Uniform Residential Loan Application

___________________________________________________________________________________________________________________________________________________________________
This application is designed to be completed by the applicant(s) with the Lenders 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 Borrowers spouse) will be used as a basis for loan
qualification or the income or assets of the Borrowers 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
Housing Service

Amount
$

Interest Rate

Other (explain):

Agency Case Number

Amortization Type:

No. of Months

Fixed Rate
GPM

Lender Case Number

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
Other (explain):
Construction-Permanent

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

made

Describe Improvements

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

III. BORROWER INFORMATION

Borrowers Name (include Jr. or Sr. if applicable)

Social Security Number

Married
Separated

Home Phone
(incl. area code)

Unmarried (include
single, divorced, widowed)

Present Address (street, city, state, ZIP)

Co-Borrower

Co-Borrowers Name (include Jr. or Sr. if applicable)

DOB (mm/dd/yyyy)

Yrs. School

Married
Separated

Dependents (not listed by Co-Borrower)

no.

ages
Own

Social Security Number

Rent ____No. Yrs.

Home Phone
(incl. area code)

Unmarried (include
single, divorced, widowed)

Present Address (street, city, state, ZIP)

Mailing Address, if different from Present Address

DOB (mm/dd/yyyy)

Yrs. School

Dependents (not listed by Borrower)

no.

ages

Own

Rent ____No. Yrs.

Own

Rent ____No. Yrs.

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.

Borrower
Name & Address of Employer

Former Address (street, city, state, ZIP)

IV. EMPLOYMENT INFORMATION

Self Employed

Yrs. on this job

Name & Address of Employer

Yrs. employed in this

line of work/profession

Position/Title/Type of Business

Business Phone (incl. area code)

Co-Borrower
Self Employed

Yrs. on this job

Yrs. employed in this
line of work/profession

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:

Uniform Residential Loan Application

Freddie Mac Form 65 7/05 (rev.6/09)

Page 1 of 5

Fannie Mae Form 1003

7/05 (rev.6/09)

Borrower

IV. EMPLOYMENT INFORMATION (contd)

Name & Address of Employer

Self Employed

Dates (from to)

Co-Borrower

Name & Address of Employer

Self Employed

Dates (from to)

Monthly Income

Monthly Income

$
Position/Title/Type of Business

Business Phone
(incl. area code)

Name & Address of Employer

Self Employed

Position/Title/Type of Business

Business Phone
(incl. area code)

Name & Address of Employer

Dates (from to)

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
Base Empl. Income*

Borrower

Co-Borrower

Combined Monthly
Housing Expense

Total
$

Overtime

First Mortgage (P&I)

Bonuses

Other Financing (P&I)

Commissions

Hazard Insurance

Dividends/Interest

Real Estate Taxes

Net Rental Income

Mortgage Insurance

Homeowner Assn. Dues

see the notice in describe

other income, below)

Other:
$

Total

Proposed

Other (before completing,

Total

Present

Rent

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
Cash or
Market Value

ASSETS
Description
Cash deposit toward
purchase held by:

Liabilities and Pledged Assets. List the creditors 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.
LIABILITIES

List checking and savings accounts below

Name and address of Bank, S&L, or Credit Union

Name and address of Company

Acct. no.

Acct. no.

Name and address of Bank, S&L, or Credit Union

Acct. no.

Name and address of Company

Name and address of Company

Acct. no.

Acct. no.

Uniform Residential Loan Application

Freddie Mac Form 65 7/05 (rev. 6/09)

Unpaid Balance

$ Payment/Months

$ Payment/Months

$ Payment/Months

Acct. no.

Name and address of Bank, S&L, or Credit Union

Monthly Payment &

Months Left to Pay

Page 2 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)

VI. ASSETS AND LIABILITIES (contd)

Name and address of Bank, S&L, or Credit Union

Name and address of Company

$ Payment/Months

Acct. no.

Acct. no.

Stocks & Bonds (Company name/

number & description)

Name and address of Company

$ Payment/Months

Life insurance net cash value

Acct. no.
Name and address of Company

$ Payment/Months

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.

$
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.

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

Amount
of Mortgages
& Liens

Present
Market Value
$

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

VII. DETAILS OF TRANSACTION

Net Rental
Income

Account Number

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

a.

Purchase price

b.

Alterations, improvements, repairs

c.

Land (if acquired separately)

b. Have you been declared bankrupt within the past 7 years?

d.

Refinance (incl. debts to be paid off)

e.

Estimated prepaid items

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?

f.

Estimated closing costs

g.

PMI, MIP, Funding Fee

h.

Discount (if Borrower will pay)

i.

Total costs (add items a through h)

Uniform Residential Loan Application

Freddie Mac Form 65 7/05 (rev.6/09)

Insurance,
Maintenance,
Taxes & Misc.

Mortgage
Payments

Gross
Rental Income

Borrower
Yes No

Co-Borrower
Yes No

a. Are there any outstanding judgments against you?

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.)

Page 3 of 5

Fannie Mae Form 1003

7/05 (rev.6/09)

VII. DETAILS OF TRANSACTION

j.

VIII. DECLARATIONS

Subordinate financing

k.

Borrowers closing costs paid by

Seller

l.

Borrower

If\ou aQswer <es toany queVWionV athrougK L pleaVe usH

continuation sheet for explanation.

Other Credits (explain)

Yes

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?

m.

Loan amount (exclude PMI, MIP,

Funding Fee financed)

j.

Are you a U.S. citizen?

n.

PMI, MIP, Funding Fee financed

k.

Are you a permanent resident alien?

o.

Loan amount
(add m & n)

l.

Do you intend to occupy the property as your primary

residence?

p.

Cash from/to Borrower

(subtract j, k, l & o from i)

m.

Have you had an ownership interest in a property in the last

three years?
(1) What type of property did you ownprincipal 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)?

Co-Borrower
No

Yes

No

-------------------------------------------------------

If Yes, complete question m below.

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 ri ghts 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 d efined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my s ignature, 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.
Borrowers Signature

Date

Co-Borrowers 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 m ay not discriminate ei ther o n t he bas is of t his
information, or on whether you ch oose to fu rnish it . If y ou fu rnish th e information, p lease provide bot h ethnicity and race. Fo r race, you may check m ore than one designation. If you do not furnish
ethnicity, race, o r 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
Ethnicity:
Race:

Sex:

I do not wish to furnish this information

CO-BORROWER
Not Hispanic or Latino
Hispanic or Latino
Ethnicity:

I do not wish to furnish this information

Not Hispanic or Latino

Hispanic or Latino

American Indian or
Alaska Native
Native Hawaiian or
Other Pacific Islander
Female
Male

Asian

Race:

Black or African American

White
Sex:

To be Completed by Loan Originator:

American Indian or
Alaska Native
Native Hawaiian or
Other Pacific Islander
Female
Male

Asian

Black or African American

White

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 Originators Signature

Loan Originators Name (print or type)

Loan Originator Identifier

Date
Loan Originators Phone Number (including area code)

Loan Origination Companys Name

Loan Origination Company Identifier

Loan Origination Companys Address

Uniform Residential Loan Application

Freddie Mac Form 65 7/05 (rev.6/09)

Page 4 of 5

Fannie Mae Form 1003

7/05 (rev.6/09)

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:

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.
Borrowers Signature
Date
Co-Borrowers Signature
Date

Uniform Residential Loan Application

Freddie Mac Form 65 7/05 (rev.6/09)

Page 5 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)