Amount
Interest Rate
No. of Months
Country
State / Province
City
Street Address1
Street Address2
Postcode / Zip
No. of Units
Legal Description of Subject Property (attach description if necessary)
Year Lot Acquired
Original Cost
Amount Existing Liens
(a) Present Value of Lot
(b) Cost of Improvements
Total (a + b)
Year Acquired
Original Cost
Amount Existing Liens
Purpose of Refinance
Cost:
Title will be held in what Name(s)
Manner in which Title will be held
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
No
Ages
Country
State / Province
City
Street Address1
Postcode / Zip
Mailing Address, if different from Present Address
Country
State / Province
City
Street Address1
Postcode / Zip
Co-Borrower’s Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone (incl. area code)
DOB (mm/dd/yyyy)
Yrs. School
Select Married Unmarried (include single, divorced, widowed) Separated
NO
ages
Country
State / Province
City
Street Address1
Postcode / Zip
Mailing Address, if different from Present Address
Country
State / Province
City
Street Address1
Postcode / Zip
Select Own Rent No. Yrs.
Name & Address of Employer
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
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
Position/Title/Type of Business
Business Phone (incl. area code)
Dates (from – to)
Monthly Income
Name & Address of Employer
Position/Title/Type of Business
Business Phone (incl. area code)
Dates (from – to)
Monthly Income
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Borrower
Co-Borrower
Total
Present
Proposed
Present
Proposed
Present
Proposed
Present
Proposed
Present
Proposed
Present
Proposed
Present
Proposed
Present
Proposed
Present Total
Proposed Total
B/C
Describe
Monthly Amount
B/C
Describe
Monthly Amount
B/C
Describe
Monthly Amount
Cash deposit toward purchase held by:
Cash or Market Value
Name and address of Bank, S&L, or Credit Union
Acct. no.
Cash
Name and address of Bank, S&L, or Credit Union
Acct. no.
Cash
Name and address of Bank, S&L, or Credit Union
Acct. no.
Cash
Name and address of Bank, S&L, or Credit Union
Acct. no.
Cash
Stocks & Bonds (Company name/ number & description)
Cash
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)
Cash/Market value
Total Assets a.
Name and address of Company
Acct. no.
$ Payment/Months
Unpaid Balance
Name and address of Company
Acct. no.
$ Payment/Months
Unpaid Balance
Name and address of Company
Acct. no.
$ Payment/Months
Unpaid Balance
Name and address of Company
Acct. no.
$ Payment/Months
Unpaid Balance
Name and address of Company
Acct. no.
$ Payment/Months
Unpaid Balance
Alimony/Child Support/Separate Maintenance Payments Owed to:
$ Payment/Months
Job-Related Expense (child care, union dues, etc.)
$ Payment/Months
Total Monthly Payments
Net Worth (a minus b)
Total Liabilities b.
Property Address
(enter S if sold, PS if pending sale or R if rental being held for income)
Property Address
(enter S if sold, PS if pending sale or R if rental being held for income)
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
Type of Property
Present Market Value
Amount of Mortgages & Liens
Type of Property
Present Market Value
Amount of Mortgages & Liens
Total
Total
Totals
Gross Rental Income
Mortgage Payments
Net Rental Income
Insurance, Maintenance, Taxes & Misc.
Gross Rental Income
Mortgage Payments
Net Rental Income
Insurance, Maintenance, Taxes & Misc.
Gross Rental Income
Mortgage Payments
Net Rental Income
Insurance, Maintenance, Taxes & Misc.
Total
Total
Total
Total
Alternate Name
Creditor Name
Account Number
Alternate Name
Creditor Name
Account Number
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)
Cash from/to Borrower (subtract j, k, l & o from i)
(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— by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
(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— by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
Date
Date
Date
Loan Originator’s Name (print or type)
Loan Originator Identifier
Loan Originator’s Phone Number (including area code)
Loan Origination Company’s Name
Loan Origination Company Identifier
Loan Origination Company’s Address
Borrower:
Agency Case Number:
Co-Borrower:
Agency Case Number:
Date
Date
Send