Loan Pre-Approval Denial Risk Assessment Form
Use this form to evaluate the risk of loan pre-approval denial by providing non-sensitive information about the applicant, income, housing, debt obligations, and credit history indicators.
Applicant and Loan Request
Applicant full name
*
First Name
Middle Name
Last Name
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Desired loan amount (USD)
*
Loan purpose
*
Home purchase
Debt consolidation
Vehicle purchase
Business use
Education
Personal expense
Other
Preferred loan term
*
Please Select
6 months
12 months
24 months
36 months
48 months
60 months
Other
Employment, Income, and Stability
Employment Status
*
Employed full-time
Employed part-time
Self-employed
Contract/Gig
Unemployed
Retired
Student
Other
Monthly Gross Income
*
Months at Current Job or Business
*
Total Household Income (if applicable)
Income Stability / Predictability (Past 12 Months)
*
Very unstable
1
2
3
4
5
6
7
8
9
Very stable
10
1 is Very unstable, 10 is Very stable
Housing and Living Situation
Housing status
*
Own
Rent
Live with family/friends
Employer-provided
Other
Monthly housing payment or rent estimate (USD)
*
Years at current address
*
Expected major housing change in the next 6 months?
*
Yes
No
Debt Load and Ongoing Obligations
Total Monthly Debt Obligations (excluding housing)
*
Number of Active Debt Obligations
*
Debt Obligation Details
*
Enter approximate, non-sensitive monthly amounts only. Do not include housing costs or account numbers.
Credit History Indicators
Self-Reported Credit Band
*
Poor
Fair
Good
Very Good
Excellent
Prefer not to say
Late Payments in the Last 24 Months
*
Yes
No
Adverse Credit Events in History
Bankruptcy
Foreclosure
Repossession
Collections
None of the above
Approximate Credit Score Range
Explanation of Any Adverse Credit Events
Risk Notes and Review
Current delinquency, missed payments, or pending obligations?
*
Yes
No
Risk notes or explanation
Supporting document upload (optional)
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