Uniform Residential Loan Application

Type of Mortgage & Terms of Loan

Application Type *
Individual Joint
Mortgage Services
VA Conventional Other Applied For FHA USDA/Rural Housing
Agency Case Number
Lender Case Number
Amount *
Interest Rate
Number of Months *
Amortization
Fixed Rate Other (Explain) GPM ARM (List type) Amortization Other
Subject Property Address (Street, City, State, Zip) *
Legal Description of Subject Property (Tax Township/Lot/Block) *
Number of Units
Year Built *
Purpose of Loan
Purchase Refinance Construction-Permanent Construction Other
Property will be
Primary Residence Secondary Residence Investment
Are you refinancing? *
Yes No

Year Lot Acquired *
Original Cost *
Amount Existing Loans *
(a) Present Value of Lot *
(b)Cost of Improvements *
Total (a+b) *

Year Acquired *
Original Cost *
Amount Existing Loans *
Purpose of Refinance *
Improvements *
Made To be made
Cost $ *
Describe Improvements *
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Title is held in what Name(s) *
Manner in which title is held *
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain): *
Estate will be held in
Fee Simple Leasehold

Borrower Information

Borrower
Borrower's Name *
(Include Jr. or Sr. if applicable)
Social Security Number *
Home Phone *
(Include area code)
Date of Birth *
(MM/DD/YYYY)
Years School *
Marital Status
Married Separated Unmarried (Include Single, Divorced, Widowed)
Number of Dependents
Ages
Present Street Address *
Rent Own
Number of Years *
Mailing Address
(If different from Present Address)
Former Address
(If residing at present address for less than two years)
Rent Own
Number of Years

Co-Borrower
Co-Borrower's Name *
(Include Jr. or Sr. if applicable)
Social Security Number *
Home Phone *
(Include area code)
Date of Birth *
(MM/DD/YYYY)
Years School *
Marital Status *
Married Separated Unmarried (Include Single, Divorced, Widowed)
Number of Dependents
Ages
Present Street Address *
Rent Own
Number of Years *
Mailing Address
(If different from Present Address)
Former Address
(If residing at present address for less than two years)
Rent Own
Number of Years

Employment Information

Borrower
Name & Address of Employer *
Self Employed
Years on this job *
Years employed in this line of work/profession *
Position/Title/Type of Business *
Gross Monthly Income *
Business Phone *
(Include area code)
Name & Address of Previous Employer
(If employed in current position for less than two years or if currently employed in more than one position)
Self Employed
Dates (From - To)
Gross Monthly Income $
Position/Title/Type of Business
Business Phone
(Include area code)
Name & Address of Previous Employer
Self Employed
Dates (From - To)
Gross Monthly Income $
Position/Title/Type of Business
Business Phone
(Include area code)

Co-Borrower
Name & Address of Employer *
Self Employed
Years on this job *
Years employed in this line of work/profession *
Position/Title/Type of Business *
Gross Monthly Income *
Business Phone *
(Include area code)
Name & Address of Previous Employer
(If employed in current position for less than two years or if currently employed in more than one position)
Self Employed
Dates (From - To)
Gross Monthly Income $
Position/Title/Type of Business
Business Phone
(Include area code)
Name & Address of Previous Employer
Self Employed
Dates (From - To)
Gross Monthly Income $
Position/Title/Type of Business
Business Phone
(Include area code)

Monthly Income & Combined Housing Expense Information

Gross Monthly Income

Income Type	Borrower	Co-Borrower	Total
Base Employment Income**	Borrower Base Employment Income	Co-Borrower Base Employment Income	Base Employment Income Total
Overtime	Borrower Overtime	Co-Borrower Overtime	Overtime Total
Bonuses	Borrower Bonuses	Co-Borrower Bonuses	Bonuses Total
Commissions	Borrower Commissions	Co-Borrower Commissions	Commissions Total
Dividends/Interest	Borrower Dividends/Interest	Co-Borrower Dividends/Interest	Dividends/Interest Total
Net Rental Income	Borrower Net Rental Income	Co-Borrower Net Rental Income	Net Rental Income Total
Other	Borrower Other	Co-Borrower Other	Other Total
Total	Borrower Total	Co-Borrower 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	Income Type	Monthly Amount
bc_1	income_type_1	monthly_amount_1
bc_2	income_type_2	monthly_amount_2
bc_3	income_type_3	monthly_amount_3

Combined Monthly Housing Expense

Expense Type	Present	Proposed
Rent	Rent Present	Rent Proposed
First Mortgage (P&I)	First Mortgage (P&I) Present	First Mortgage (P&I) Proposed
Other Financing (P&I)	Other Financing (P&I) Present	Other Financing (P&I) Proposed
Hazard Insurance	Hazard Insurance Present	Hazard Insurance Proposed
Real Estate Tax	Present Real Estate Tax Present	Real Estate Tax Proposed
Mortgage Insurance	Mortgage Insurance Present	Mortgage Insurance Proposed
Homeowner Association Dues	Homeowner Association Dues Present	Homeowner Association Dues Proposed
Other	Other Present	Other Proposed
Total	Total Present	Total Proposed

Assets & 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 *
Individual Joint
Assets
Cash deposit toward purchase held by
Cash or Market Value

List checking & savings accounts below

Name & Address of Bank, S&L, or Credit Union
Account Number
Amount
Name & Address of Bank, S&L, or Credit Union
Account Number
Amount
Name & Address of Bank, S&L, or Credit Union
Account Number
Amount
Name & Address of Bank, S&L, or Credit Union
Account Number
Amount
S & Bonds
(Company Name, Number & Description)
Value
Life insurance net cash value face amount
Cash Value
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
Automobiles owned
(Make & Year)
Value
Other Assets
(Itemize)
Value
Total Assets Value

Liabilities

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.

Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance
Name & Address of Company	Account No.	Monthly Payment	Unpaid Balance

Alimony/Child Support/Separate Maintenance Payments Owed to:
Monthly Payment
Job-Related Expense
(Child care, union dues, etc.)
Total Monthly Payments
Total Liabilities
Net Worth
(Total Assets minus Total Liabilities)

Schedule of Real Estate Owned

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
Property Address	Property Status	Type of Property	Present Market Value	Amount of Mortgages & Liens	Gross Rental Income	Mortgage Payments	Misc	Net Rental Income
Property Address	Property Status	Type of Property	Present Market Value	Amount of Mortgages & Liens	Gross Rental Income	Mortgage Payments	Misc	Net Rental Income
Property Address	Property Status	Type of Property	Present Market Value	Amount of Mortgages & Liens	Gross Rental Income	Mortgage Payments	Misc	Net Rental Income
		Totals	Total Property Value	Total Amount Mortgages & Liens	Total Gross Monthly Income	Total Mortgage Payments	Total Misc	Total Net Rental

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

Details of Transaction

Description		Amount
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)	Other Credits Amount
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)

Declarations

Description		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 or 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.
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?
Additional Details
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.
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)?

Acknowledgment & 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.

Applicant Signature *
Co-Applicant Signature *

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 want to furnish this information
Ethnicity
Hispanic or Latino Not Hispanic or Latino
Race
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White
Sex
Female Male

Continuation Sheet

Use this continuation sheet if you need more space to complete the Residential Loan Application.

Bank Representative