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Demographic Information Addendum. This section asks about your ethnicity, sex, and race.
Demographic Information of Borrower
The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities
and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic
information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage
disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for
"Ethnicity" and one or more designations for "Race."
The law provides that we may not discriminate on the basis of this information, or on
whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person,
Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we
may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of
this
information, please check below.
Ethnicity: Check one or more
Hispanic or Latino
Mexican Puerto Rican Cuban
Other Hispanic or Latino Print origin:
For example: Argentinean, Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, and so on.
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race: Check one or more
American Indian or Alaska Native – Print name of enrolled
or principal tribe:
Asi
an
Asian Indian Chinese Filipino
Japanese Korean Vietnamese
Other Asian – Print race:
For e
xample: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian Guamanian o
r Chamorro Samoan
Other Pacific Islander – Print race:
For example: Fijian, Tongan, and so on.
White
I do not wish to provide this information
To
Be Completed by Financial Institution (for application taken in person):
Was the ethnicity of the Borrower collected on the basis of visual observation or surname? NO YES
Was the sex of the Borrower collected on the basis of visual observation or surname? NO YES
Was the race of the Borrower collected on the basis of visual observation or surname? NO YES
The Demographic Information was provided through:
Face-to-Face Interview (includes Electronic Media w/ Video Component)
Telephone Interview Fax or Mail Email or Internet
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 • Fannie Mae Form 1003
Revised 09
/2017
