Reverse Mortgage Loan Summary Page 3

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Repayment Options
[Description of repayment options]
Risks
[Statement about security interest in the consumer’s dwelling]
[Description of ways the borrower may default on the loan]
[Statements about possible action by creditor]
Foreclose On Your Home
[Statements about possible actions by creditor]
Stop Giving You Money
[Statements about possible actions by creditor]
Terminate Your Loan
[Statements that other changes can be made to the loan]
[Statement that the consumer has no obligation to accept the terms disclosed in the table] [Identification of
any disclosed term that is subject to change prior to opening the plan, or a statement that all terms disclosed
could change before the plan is opened, as applicable]
[Statement that the consumer may be entitled to refund of all fees paid if the consumer decides not to open
the plan] [Cross reference to the “Fees” section in the table]
[Statement about asking questions]
[Statement about Board’s website]
[if the creditor has a provision for the consumer’s signature, a statement that a signature by the consumer
only confirms receipt of the disclosure statement]
[
Borrower’s Signature
Date]

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