Fillable Mortgage Loan Application (My Homebank)

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Mortgage Loan Application (My Homebank)

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130 HL - FNMA 1003/FHLMC 65 (3/12/13)
Stock No. 11518
W.B.A.
Freddie Mac Form 65 6/09 Page 1 of 4 Fannie Mae Form 1003 6/09
Uniform Resid
ential 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
K
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
K
the income or assets of the Borrower’s 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 prop-
erty 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
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
III. BORROWER INFORMATION
IV. EMPLOYMENT INFORMATION
Mortgage
K
VA
K
Conventional
K
Other (explain):
Applied for:
K
FHA
K
USDA/Rural Housing Service
Purpose of Loan
K
Purchase
K
Construction
K
Other (explain):
K
Refinance
K
Construction-Permanent
K
Married
K
K
Separated
Property will be:
KKK
Amortization
K
Fixed Rate
K
Other (explain):
Type:
K
GPM
K
ARM (type):
Agency Case Number
Amount
$
Subject Property Address (street, city, state & ZIP) No. of Units
Interest Rate
%
No. of Months
Lender Case Number
Legal Description of Subject Property (attach description if necessary)
Title will be held in what Name(s)
Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)
Borrower’s Name (include Jr. or Sr. if applicable)
Social Security Number
Former Address (street, city, state, ZIP)
K
Own
K
Rent______________No. Yrs. Former Address (street, city, state, ZIP)
K
Own
K
Rent______________No. Yrs.
Present Address (street, city, state, ZIP)
K
Own
K
Rent______________No. Yrs.
Mailing Address, if different from Present Address Mailing Address, if different from Present Address
Present Address (street, city, state, ZIP)
K
Own
K
Rent______________No. Yrs.
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Home Phone (incl. area code)
Dependents (not listed by Co-Borrower)
no. ages
DOB
(MM/DD/YYYY) Yrs. School
Co-Borrower’s Name (include Jr. or Sr. if applicable)
Manner in which Title will be held Estate will be held in:
K
Fee Simple
K
Leasehold
(show expiration date)
Complete this line if construction or construction-permanent loan.
Year Lot
Acquired
Complete this line if this is a refinance loan.
Year
Acquired
Year Built
Primary
Residence
Secondary
Residence
Investment
Original Cost
$
Original Cost
$
Amount Existing Liens
$
Amount Existing Liens
$
(a) Present Value of Lot
$
Purpose of Refinance
(b) Cost of Improvements
$
Describe Improvements
K
made
K
to be made
Cost: $
Total (a + b)
$
Borrower Co-Borrower
Borrower Co-Borrower
Unmarried (include single,
divorced, widowed)
Unmarried (include single,
divorced, widowed)
Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY) Yrs. School
K
Married
K
K
Separated
Dependents (not listed by Borrower)
no. ages
If residing at present address for less than two years, complete the following:
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Yrs. on this job
Yrs. employed in this line
of work/profession
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Yrs. on this job
Yrs. employed in this line
of work/profession
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Dates (from - to)
Monthly Income
$
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Dates (from - to)
Monthly Income
$
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Dates (from - to)
Monthly Income
$
Name & Address of Employer
K
Self Employed
Position/Title/Type of Business Business Phone (incl. area code)
Dates (from - to)
Monthly Income
$
Freddie Mac Form 65 6/09 Page 2 of 4 Fannie Mae Form 1003 6/09
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
VI. ASSETS AND LIABILITIES
Gross Monthly Income Borrower Co-Borrower Total Present Proposed
Combined
Monthly Housing Expense
Base Empl. Income*
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other
(before completing, see
the notice in “describe other
income.” below.)
Total
$$$
$$$
Rent
First Mortgage (P&I)
Other Financing (P&I)
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Assn. Dues
Other:
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 Monthly Amount
$
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
I
I
Jointly
I
I
Not Jointly
ASSETS
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. $
Cash or Market
Value
$
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: $
Real estate owned (enter market value $
from schedule of real estate owned)
Net worth of business(es) owned $
(attach financial statement)
Automobiles owned (make and year) $
Other Assets (itemize)
$
Vested interest in retirement fund $
Subtotal Liquid Assets $
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.
LIABILITIES
Name and address of Company
Acct. No.
Monthly Payment &
Months left to Pay
$ Payment/Months
Unpaid
Balance
$
Name and address of Company
Acct. No.
$ Payment/Months $
Name and address of Company
Acct. No.
$ Payment/Months $
Name and address of Company
Acct. No.
$ Payment/Months $
Name and address of Company
Acct. No.
$ Payment/Months $
Name and address of Company
Acct. No.
$ Payment/Months $
Name and address of Company
Acct. No.
$ Payment/Months
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.
$Total Assets a.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 0.00 0.00 0.00 0.00
0.00
0.00
0.00 0.00 0.00
Freddie Mac Form 65 6/09 Page 3 of 4 Fannie Mae Form 1003 6/09
I
I
I
I
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 if pending sale
or R if rental being held for income)
Type of
Property
Totals $ $ $ $ $ $
$$$$$$
Present
Market Value
Amount of
Mortgages & Liens
Gross
Rental Income
Mortgage
Payments
Net
Rental Income
Insurance
Maintenance,
Taxes & Misc.
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
(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)
If you answer “Yes” to any questions a through i, please use continuation
sheet for explanation.
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 deliquent 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)?
Borrower
Yes No
KK
KK
KK
KK
KK
Co-Borrower
Yes No
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
KK
IX. ACKNOWLEDGMENT AND AGREEMENT
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
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 rights 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 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.
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.
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 not discriminate either
on the basis of this information, or 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 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’s Signature: Date Co-Borrower’s Signature: Date
XX
BORROWER
Ethnicity:
Race:
Sex:
K
K
K
K
K
K
K
K
K
K
To be Completed by Loan Originator:
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
K
K
K
K
CO-BORROWER
Ethnicity:
Race:
Sex:
K
K
K
K
K
K
K
K
K
K
I do not wish to furnish this information
Hispanic or Latino Not Hispanic or Latino
American Indian or Alaska Native
Asian White Black or African American
Native Hawaiian or Other Pacific Islander
Female Male
I do not wish to furnish this information
Hispanic or Latino Not Hispanic or Latino
American Indian or Alaska Native
Asian White Black or African American
Native Hawaiian or Other Pacific Islander
Female Male
Loan Originator’s Signature
X
Loan Originator’s Name (print or type)
Loan Origination Company’s Name
Loan Originator Identifier
Loan Origination Company Identifier
Loan Originator’s Phone Number (including area code)
Loan Origination Company’s Address
Date
0.00 0.00 0.00 0.00 0.00 0.00
0.00
0.00
0.00
(573)769-2001
HOMEBANK 450000
400 South Main, PO Box 311, Palmyra, MO 63461
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:
Lender Case Number:Co-Borrower:
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
XX
Freddie Mac Form 65 6/09 Page 4 of 4 Fannie Mae Form 1003 6/09
IMPORTANT INFORMATION ABOUT
PROCEDURES FOR OBTAINING CREDIT
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and
record information that identifies each person who obtains credit.
What this means for you: When you obtain credit, we will ask for your name, address, date of birth, and other information that will allow us to identify
you. We may also ask to see your driver’s license or other identifying documents.
NOTICE: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be
reflected in your credit report.
NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under §766.59, Wis. Stats., or court decree
under §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered
into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.
Mortgage Application Checklist
The following documents may be required through the mortgage application process, but are not required to receive a
Loan Estimate.
Income
Past two years w-2’s & tax returns
Most recent paycheck stubs (30 day minimum)
Contact name & phone number to verbally verify employment
Verification of other income: social security, child support, retirement, etc.
If self-employed: past two years tax returns including all schedules and a profit and loss statement for
the current year signed by your accountant
Assets
Last two months statements for all bank and credit union accounts
Most recent retirement account statement – if used for down payment or funds
Other Information Needed
Copy of driver's license for each borrower
Homeowner’s insurance agents name & phone number
Divorce decrees, if applicable, including property settlements, modifications, etc.
For Purchases Only
Contact name, phone number and address of all landlords for the past two years
Accepted purchase agreement and copy of listing sheet
Please note that any material changes in your employment, income, assets and/or credit must be reported
to us as soon as possible, as it may affect your financing. Also, you may provide computer print-outs of any
of the above documents, provided that they are dated and contain your full name, the institutions names, and
the full account number.
Revised: 03/2015 als
Credit Application and Borrower’s Certification
Type of Credit Requested-Check the appropriate boxes below and complete the applicable section.
