Uniform Residential Loan Application and
Borrowers Certification and Authorization Form
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 will not be used as a basis for loan qualification, but his
or her liabilities must be considered because the 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.
| I. TYPE OF
MORTGAGE AND TERMS OF LOAN |
Mortgage
V.A.
Conventional
Other:
Applied for: FHA FmHA
|
Agency Case #
|
Lender Case #
|
Amount
$ |
Interest Rate
% |
No. of Months
|
Amortization
Fixed Rate
Other (explain):
Type:GPM
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
Construction
Other (explain):
Refinance
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 Improvements
made
to be made
Cost $ |
| Borrower
III. BORROWER INFORMATION
Co-Borrower |
Borrower’s Name (include Jr. or Sr. if
applicable)
|
Co-Borrower’s Name (include Jr. or Sr. if
applicable
|
Social Security #
|
Home Phone (incl. area code)
|
Age
|
Yrs. School
|
Social Security #
|
Home Phone (incl. area code)
|
Age
|
Yrs. School
|
Married
Unmarried (include single divorced,
widowed)
Separated |
Dependents
(not listed by Co- Borrower)
no. ages
|
Married
Unmarried (include single divorced,
widowed)
Separated |
Dependents
(not listed by Borrower)
no. ages
|
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
| If residing at present address for less than
two years, complete the following: |
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
Present Address (street, city, state, ZIP)
Own
Rent ____No. Yrs.
|
| Borrower
IV.
EMPLOYMENT INFORMATION
Co-Borrower |
Self Employed (check
above box)
Name and Address of Employer |
Yrs. on this job
|
Self Employed (check above box)
Name and Address of Employer |
Yrs. on this job
|
Yrs. employed
in this line of
work/profession
|
Yrs. employed
in this line of
work/profession
|
Position/Title/Type of
Business
|
Business Phone (incl. area code)
|
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: |
Self Employed (check
above box)
Name and Address of Employer |
Dates(from-to)
|
Self Employed (check
above box)
Name and Address of Employer |
Dates(from-to)
|
Monthly Income
$ |
Monthly Income
$ |
Position/Title/Type of
Business
|
Business Phone (incl. area code)
|
Position/Title/Type of
Business
|
Business Phone (incl. area code)
|
Self Employed (check
above box)
Name and Address of Employer |
Dates(from-to)
|
Self Employed (check
above box)
Name and Address of Employer |
Dates(from-to)
|
Monthly Income
$ |
Monthly Income
$ |
Position/Title/Type of
Business
|
Business Phone (incl. area code)
|
Position/Title/Type of
Business
|
Business Phone (incl. area code)
|
|