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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.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

Borrower*

Co Borrower*

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied for:*		VA FHA		Conventional USDA/Rural		Other (explain):	Agency Case Number*	Lender Case Number
Amount*		Interest Rate*		No. of Months*		Amortization Type:*	Fixed Rate GPM	Other (explain): ARM (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*	Purchase Refinance		Construction Construction-Permanent		Other (explain):		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 made to be made 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					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) no ages		Married Separated Unmarried (include single, divorced, widowed)		Dependents (not listed by Co-Borrower) 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

Borrower		IV. EMPLOYMENT INFORMATION
Name & Address of Employer Self Employed		Yrs. on this job Yrs. employed in this line of work/profession	Name & Address of Employer Self Employed		Yrs. on this job 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:

Borrower		IV. EMPLOYMENT INFORMATION (cont’d)
Name & Address of Employer Self Employed		Dates (from – to) Monthly Income	Name & Address of Employer Self Employed		Dates (from – to) 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) Monthly Income	Name & Address of Employer Self Employed		Dates (from – to) 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, Homeowner Assn. Dues 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 deposit toward purchase held by:*	Cash or Market 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 by (*) those liabilities, which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
List checking and savings accounts below		LIABILITIES	Monthly Payment & Months Left to Pay	Unpaid Balance
Name and address of Bank, S&L, or Credit Union Acct. no. $		Name and address of Company Acct. no	$ Payment/Months	$
Name and address of Bank, S&L, or Credit Union Acct. no. $		Name and address of Company Acct. no	$ Payment/Months	$
Name and address of Bank, S&L, or Credit Union Acct. no. $		Name and address of Company Acct. no	$ Payment/Months	$

VI. ASSETS AND LIABILITIES (cont’d)
Name and address of Bank, S&L, or Credit Union Acct. no. $	Name and address of Company Acct. no	$ Payment/Months	$
Stocks & Bonds (Company name/ number & description) Acct. no. $	Name and address of Company Acct. no	$ Payment/Months	$
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) $	Name and address of Company Acct. no	$ Payment/Months	$
Automobiles owned (make $ and year) $ Automobiles owned (make $ and year) $	Alimony/Child Support/Separate Maintenance Payments Owed to: Job-Related Expense (child care, union dues, etc.) Total Monthly Payments	$ $ $
Total Assets a $	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
		$	$	$	$	$	$
		$	$	$	$	$	$
		$	$	$	$	$	$
		$	$	$	$	$	$

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name*	Alternate Name*	Alternate Name*

VII. DETAILS OF TRANSACTION VIII. DECLARATIONS

VII. DETAILS OF TRANSACTION	VIII. DECLARATIONS
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)*	$	If you answer “Yes” to any questions a through i,please use continuation sheet for explanation. 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.)	Borrower* Yes No Yes No Yes No Yes No Yes No	Co-Borrower* Yes No Yes No Yes No Yes No Yes No

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)*

If you answer “Yes” to any questions a through i,please use continuation sheet for explanation.

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.)

Borrower*

Yes

Co-Borrower*

Yes

VII. DETAILS OF TRANSACTION VIII. DECLARATIONS

VII. DETAILS OF TRANSACTION	VIII. DECLARATIONS
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)*		If you answer “Yes” to any question a through i, please use continuation sheet for explanation. f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? 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? m. If Yes,” complete question m below 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— by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?	Borrower* Yes No Yes No Yes No Yes No Yes No Yes No Yes No	Co-Borrower* Yes No Yes No Yes No Yes No Yes No Yes No Yes No

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)*

If you answer “Yes” to any question a through i, please use continuation sheet for explanation.

f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?

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?

m. If Yes,” complete question m below 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— by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

Borrower*

Yes

Co-Borrower*

Yes

IX. ACKNOWLEDGEMENT 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 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; (9) ownership of the Loan and/or administration of the Loan account may be tra nsferred with such notice as m ay be require d by law; (10) neither Lender nor i ts 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*

IX. ACKNOWLEDGEMENT 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 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; (9) ownership of the Loan and/or administration of the Loan account may be tra nsferred with such notice as m ay be require d by law; (10) neither Lender nor i ts 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 ho me mortgage disclosure laws . You are no t requ ired to furnish this in formation, bu t are en couraged to do so . Th e law p rovides t hat a le nder may not discriminate ei ther o n t he bas is of t his information, or on whether you choose to furnish it. If y ou furnish the information, please provide both ethnicity and race. Fo r race, you may check m ore 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.)
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 Alaska Native Native Hawaiian or Other Pacific Islander White						Race:* American Indian or Alaska Native Asian Black or African American Alaska Native Native Hawaiian or Other Pacific Islander White
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 Signature		Date
Loan Originator’s Name (print or type)	Loan Originator Identifier	Loan Originator’s Phone Number (including area code)
Loan Origination Company’s Name	Loan Origination Company Identifier	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 f or Borrower or C for Co-Borrower.			Borrower:* Co-Borrower:*						Agency Case Number:* 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 X			Date*			Co-Borrower’s Signature X			Date*

Uniform Residential Loan Application

Uniform Residential Loan Application

Mortgage Applied for:*

Amortization Type:*

Purpose of Loan*

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