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 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: V.A. Conventional Other(explain):  Agency Case Number  Lender Case Number
FHA USDA/Rural
Housing Service
     
Amount
 
 Interest Rate
 
 No. of Months
 
 Amortization
 Type:
Fixed Rate: Other (explain):  
GPM 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 Construction  Other (explain):  Property will be:
   Refinance  Construction-Permanent     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
Source of Down Payment, Settlement Charge and/or Subordinate Financing (explain)
Leasehold (show expiration date)
 
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)
 
 DOB
 
Yrs. School
 
 Social Security Number
 
 Home Phone (incl. area code)
 
 DOB
 
 Yrs. School
 
 Married   Unmarried (include single,
divorced, widowed)
 Dependents (not listed
 by Co-Borrower)
 Married   Unmarried (include single,
divorced, widowed)
 Dependents (not listed
 by Borrower)
 Separated  no.
 
 ages
 
Separated   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 Co-Borrower
Name & Address of Employer


 Self Employed
 
 Yrs. on this job
 
 Name & Address of Employer
 

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

 Self Employed
 
 Dates (from-to)
 
 
 Name & Address of Employer
 

 Self Employed
 
 Dates (from-to)
 
 
 
 
 Monthly Income
 
 
 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)
 
 
 Name & Address of Employer
 

 Self Employed
 
 Dates (from-to)
 
 
 
 
 Monthly Income
 
 
 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,
see the notice in "describe
other income," below) 
       Homeowner Assn. Dues    
       Other    
Total        Total    
*Self Employer 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 joinly 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 basisotherwise 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 Cash or Market Value
Description
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.    
Stocks & 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 estate 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 estate owned or upon refinancing of the subject property.



Monthly Payment &
Months Left to Pay
Unpaid
Balance

LIABILITIES
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Name and address of Company
 
 
 Payment/Months
 

 

 Acct. no.   
 Alimony/Child Support/Separate Maintenance Payments Owed to:  

 
 Job Related Expense (child care, union dues, etc.)  
 Total Monthly Payments  
 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 is 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 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)  
j. Subordinate financing  
k. Borrower's closing costs paid by Seller  
l. Other Credits (explain)
 
m. Loan amount
    (exlude 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 questions a through i, please  Borrower  Co-Borrower
 use continuation sheet for explanation. 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?
 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. ACKNOWLEDGEMENT 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 propertyand (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  Date  Co-Borrower's Signature  Date
 X  X
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, nor 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 disclosure 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              Not Hispanic   Ethnicity:               Hispanic              Not Hispanic
Race/National Origin: American Indian or Alaska Native Asian
Black or African American Native Hawaiian or Other Pacific Islander White
Sex: Female Male
Race/National Origin: American Indian or Alaska Native Asian
Black or African American Native Hawaiian or Other Pacific Islander White
Sex: Female Male
To be Completed by Interviewer

This application was taken by:

  Face-to-face interview
  Mail
  Telephone
  Internet
 Interviewer's Name (print or type)
 
 Name and Address of Interviewer's Employer
 
 
 
 
 Interviewer's Signature
 
Date 
 
 Interviewer's Phone Number (incl. area code)
 

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.  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
 X    X  
Freddie Mac Form 65     Fannie Mae Form 1003