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

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage
Applied for:		  [  ] VA
 [  ] FHA		  [  ] Conventional    [  ] Other (explain):
 [  ] USDA/Rural Housing Service		  Agency Case Number  Lender Case Number
Amount
$		  Interest Rate
                                          %		  No. of Months  Amortization
 Type:		  [  ] Fixed Rate
 [  ] GPM		  [  ] 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
 		  Describe                      [  ] made         [  ] to be made
 Improvements
 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                                                                   Co-Borrower
Borrower's Name (include Jr. or Sr. if applicable)
 
Social Security Number  Home Phone (incl. area code)  DOB
(mm/dd/yyyy(
  		  Yrs.
 School
[  ] Married  [  ] Unmarried (include single,
       divorced, widowed)		  Dependents (not listed by Co-Borrower
[  ] Separated  no.  ages
Present Address (street, city, state, ZIP)           [  ] Own    [  ] Rent __________ No. Yrs.
 
   
Mailing Address, if different from Present Address
 
  
 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

 [  ] Unmarried (include single,
       divorced, widowed)

  Dependents (not listed by Co-Borrower
 [  ] Separated  no.  ages
 Present Address (street, city, state, ZIP)           [  ] 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.

  

Borrower                                                                   IV. EMPLOYMENT INFORMATION                                                                   Co-Borrower
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

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:
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)

Freddie Mac Form 65 7/05
Fannie Mae Form 1003 7/05
-21N  (0507)
Page 1 of 4                                                Initials _____________
                         VMP Mortgage Solutions, Inc. (800)521-7291

  

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income

Borrower

Co-Borrower

Total

 Combined Monthly
 Housing Expense

Present

Proposed
Base Impl. Income*  $  $  $  Rent  $   
Overtime           First Mortgage (P&I)     $
Bonuses           Other Financing (P&I)      
Commissions           Hazard Insurance      
Dividends/Interest           Real Estate Taxes      
Net Rental Income           Mortgage Insurance      
Other (before completing
see the notice in "describe
other income," below)		           Homeowner Assn. Dues     
          Other:      
Total  $  $  $  Total  $  $
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

B/C

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.

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
Description ASSETS

Cash or Market
Value
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.  $
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)		  $
Automobile owned (make and year)

  

  $
Other Assets (itemize)

  

  $

Total Assets a.

  $
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

Monthly Payment &
Months Left to Pay

Unpaid Balance
 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.
 Name and address of Company

  

  $ Payment/Months  $
 Acct. no.
 Alimony/child Support/Separate Maintenance
 Payments Owed to:
  		  $   
 Job-Related Expense (child card, union dues, etc.)
  		  $
 Total Monthly Payments  $
 Net Worth
 (a minus b)

»

  $  Total Liabilities b.  $

Freddie Mac Form 65 7/05
Fannie Mae Form 1003 7/05
-21N  (0507)
                                                 Page 2 of 4                              Initials _____________

  

VI. ASSETS AND LIABILITIES (cont'd)
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  q		 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
  
  
 
  
 
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

Borrower

Co-Borrower
use continuation sheet for explanation. 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 obligations, 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)?		      

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 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.
Borrower's Signature

X

  Date  Co-Borrower's Signature

 X

  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 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  [  ] I do not wish to furnish this information.  CO-BORROWER  [  ] I do not wish to furnish this information.
Ethnicity:  [  ] Hispanic or Latino  [  ] Not Hispanic or Latino  Ethnicity:  [  ] Hispanic or Latino  [  ] Not Hispanic or Latino
Race:  [  ] American Indian or
       Alaska Native
 [  ] Native Hawaiian or
       Other Pacific Islander		  [  ] Asian
 
 [  ] White		  [  ] Black or
       African American		  Race:  [  ] American Indian or
       Alaska Native
 [  ] Native Hawaiian or
       Other Pacific Islander		  [  ] Asian
 
 [  ] White		  [  ] Black or
       African American
Sex:  [  ] Female  [  ] Male  Sex:  [  ] Female  [  ] Male
To be Completed by Interviewer

This application was taken by:
[  ] Face-to-face interview
[  ] Mail
[  ] Telephone
[  ] Internet

  Interviewer's Name (print or type)
 		  Name and Address of Interviewer's Employer
 Interviewer's Signature                                                               Date
 
 Interviewer's Phone Number (incl. area code)
 
-21N  (0507)                Page 3 of 4                                                                                                                                                                                                                                       Freddie Mac Form 65 7/05
                                                                                                                                                                                                                                                                                                    Fannie Mae Form 1003 7/05

  

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:
 
 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.
Borrower's Signature:

X 

  Date  Co-Borrower's Signature:

 X

  Date
Freddie Mac Form 65 7/05
Fannie Mae Form 1003 7/05
-21N  (0507)
                                                                                                                                                         Page 4 of 4