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Borrower's Certification & Authorization
The undersigned certify the following:
1. I/We have applied for a mortgage loan from NATIONAL BANK (lender). In applying for the loan,
I/We completed a loan application containing various information on the purpose of the loan, the
amount and source of the down payment, employment and income information, and assets and
liabilities. I/We certify that all of the information is true and complete. I/We made no
misrepresentations in the loan application or other documents, nor did I/We omit any pertinent
2. I/We understand and agree that NATIONAL BANK (lender) reserves the right to change the
mortgage loan review process to a full documentation program. This may include verifying the
information provided on the application with the employer and/or the financial institution.
3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to
knowingly make any false statements when applying for this mortgage, as applicable under the
provisions of Title 18, United States Code, Section 1014.
Authorization to Release Information
To Whom It May Concern
1. I/We have applied for a mortgage loan from NATIONAL BANK (lender). As part of the
application process, NATIONAL BANK (lender) may verify information contained in my/our loan
application and in other documents required in connection with the loan, either before the loan is
closed or as part of its quality control program.
2. I/We authorize you to provide to NATIONAL BANK (lender), and to any investor to whom
NATIONAL BANK (lender) may sell my mortgage, and all information and documentation that
they request. Such information includes, but is not limited to, employment history and income;
bank, money market, and similar account balances; credit history; and copies of income tax returns.
3. NATIONAL BANK (lender) or any investor that purchases the mortgage may address this
authorization to any party named in the loan application.
4. A copy of this authorization may be accepted as an original.
5. Your prompt reply to NATIONAL BANK (lender) or the investor that purchased the mortgage is
(Borrower's Signature)
(Borrower's Signature)
(Social Security Number)
(Social Security Number)
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