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To be completed by the Lender
Lender Loan No./Universal Loan Identifier
Agency Case No.
Uniform Residential Loan Application

Verify and complete the information on this application. If you are applying for this loan with others, each additional Borrower must provide information as directed by your Lender.

Section 1: Borrower Information.This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.
1a. Personal Information
Name (First, Middle, Last, Suffix)
Alternate Names - List any names by which you are known or any names under which credit was previously received (First, Middle, Last, Suffix)
Social Security Number--
(or individual Taxpayer Identification Number)
Date Of Birth
(mm/dd/yyy)
//
Citizenship
U.S. Citizen
Permanent Resident Alien
Non-Permanent Resident Alien
Type of Credit
I am applying for
I am applying for
individual credit.
joint credit.Total Number of Borrowers:
Each Borrower intends to apply for joint credit. Your initials:
List Name(s) of Other Borrower(s) Applying for this Loan(First, Middle, Last, Suffix) - Use a seperator between names
Marital Status
Married
Seperated
Unmarried
Dependents(not listed by another Borrower)
Number
Ages
(Single, Divorced, Widowed, Civil Union Domestic Partnership, Registered Recriprocal Beneficiary Relationships)
Contact Information
Home
Phone
()-
Cell
Phone
()-
Work
Phone
()-
Email
Current Address
StreetUnit #
CityState
ZipCountry
How Long at Current Address?YearsMonths
Housing
No primary housing expense
Own
Rent
($/month)
If at Current Address for LESS than 2 years, list Former Address
Does not apply
StreetUnit #
CityState
ZipCountry
How Long at Current Address?YearsMonths
Housing
No primary housing expense
Own
Rent
($/month)
Mailing Address - If different from Current Address
Does not apply
StreetUnit #
CityStateZipCountry
1b. Current Employment/Self-Employment and Income
Does not apply
Employer or Business Name
Phone
()-
Street Unit #
City State Zip Country
Position or Title
Start Date
//
(mm/dd/yyy)
How long in this line of work? Years Months
Check if this statement applies:
I am employed by a family member, property seller, real estate agent,or other party to the transaction.
Check if you are the Business Owner or Self-Employed
I have an ownership share of less than 25%.
I have an ownership share of 25% or more.
Monthly Income (or Loss)
$
Gross Monthly Income
Base
$ /month
Overtime
$ /month
Bonus
$ /month
Commision
$ /month
Military Entitlements
$ /month
Other
$ /month
TOTAL
$/month
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
1c. IF APPLICABLE, Complete Information for Additional Employment/Self-Employment Income
Does not apply
Employer or Business Name
Phone
()-
Street Unit #
City State Zip Country
Position or Title
Start Date
//
(mm/dd/yyy)
How long in this line of work? Years Months
Check if this statement applies:
I am employed by a family member, property seller, real estate agent,or other party to the transaction.
Check if you are the Business Owner or Self-Employed
I have an ownership share of less than 25%.
I have an ownership share of 25% or more.
Monthly Income (or Loss)
$
Gross Monthly Income
Base
$ /month
Overtime
$ /month
Bonus
$ /month
Commision
$ /month
Military Entitlements
$ /month
Other
$ /month
TOTAL
$/month
1d. IF APPLICABLE, Complete Information for Previous Employment/Self-Employment and Income
Does not apply
Provide at least 2 years of current and previous employment and income
Employer or Business Name
Street Unit #
City State Zip Country
Position or Title
Start Date
//
(mm/dd/yyy)
End Date
//
(mm/dd/yyy)
Check if you are the Business Owner or Self-Employed
Previous Gross Monthly Income
$/month/
1e. Income from other sources
Does not apply
Include Income from other sources below. Under Income Source, choose from the sources listed here:
  • Alimony
  • Automobile Allowance
  • Boarder Income
  • Capital Gains
  • Child Support
  • Disability
  • Foster Care
  • Housing or Personage
  • Interest and Dividends
  • Mortgage Credit Certificate
  • Mortgage Differential Payments
  • Notes Receivable
  • Public Assistance
  • Retirement (e.g. Pension, IRA)
  • Royalty Payments
  • Seperate Maintenance
  • Social Security
  • Trust
  • Unemployment Benefits
  • VA Compensation
  • Other
NOTE: Reveal alimony, child support, seoparate mainenance, or other income ONLY IF you want it considered in determining your qualificationfor this loan.
Income Source - use list above
Provide TOTAL amount Here
Monthly Income
$
$
$
$
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 2: Financial Information -- Assets and Liabilities This section asks about things you own that are worth money and that you want considered to qualify for this loan. It then asks about your liabilities (or debts) that you pay each month, such as credit cards, alimony, or other expenses.
2a. Assets - Bank Accounts, Retirement, and Other Accounts You Have
Include all accounts below, Under Account Type, choose from the types listed here:
  • Checking
  • Savings
  • Money Market
  • Certification of Deposit
  • Mutual Fund
  • Stocks
  • Stock Options
  • Bonds
  • Retirement (e.g., 401k, IRA)
  • Bridge Loan Proceeds
  • Individual Development
  • Account
  • Trust Account
  • Cash Value of Life Insurance
    • (used for the transaction
Account Type - use list above
Financial Institution - use list above
Account Number
Cash or Market Value
Account Type
Financial Institution
Account Number
Cash or Market Value $
Account Type
Financial Institution2
Account Number
Cash or Market Value $
Account Type
Financial Institution
Account Number
Cash or Market Value $
Account Type
Financial Institution
Account Number
Cash or Market Value $
Provide TOTAL Amount Here
$
2b. Other Assets and Credits You Have
Does not apply
Include all other assets and credits below. Under Asset or Credit Type, choose from the types listed here:
Assets
  • Proceeds from Real Estate Property to be sold on or before closing
  • Proceeds from Sale of Non-Real Estate Asset
  • Secured Borrowed Funds
  • Unsecured Borrowed Funds
  • Other
Credits
  • Earnest Money
  • Employer Assistance
  • Lot Equity
  • Relocation Funds
  • Rent Credit
  • Sweat Equity
  • Trade Equity
Asset or Credit Type
-use list above
Cash or Market Value
$
$
$
$
Provide TOTAL Amount Here
$
2c. Liabilities - Credit Cards, Other Debts, and Leases that You Owe
Does not apply
List all liabilities below (except real estate) and include deferred payments. Under Account Type, choose from the types listed here:
  • Revolving (eg., credit cards)
  • Installment (e.g., car, student, personal loans
  • Open 30-Day (balance paid monthly)
  • Lease (not real estate)
  • Other
Account Type -
use list above
Company Name
Account Number
Unpaid Balance
To be paid off at or before closing
Monthly Payments
Account Type
Company Name
Account Number
Unpaid Balance
$
Liabilities To Be Paid
Monthly Payments
$
Account Type
Company Name
Account Number
Unpaid Balance
$
Liabilities To Be Paid
Monthly Payments
$
Account Type
Company Name
Account Number
Unpaid Balance
$
Liabilities To Be Paid
Monthly Payments
$
Account Type
Company Name
Account Number
Unpaid Balance
$
Liabilities To Be Paid
Monthly Payments
$
Account Type
Company Name
Account Number
Unpaid Balance
$
Liabilities To Be Paid
Monthly Payments
$
2d. Other Liabilities and Expenses
Does not apply
Include all other liabilities and expenses below. Choose from the types listed here:
  • Revolving (e.g., credit cards)
  • Installment (e.g., car, student, personal loans)
  • Open 30-Day (balance paid monthly)
  • Lease (not real estate)
  • Other
Monthly Payments
Other Liabilities
Monthly Payment $
Other Liabilities
Monthly Payment $
Other Liabilities
Monthly Payment $
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 3: Financial Information -- Real Estate. This section asks you to list all properties you currently own and what you owe them.
I do not own any real estate
3a.Property You Own
If you are refinancing, list the property you are refinancing FIRST.
Address
StreetUnit #
CityState
ZIPCountry
Property Value
$
Status:Sold, Pending Sale, or Retained
Intended Occupancy:Investment, Primary Residence, Second Home, Other
Monthly Insurance, Taxes, Association Dues, etc.If not included in Monthly Mortgage Payment
$
For 2-4 Unit Primary or Investment Property
Monthly Rental Income
For LENDER to calculate:Net Monthly Rental Income
Mortgage Loans on this Property
Does not apply
Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
To be paid off at or before closing
Type:
FHA, VA, Conventional, USDA-RD, Other
Credit Limit
(if applicable)

Primary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$

Secondary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$
3b. Property You Own
Does not apply
Address
StreetUnit #
CityState
ZIPCountry
Property Value
$
Status:Sold, Pending Sale, or Retained
Intended Occupancy:Investment, Primary Residence, Second Home, Other
Monthly Insurance, Taxes, Association Dues, etc.If not included in Monthly Mortgage Payment
$
For 2-4 Unit Primary or Investment Property
Monthly Rental Income
For LENDER to calculate:Net Monthly Rental Income
Mortgage Loans on this Property
Does not apply
Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
To be paid off at or before closing
Type:
FHA, VA, Conventional, USDA-RD, Other
Credit Limit
(if applicable)

Primary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$

Secondary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$
3c. Property You Own
Does not apply
Address
StreetUnit #
CityState
ZIPCountry
Property Value
$
Status:Sold, Pending Sale, or Retained
Intended Occupancy:Investment, Primary Residence, Second Home, Other
Monthly Insurance, Taxes, Association Dues, etc.If not included in Monthly Mortgage Payment
$
For 2-4 Unit Primary or Investment Property
Monthly Rental Income
For LENDER to calculate:Net Monthly Rental Income
Mortgage Loans on this Property
Does not apply
Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
To be paid off at or before closing
Type:
FHA, VA, Conventional, USDA-RD, Other
Credit Limit
(if applicable)

