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 the Borrower’s spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the 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.
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 code)
No. of Units
Legal Description of Subject Property (attach description if necessary)
 Year Built
Purpose of Loan
 Property Will Be:
Primary Residence
Secondary Residence
Investment
Complete this line if construction or construction-permanent loan.
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
   $    $  Cost: $  
Title will be held in what Name(s)  
 Manner in which Title will be held  Estate Will Be Held In:
 
Fee Simple
Leasehold (show expiration date)
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
Borrower III. BORROWER INFORMATION 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)
Age
Yrs. School
 Social Security Number
Home Phone (incl. area code)
Age
Yrs. School
Married
Seperated
Dependents
Unmarried (include single, divorced, widowed)
 No
ages  
Married
Seperated
Dependents
Unmarried (include single, divorced, widowed)
 No
ages  
Present Address (street, city, state, zip code)
No. Yrs:
 Present Address (street, city, state, zip code)
No. Yrs:
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)
No. Yrs:
 Former Address (street, city, state, zip code)
No. Yrs:
Former Address (street, city, state, zip code)
 No. Yrs:
 Former Address (street, city, state, zip code)
No. Yrs:
Borrower IV.EMPLOYMENT INFORMATION Co-Borrower
Name & Address of Employer
Years employed in  this line of work/ profession    
Self Employed
Years on this job:  
 Name & Address of Employer
 Years employed in  this line of work/  profession:   
Self mployed
Years on this job:  
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
  Dates  (from - to):
to
Self Employed
  Monthly Income  
 $   
 Name & Address of Employer
  Dates (from - to):  
to
Self Employed
 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
  Dates(from - to):
to
Self Employed
 Monthly Income  
 $   
   
Name & Address of Employer
  Dates  (from - to):
to
Self Employed
 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 EXPENSE INFORMATION
  Gross Monthly Income Borrower Co-Borrower Total Combined Monthly
Housing Expense		 Present Proposed
  Self 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 incomebelow)
 Homeowner Assn. Dues
 Other:
  Total
 $
 Total
 $
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
B/C
 Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co- Borrower (C) doesn’t choose to have it considered for repaying this loan.
Monthly Amount
 $  
 $  
 $  
VI. ASSETS AND LIABILITIES
This Statement and any applicable supporting schedule 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.
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.  $
Stock & 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 estated owned)		  $
Vested interest in retirement fund  $
Net worth of business(es) owned
(attach financial statement)		  $
Automobiles owned (make and year)  $
Other Assets (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 estate1 owned or upon refinancing of the subject property.
Monthly Payt. &
Mos. Left to Pay		   Unpaid
Balance
LIABILITIES
 Name and address of Company
 $ Payt./Mos. 
/ 		 $
 Acct. no.      
 Name and address of Company
  $ Payt./Mos.
  / 		 $
 Acct. no.      
 Name and address of Company
  $ Payt./Mos.
/
 $
 Acct. no.      
 Name and address of Company
 $ Payt./Mos.  
/ 		 $
 Acct. no.      
 Name and address of Company  
 $ Payt./Mos.  
/ 		 $
 Acct. no.      
 Name and address of Company
 $ Payt./Mos.  
/ 		 $
 Acct. no.      
 Name and address of Company
 $ Payt./Mos.  
/ 		 $
 Acct. no.      
Alimony/Child Suppport/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 is it rental being held for income)		 Type of
Property		 Present
Market Value		 Amount of
Mortgage & Liens		 Gross
Rental Income		 Mortgage
Payments		 Insurance,
Maint.,
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):
Alternative Name Creditor Name Account Number
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
 a. Purchase price
 $
  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 judgements 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 judgement? (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 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)?
         
 b. Alterations, improvements, repairs
 c. Land (if acquired separately)
 d. Refinance (incl. in debts to be paid off)
 e. Estimated prepaid items
 f. Estimated closing costs
 g. PMI, MIP, Funding Fee paid in cash
 h. Discount (if Borrower will pay)
 i. otal 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)
IX. ACKNOWLEDGEMENT AND AGREEMENT
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein: (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me: (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
 
Right to Receive Copy of Appraisal. I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/We must send Lender written request at the mailing address Lender has provided. Lender must hear from me/us no later than 90 days after Lender notifies me/us about the action taken on this application, or I/we withdraw this application.
 
Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any 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 or 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.
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, not on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. 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
 
Race/National Origin: I do not wish to furnish this information Race/National Origin: I do not wish to furnish this information
American Indian or Alaskan Native Asian or Pacific Islander American Indian or Alaskan Native Asian or Pacific Islander
  White, not of Hispanic origin   White, not of  Hispanic origin Black, not of Hispanic origin
   
             
Sex:
  
Sex:
  
To be Completed by Interviewer
This application was taken by:
Interviewer’s Name (print or type)
Interviewer's Signature
Date
Interviewer’s Phone Number (incl. area code)
Name and Address of Interviewer's Employer
Continuation Sheet/Residential Loan Application
Use this continuation sheet if you need more space to omplete 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.
  Borrower’s Signature:   Date:      Co-Borrower’s Signature:   Date: