Uniform Residential Loan Application

I. Type of Mortgage and Terms of Loan


II. Property Information and Purpose of Loan

III. Borrower Information


If residing at present address for less than two years, complete the following

IV. Employment Information


If employed in current position for less than two years or if currently employed in more than one position, complete the following

V. Monthly income & combined housing expense information

Gross Monthly Income Borrower Total Combined Monthly Housing Expense Present Proposed
Base Employment 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 Homeowner Assn. Dues
Other Other
Total Total

* Self Employment Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Described 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

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


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. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.


Description Cash or Market Value
List all checking and savings accounts below
Subtotal Liquid Assets
Real estate owned (enter market value from schedule of real estate owned in form below)
Vested interest in retirement fund
Net worth of business(es) owned (attach financial statement)
Automobiles owned (make & year)
Other Assets
Total Assets


Description Monthly Payment & Months Left to Pay Unpaid Balance
Job-Related Expense (child care, union dues, etc)
Total Monthly Payments
Total Liabilities
Net Worth (Total Assets - Total Liabilities)

Schedule of Real Estate Owned

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
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

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 (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 (m + n)
p. Cash from/to Borrower (subtract j, k, l & o from i)

VIII. Declarations

If you answer "Yes" to any questions a through i, please use the text area below for explanation. Borrower
Yes No
a. Are there any outstanding judgements 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 in 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 judgement?
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?
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 US citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?