Uniform Residential Loan Application Form
Section 1: Borrower Information
This section, information about the person applying for the loan is asked.
Name
First
Middle
Last
Date of Birth
 /
Month
 /
Day
Year
1
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Marital Status
Married
Unmarried
Separated
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Housing
Own
Rent
No primary housing expense
Rent
$/Month
Is your mailing address the same as your current address?
Yes
No
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Section 2: Employment Information
This section asks about your employment and retirement information.
What is your current working status?
Full Time
Part-Time
Freelancer
Retired
Business Name
2
Check if you are the Business Owner or Self-Employed
Start Date
 -
Month
 -
Day
Year
3
Position or Title
Business Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Monthly Income
$/Month
Business Office Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Ownership Type
Own
Rent
No primary housing expense
Rent
$/Month
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Section 3: Monthly Income Information
This section asks about your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.
Base Employment Income
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other
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Section 4: Loan & Property Information
This section asks you specific questions about the property, your funding, and your past financial history.
1) Will you occupy the property as your primary residence?
Yes
No
1.a) Have you had an ownership interest in another property in the last three years?
Yes
No
1.b) What type of property did you own: primary residence (PR), FHA secondary residence (SR), second home (SH), or investment property (IP)?
PR
SR
SH
IP
1.c) How did you hold title to the property: by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
S
SP
O
2) If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?
Yes
No
3) 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?
Yes
No
3.a) What is the amount of this money?
4) 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?
Yes
No
5) 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?
Yes
No
6) 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)?
Yes
No
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Section 5: Demographic Information
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.
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
I do not wish to provide this information
Sex
Female
Male
I do not wish to provide this information
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
I do not wish to provide this information
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Section 6: Acknowledgement and Agreement
Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.
Date
 /
Month
 /
Day
Year
4
Signature
Submit
Should be Empty: