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 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
VA Conventional Other (explain):
Agency Case Number Lender Case Number
FHA
USDA/Rural
Housing Service
Amount
$%
Interest Rate No. of Months
Fixed Rate Other (explain):
GPM ARM (type):
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) P
resent Value of Lot
$
(b) Cost of Improv
ements
$
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
Leasehold (show
expiration date)
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School
Married (includes registered domestic partners)
Unmarried (includes single, divorced, widowed)
Separated
Dependents
(not listed by
Co-Borrower)
No.
Ages
Present Address (street, city, state, ZIP/ country)
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.
Former Address (street, city, state, ZIP)
Own Rent No. Yrs.
Co-Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School
Married (includes registered domestic partners)
Unmarried (includes single, divorced, widowed)
Separated
Dependents
(not listed by
Borrower)
No.
Ages
Present Address (street, city, state, ZIP/ country)
Own Rent No. Yrs.
Mailing Address, if different from Present Address
Former Address (street, city, state, ZIP)
Own Rent No. Yrs.
Former Address (street, city, state, ZIP)
Own Rent No. Yrs.
Mortgage
Applied for:
Amortization Type:
I. TYPE OF MORTGAGE AND TERMS OF LOAN
II. PROPERTY INFORMA
TION AND PURPOSE OF LOAN
III. BORROWER INFORMA
TIONBorrower Co-Borrower
Borrower
Co-Borrower
Uniform Residential Loan Application
Freddie Mac Form 65 7/05 (rev. 6/09)
Page 1
Fannie Mae Form 1003 7/05 (rev. 6/09)
IV. EMPLOYMENT INFORMATIONBorrower Co-Borrower
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
Yrs. on this job
Yrs. employed in this
line of work/profession
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Yrs. on this job
Yrs. employed in this
line of work/profession
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed Dates (from-to)
Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code)
Name & Address of Employer
Self Employed Dates (from-to)
Monthly Income
$
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
Total Total
Base Empl. Income*
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other
(before completing,
see the notice in "describe
other income," below)
Rent
First Mortgage (P&I)
Other Financing (P&I)
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Other:
$$$ $
$
$$$ $$
Homeowner Assn. Dues
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income 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.
Notice:
B/C Monthly Amount
$
Borrower
Co-Borrower
Uniform Residential Loan Application
Freddie Mac Form 65 7/05 (rev. 6/09)
Page 2
Fannie Mae Form 1003 7/05 (rev. 6/09)
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 by that spouse or other person also.
Completed
Jointly Not Jointly
ASSETS
Cash or
Market ValueDescription
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. $
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) $
Liabilities and Pledged Assets.
Total Assets a. $
LIABILITIES
Monthly Payment &
Months Left to Pay
Unpaid Balance
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.
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. $=>
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
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
Borrower
Co-Borrower
Uniform Residential Loan Application
Freddie Mac Form 65 7/05 (rev. 6/09)
Page 3
Fannie Mae Form 1003 7/05 (rev. 6/09)
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
IX. ACKNOWLEDGEMENT AND AGREEMENT
X
. IN
FORMATION FOR GOVERNMENT MONITORING PURPOSES
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.
Borrower Co-Borrower
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)?
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 mis-
representation 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 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 representa-
tion 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 purpose through any source, including a source named in this application
or a consumer reporting agency.
Borrower's Signature Date Co-Borrower's Signature Date
XX
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 CO-BORROWER
Ethnicity:
Race:
Sex:
Ethnicity:
Race:
Sex:
I do not wish to furnish this information
Hispanic or Latino Not Hispanic or Latino
American Indian or
Alaska Native
Asian Black or
African American
Native Hawaiian or Other Pacific Islander White
Female Male
I do not wish to furnish this information
Hispanic or Latino Not Hispanic or Latino
American Indian or
Alaska Native
Asian Black or
African American
Native Hawaiian or Other Pacific Islander White
Female Male
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
Loan Originator's Signature Date
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
Uniform Residential Loan Application
Freddie Mac Form 65 7/05 (rev. 6/09)
Page 4
Fannie Mae Form 1003 7/05 (rev. 6/09)
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