a
mortgage loan.
What does this mean for you? When you apply for a mortgage loan, we will
ask for your:
name
address
date of birth
and any other information that will allow us to identify you. At
closing, our agent will also ask to see your driver’s license or other
identifying documents.
Excellent
OK, but some
problems
Major
credit problems
Don't
know
Please specify your full legal name (Include Jr. or
Sr. if applicable).
First Name:*
Middle Name:
Last Name:*
Home phone number:*
-
-
Work phone number:
-
-
Cell phone number:
-
-
Best time to call:
Email address:*
Property Information
Street Address: *
City: * State:*
Zip: *
Property type:*
Year built:
Purpose of loan:
Purchase, property has been identified
Property will be:*
Title will be held in what name(s):
Manner in which title will be held:
Borrower's Information
Date Of Birth:*
/ /
Years in school:
Number of dependents:
Ages (separate ages with commas):
Marital Status:*
(Note: Unmarried includes single, divorced, widowed)
Current Address
Street Address:*
City:* State:*
Zip:*
Rent or Own? *
for:
years
months
If residing at present address for fewer than two
years, complete the following:
Former Address
Street Address:
City: State: Zip:
Rent or Own?
for:
years
months
Former Address
Street Address:
City: State: Zip:
Rent or Own?
for:
years
months
Borrower Employment Information
Current Employer
Name:
Position/Title/Type of Business:
Street Address:
City: State: Zip:
Employed for:
years
months
Self employed?
Yes No
Years employed in this line of work/profession:
If employed in current position for fewer than two
years, or if currently employed in more than one position, complete
the following:
Previous Employer
Name:
Position/Title/Type of Business:
Street Address:
City: State: Zip:
Business Phone (incl. area code):
Self employed?
-
-
Yes No
Employed From (dates from - to):
Monthly Income:
-
$
Previous Employer
Name:
Position/Title/Type of Business:
Street Address:
City: State: Zip:
Business Phone (incl. area code):
Self employed?
-
-
Yes No
Employed From (dates from - to):
Monthly Income:
-
$
Borrower Gross Monthly Income
Base Empl. Income:1
Commissions:
Overtime:
$
$
$
Dividends/Interest:
Bonuses:
Net Rental Income:
$
$
$
Other:2
$
$
1 Self Employed Borrower(s) may be
required to provide additional documentation such as tax returns and
financial statements.
2 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.
Current Housing Expenses:
Rent:
$
First Mortgage (P&I):
$
$
Second Mortgage (P&I):
$
$
Hazard Insurance:
$
$
Real Estate Taxes:
$
$
Mortgage Insurance (PMI):
$
$
Homeowner Assn. Dues:
$
$
Other:
$
$
Asset Info
Cash deposit toward purchase:
$
1
Accounts/Assets
Account/Asset Type:
Name of Bank or Credit Union:
Account number:
Account Balance: $
2
Accounts/Assets
Account/Asset Type:
Name of Bank or Credit Union:
Account number:
Account Balance: $
3
Accounts/Assets
Account/Asset Type:
Name of Bank or Credit Union:
Account number:
Account Balance: $
4
Accounts/Assets
Account/Asset Type:
Name of Bank or Credit Union:
Account number:
Account Balance: $
Other Assets
Life insurance net cash value: $
Face amount: $
Vested interest in retirement fund (IRA, 401K, SEP): $
Automobiles:
Year:
Make:
Value: $
Year:
Make:
Value: $
Year:
Make:
Value: $
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 those
liabilities which will be satisfied upon sale of real estate owned
or upon refinancing of the subject property.
1
Liability
Name of creditor:
Monthly payment:
$
Unpaid balance:
$
Type of liability:
Will this debt be paid off?
Yes
No
2
Liability
Name of creditor:
Monthly payment:
$
Unpaid balance:
$
Type of liability:
Will this debt be paid off?
Yes
No
3
Liability
Name of creditor:
Monthly payment:
$
Unpaid balance:
$
Type of liability:
Will this debt be paid off?
Yes
No
4
Liability
Name of creditor:
Monthly payment:
$
Unpaid balance:
$
Type of liability:
Will this debt be paid off?
Yes
No
Other Payments
Monthly Payments
Alimony payment:
$
Child support payment:
$
Separate maintenance payment:
$
Job related expense (child care, union dues, etc.):
$
General Transaction Information
Are you going to be documenting your income?
Yes No
Does the property have more than 5 acres?
Yes No
Borrowers Landlord Information
(Required to verify rent history)
Landlord name:
Phone:
-
-
Street address:
City: State: Zip:
Purchase Transaction Information
Cash to Close Worksheet
Purchase price:
$
Down payment from checking, savings, money market, CD account:
$
Down payment from sale of stock or stock options:
$
Down payment from family gift:
$
Loan secured by 401K or other assets:
$
Second mortgage from seller or lender:
$
Closing Information
Please specify your closing
date:
(MM/DD/YYYY)
Closing costs paid by seller:
$
Borrower Declarations
a.
Are there any outstanding judgments against you?*
Yes
No
b.
Have you been declared bankrupt within the past 7
years? *
Yes
No
c.
Have you had property foreclosed upon or given title
or deed in lieu thereof in the last 7 years? *
Yes
No
d.
Are you a party to a lawsuit?
*
Yes
No
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 (in space below),
including date, name and address of Lender, FHA or VA case number, if
any, and reasons for the action.) *
Yes
No
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 (in space below) as
described in the preceding question. *
Yes
No
g.
Are you obligated to pay alimony, child support, or
separate maintenance? *
Yes
No
h.
Is any part of the down payment borrowed?
*
Yes
No
i.
Are you a co-maker or endorser on a note?
*
Yes
No
j.
Are you a U. S. citizen? *
Yes
No
k.
Are you a permanent resident alien?
*
Yes
No
l.
Do you intend to occupy the property as your primary
residence? If "Yes," complete question m below.
*
Yes
No
m.
Have you had an ownership interest in a property in
the last three years? *
How did you hold title to the home-solely by yourself
(S), jointly with your spouse (SP), or jointly with another person
(O)?
Sole (Individual)
Joint with Spouse
Joint with Other
than Spouse
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:
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.;
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;
the property will not be used for any illegal or
prohibited purpose or use;
all statements made in this application are made for the purpose of
obtaining a residential mortgage loan;
the property will be occupied as indicated in this
application;
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;
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;
in the event that my payments on the Loan become delinquent, the
Lender, its servicers, 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 reporting
agencies;
ownership of the Loan and/or administration of the
Loan account may be transferred with such notice as may be required by
law;
neither Lender nor its agents, brokers, insurers, services, 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
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 services, 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.
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 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
and surname if you have made this application in person. 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.)
Additional Information
Please enter any comments that could be helpful in processing your
application:
