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)
|
|
|