□ secured □ individual credit – relying solely on my income or assets
□ unsecured □ individual credit – relying on my income or assets as well as
income or assets from other sources
□ joint credit – we intend to apply for joint credit
□ entity owners – the undersigned understand they may be asked
to co-sign or guarantee the loan being requested as they are the
owners, officers or control parties for the entity.
Amount Requested Payment Due Desired Proceeds of Credit to be used for
$______________ __________________ ____________________________
Loan Number _______________ Date of Application ________________
Above references are for lender’s use only and do not limit the applicability of this document to any particular loan or item.
CERTIFICATION
The undersigned hereby certifies the accuracy of all financial statements provided in connection with
this credit application and indicates that our financial condition has not materially changed by
signing below.
-------------------------------------------- Fold to Copy --------------------------------------------
AUTHORIZATIONS
1) (I/We) authorize the bank to perform any credit investigation necessary to verify
information supplied to us by the following means:
• By contacting banks or other credit sources disclosed to us to verify balance,
collateral and payment history.
• By requesting and obtaining a credit report from a third party Credit Reporting
Agencies.
• By contacting references provided.
2) (I/We) authorize the bank to report (my/our) names and information regarding this loan to
Credit Reporting Agencies.
3) (I/We) understand a copy of this authorization may be mailed or faxed to (my/our) creditors
as authorization to release information on (my/our) account directly to HOMEBANK and
any information received will be held strictly confidential and covered under the
HOMEBANK’s privacy policy.
4) In the event (my/our) loan is approved, (I/we) hereby authorize the HOMEBANK to request
payoff information directly from any creditor we intend to refinance with the proceeds.
Entity Name (if Applicable): _______________________________
___________________________________ _______________________________
Borrower Borrower
___________________________________ _______________________________
Borrower Borrower
____________________________________ ______________________________
Guarantor/Co-signer Guarantor/Co-signer
Fees to be Collected: $_________ Interest $_________Other Fees = __________ Total to be Collected
NOTICE OF RIGHT TO RECEIVE COPY OF APPRAISAL/APPRAISAL EVALUATION
FROM:
HOMEBANK
400 SOUTH MAIN
P.O. BOX 311
PALMYRA, MO 63461
TO:
Loan Number: _________________
Property Address: ______________________________________________________________
Right to Receive Copy
We may order an appraisal to determine the property’s value and charge you for this appraisal. We will
promptly give you a copy of any appraisal/appraisal evaluation, even if your loan does not close.
You can pay for an additional appraisal for your own use at your own cost.
Acknowledgment
By signing below, you acknowledge you have received this Disclosure.
_____________________________________________________Date ____________________
_____________________________________________________Date ____________________
–
–
–
–
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. 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.
Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.” If you do not wish to provide
some or all of this information, select the applicable check box.
Ethnicity
Hispanic or Latino
Mexican Puerto Rican Cuban
Other Hispanic or Latino Enter origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, etc.
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race
American Indian or Alaska Native Enter name of enrolled
o
r
principal tribe:
Asian
Asian Indian Chinese Filipino
Japanese Korean Vietnamese
Other Asian Enter race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Black or African American
Native Hawaiian or Other Pacic Islander
Native Hawaiian Guamanian or Chamorro Samoan
Other Pacic Islander Enter race:
Examples: Fijian, Tongan, etc.
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 08/2016 • Effective 01/2018
–
–
–
–
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. 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.
Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.” If you do not wish to provide
some or all of this information, select the applicable check box.
Ethnicity
Hispanic or Latino
Mexican Puerto Rican Cuban
Other Hispanic or Latino Enter origin:
Examples: Argentinean, Colombian, Dominican, Nicaraguan,
Salvadoran, Spaniard, etc.
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race
American Indian or Alaska Native Enter name of enrolled
o
r
principal tribe:
Asian
Asian Indian Chinese Filipino
Japanese Korean Vietnamese
Other Asian Enter race:
Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.
Black or African American
Native Hawaiian or Other Pacic Islander
Native Hawaiian Guamanian or Chamorro Samoan
Other Pacic Islander Enter race:
Examples: Fijian, Tongan, etc.
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 08/2016 • Effective 01/2018
CRITICAL CLIENT INFORMATION REGARDING DEBT AND CREDIT
Thank you for allowing us to assist you with your home financing needs. Our top priority is to provide
our clients with outstanding, personalized service and a stress-free mortgage process. To help ensure
there are no surprises and your loan closes as expected, it is of critical importance that you are aware of
the following:
All existing and new debts must be considered for qualification purposes prior to funding your loan. This
means that your file could be subject to a pre-funding check to verify that:
• You have not acquired any new debt or opened any new accounts/loans;
• Your current loan balances have not increased (applies to loans, credit cards, lines of credit, etc.)
• You do not have any new delinquencies on any existing account or any new public records
(judgments, bankruptcies, etc.)
• Your credit score has not decreased.
These requirements apply to the borrower and any co-borrowers on the loan. If any of the above
changes are discovered through verification or obtaining of a new credit report, the file is subject to re-
qualification and/or re-underwriting.
If we must re-qualify and/or re-underwrite your loan, you must qualify with your updated debt and
credit profile. If you no longer qualify, we may not be able to fund your loan and any charges incurred
would be your responsibility.
If you suspect your credit or debt profile may have changed at any point between your approval and
loan funding, please notify your Loan Officer as soon as possible. This will help us stay “ahead of the
curve” and do everything we can to ensure your loan funds without any challenges.
Thank you for your cooperation! We look forward to serving you.
By signing below, I acknowledge I read and understood the information provided above.
____________________________________ _____________________________________
Borrower Date Borrower Date
Rev 07/20/2020
FACTS
WHAT DOES HOMEBANK DO
WITH YOUR PERSONAL INFORMATION?
Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully
to understand what we do.
The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
◼ Social Security number and income
◼ Account balances and payment history
◼ Credit history and credit scores
When you are no longer our customer, we continue to share your information as described in
this notice.
All financial companies need to share customers’ personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers’ personal information; the reasons HOMEBANK chooses to share; and whether
you can limit this sharing.
Reasons we can share your personal information
Does HOMEBANK share?
Can you limit this
sharing?
For our everyday business purposes—
such as to process your transactions, maintain
your account(s), respond to court orders and legal
investigations, or report to credit bureaus
Yes
No
For our marketing purposes—
to offer our products and services to you
No
We don’t share
For joint marketing with other financial companies
No
We don’t share
For our affiliates’ everyday business purposes—
information about your transactions and experiences
No
We don’t share
For our affiliates’ everyday business purposes—
information about your creditworthiness
No
We don’t share
For our affiliates to market to you
No
We don’t share
For non-affiliates to market to you
No
We don’t share
Questions?
Call us at 573-769-2001 or Toll-Free at 1-855-577-2001 or
go to www.myhomebank.bank
Page 2
Who we are
Who is providing this notice?
HOMEBANK
What we do
How does HOMEBANK protect my
personal information?
To protect your personal information from unauthorized access
and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
How does HOMEBANK collect my
personal information?
We collect your personal information, for example, when you
◼ Open an account or deposit money
◼ Pay your bills or apply for a loan
◼ Use your credit or debit card
We also collect your personal information from others, such as credit
bureaus.
Why can’t I limit all sharing?
Federal law gives you the right to limit only
◼ sharing for affiliates’ everyday business purposes—information
about your creditworthiness
◼ affiliates from using your information to market to you
◼ sharing for non-affiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing.
Definitions
Affiliates
Companies related by common ownership or control. They can be
financial and nonfinancial companies.
◼ HOMEBANK does not share with our affiliates.
Non-affiliates
Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
◼ HOMEBANK does not share with non-affiliates so they can market
to you.
Joint marketing
A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
◼ HOMEBANK does not jointly market.
400 S. Main
P.O. Box 311
Palmyra, Missouri 63461
573-769-2001
Fax 573-769-2345
IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A
NEW ACCOUNT
To help the government fight the funding of Terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify, and record
information that identifies each person who opens an account.
What that means for you: When you open an account, we will ask for your name,
address, date of birth, and other information that will allow us to identify you. We will
also ask to copy your driver's license
Identification is for verification of identity only and will in no way be used in the loan
credit process
***Payment made by you in person, by mail or electronically Monday through Friday, will
be credited on the day we receive them.
***Payments received on Saturday will be credited on the next business day.
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Mortgage Loan Application (My Homebank)

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Completed 15 December 2020

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