Primary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$

Secondary Mortgage

Creditor Name
Account Number
Monthly Mortgage Payments
Unpaid Balance
$
Liabilities To Be Paid
Credit Type
Credit Limit
$
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 4: Loan and Property Information. This section asks about the loan's purpose and the property you want to purchase or refinance.
4a. Loan and Property Information
Loan Amount
$
Loan Purpose
Purchase
Refinance
Other
(specify)
Property AddressOccupancy
StreetUnit #
CityStateZipCountry
Number of UnitsProperty Value $
Primary Residence
Second Home
Investment Property
FHA Secondary Residence
1. Mixed-Use Property.If you occupy the property, will you set asside space within the property to operate your own business? (e.g., a factory built dwelling built on permanent chasis)
No
Yes
2. Manufactured Home. Is the property a manufactured home? (e.g., a factory built dwelling built on permanent chasis)
No
Yes
4b. Other New Mortgage Loans on the Property You are Buying or Refinancing
Does not apply
Creditor Name
Lien Type
Monthly Payment
Loan Amount/ Amount to be Drawn
Credit Limit
(if applicable)
Creditor Name
Lien Type
First Lien
Subordinate Lien
Monthly Payments
$
Loan Amount/ Amount to be Drawn
$
Credit Limit(If applicable)
$
Creditor Name
Lien Type
First Lien
Subordinate Lien
Monthly Payments
$
Loan Amount/ Amount to be Drawn
$
Credit Limit(If applicable)
$
4c. Rental Income on the Property You Want to Purchase
Does not apply
Complete if the property is a 2-4 Unit Primary Residence or an Investment Property
Amount
Expected Monthly Rental Income
$
For Lender to Calculate: Expected Net Monthly Rental Income
$
4d. Gifts or Grants You Have Been Given or Will Receive for this Loan
Does not apply
Include all gifts and grants below. Under Source, choose from the sources listed here:
  • Community Nonprofit
  • Employer
  • Federal Agency
  • Local Agency
  • Relative
  • Religious Nonprofit
  • State Agency
  • Unmarried Partner
  • Lender
  • Other
Asset Type:Cash Gift, Gift or Equity, Grant
Deposited/Not Deposited
Source -use list above
Cash or Market Value
Asset Type:Cash Gift, Gift or Equity, Grant
Deposited/Not Deposited
Deposited
Not Deposited
Source -use list above
$
Cash or Market Value
$
Asset Type:Cash Gift, Gift or Equity, Grant
Deposited/Not Deposited
Deposited
Not Deposited
Source -use list above
$
Cash or Market Value
$
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 5: Declarations. This section asks you specific questions about the property, your funding, and your past financial history.
5a. About this Property and Your Money for this Loan
A.Will you occupy the property as your primary residence
If YES, have you had an ownership interest in another preoperty in the last three years?
IF YES, complete (1) and (2) below:
(1) What type of property did you own: primary residence (PR), FHA secondary residence (SR), second home (SH), or investment property (IP)?
(2) How did you hold title to the property: by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
No
Yes
No
Yes
B.If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?
No
Yes
C.Are you borrowing any money for this real estate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?
If YES, what is the amount of this money?
No
Yes
$
D.1. Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
2. Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?
No
Yes
No
Yes
E.Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?
No
Yes
5b. About Your Finances
F.Are you a co-signer or guarantor on any debt that is not disclosed on this application?
No
Yes
G.Are there any outstanding judgments against you?
No
Yes
H.Are you currently delinquent or in default on a Federal debt?
No
Yes
I.Are you a party to a lawsuit in which you potentially have any personal financial liability?
No
Yes
J.Have you conveyed title to any property in lieu of foreclosure in the past 7 years?
No
Yes
K.Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?
No
Yes
L.Have you had property foreclosed upon in the last 7 years?
No
Yes
M.Have you declared bankruptcy within the past 7 years?
If YES, identify the type(s) of bankruptcy:
Chapter 7
Chapter 11
Chapter 12
Chapter 13
No
Yes
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 6: Acknowledgements and Agreements. This section tells you about your legal obligations when you sign this application.
Acknowledgements and Agreements
Definitions:
• "Lender" includes the Lender’s agents, service providers, and any of their successors and assigns.
• "Other Loan Participants" includes (i) any actual or potential owners of a loan resulting from this application (the “Loan”), (ii) acquirers of any beneficial or other interest in the Loan, (iii) any mortgage insurer, (iv) any guarantor, (v) any servicer of the Loan, and (vi) any of these parties' service providers, successors or assigns.

I agree to, acknowledge, and represent the following:
(1) The Complete Information for this Application
• The information I have provided in this application is true, accurate, and complete as of the date I signed this application.
• If the information I submitted changes or I have new information before closing of the Loan, I must change and supplement this application, including providing any updated/supplemented real estate sales contract.
• For purchase transactions: The terms and conditions of any real estate sales contract signed by me in connection with this application are true, accurate, and complete to the best of my knowledge and belief. I have not entered into any other agreement, written or oral, in connection with this real estate transaction.
• The Lender and Other Loan Participants may rely on the information contained in the application before and after closing of the Loan.
• Any intentional or negligent misrepresentation of information may result in the imposition of:
(a) civil liability on me, including monetary damages, if a person suffers any loss because the person relied on any misrepresentation that I have made on this application, and/or
(b) criminal penalties on me including, but not limited to, fine or imprisonment or both under the provisions of Federal law (18 U.S.C. §§ 1001 et seq.).

(2) The Property’s Security
The Loan I have applied for in this application will be secured by a mortgage or deed of trust which provides the Lender a security interest in the property described in this application.

(3) The Property’s Appraisal, Value, and Condition
• Any appraisal or value of the property obtained by the Lender is for use by the Lender and Other Loan Participants.
• The Lender and Other Loan Participants have not made any representation or warranty, express or implied, to me about the property, its condition, or its value.

(4) Electronic Records and Signatures
• The Lender and Other Loan Participants may keep any paper record and/or electronic record of this application, whether or not the Loan is approved. • If this application is created as (or converted into) an “electronic application”, I consent to the use of “electronic records” and “electronic signatures” as the terms are defined in and governed by applicable Federal and/or state electronic transactions laws. I intend to sign and have signed this application either using my: (a) electronic signature; or (b) a written signature and agree that if a paper version of this application is converted into an electronic application, the application will be an electronic record, and the representation of my written signature on this application will be my binding electronic signature. I agree that the application, if delivered or transmitted to the Lender or Other Loan Participants as an electronic record with my electronic signature, will be as effective and enforceable as a paper application signed by me in writing.

(5) Delinquency
• The Lender and Other Loan Participants may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in my credit report and will likely affect my credit score.
• If I have trouble making my payments I understand that I may contact a HUD-approved housing counseling organization for advice about actions I can take to meet my mortgage obligations.

(6) Authorization for Use and Sharing of Information
By signing below, in addition to the representations and agreements made above, I expressly authorize the Lender and Other Loan Participants to obtain, use, and share with each other (i) the loan application and related loan information and documentation, (ii) a consumer credit report on me, and (iii) my tax return information, as necessary to perform the actions listed below, for so long as they have an interest in my loan or its servicing:
(a) process and underwrite my loan;
(b) verify any data contained in my consumer credit report, my
loan application and other information supporting my loan application;
(c) inform credit and investment decisions by the Lender
and Other Loan Participants;
(d) perform audit, quality control, and legal compliance analysis
and reviews;
(e) perform analysis and modeling for risk assessments;
(f) monitor the account for this loan for potential delinquencies and
determine any assistance that may be available to me; and (g) other actions permissible under applicable law.
Borrower Signature
X
Date (mm/dd/yyy)
//
Additional Borrower Signature
X
Date (mm/dd/yyy)
//
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 7: Military Service. This section asks questions about your (or your deceased spouse`s) military service.
Military Service of Borrower
Military Service-Did you (or your deceased spouse) ever serve, or are currently serving, in the United States Armed Forces?
No
Yes
If YES, check all that apply:
Currently Serving on active duty with projected expiration date of service/tour
Currently retired, discharged, or seperated from service
Only period of service was as a non-activated member of the Reserve or National Guard
Surviving spouse
//
(mm/dd/yyy)
Section 8: Demographic Information. This section asks about your ethnicity, sex, and race.
Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below

EthnicityCheck one or more
Hispanic or Latino

Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
- Print Origin:
For example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.
Not Hispanic or Latino

I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
RaceCheck one or more
American Indian or Alaska Native -
Print name of enrolled or
principal tribe:

Asian

Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
- Print race:
For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Black or African American

Native Hawaiian or Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
- Print Race:
For example: Fijan, Tongan, and so on.
White

I do not wish to provide this information
To Be Completed by Financial Institution (for application taken in person):
Was the ethnicity of the Borrower collected on the basis of visual observation or surname?
No
Yes
Was the sex of the Borrower collected on the basis of visual observation or surname?
No
Yes
Was the race of the Borrower collected on the basis of visual observation or surname?
No
Yes
The Demographic Information was provided through:
Face-to-Face Interview (includes Electronic Media w/Video Component)
Telephone Interview
Fax or Mail
Email or Internet
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
Section 9: Loan Originator Information. To be completed by your Loan Originator.
Loan Originator Information
Loan Originator Organization Name
Address
Loan Originator Organization NMLSR ID#State License ID#
Loan Originator Name
Loan Originator NMLSR ID#State License ID#
Email
Phone
()-
Signature
X
Date (mm/dd/yyy)
//
Borrower Name:
Uniform Residential Loan Application
Freddie Mac Form 65 · Fannie Mae Form 1003
Effective 1/2021
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