Uniform Residential Loan Application Form
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4Dimond Mortgage Inc, NMLS# 190187
Uniform Residential Loan Application
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 or other person who has community
property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person
has community property rights pursuant to applicable law and 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.
If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):
Borrower
Co-Borrower
I. TYPE OF MORTGAGE AND TERMS OF LOAN
Agency Case Number
Lender Case Number
Mortgage
VA
Conventional
Other (explain):
Applied for:
FHA
USDA/Rural
Housing Service
Amount
Interest Rate
No. of Months
Amortization Type:
Fixed Rate
Other (explain):
$
%
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
Property will be:
Purchase
Construction
Other (explain):
Refinance
Construction-Permanent
Primary Residence
Secondary Residence
Investment
Complete this line if construction or construction-permanent loan.
Year Lot
Original Cost
Amount Existing Liens
(a) Present Value of Lot
(b) Cost of Improvements
Total (a+b)
Acquired
$
$
$
$
$
Complete this line if this is a refinance loan.
Year
Original Cost
Amount Existing Liens
Purpose of Refinance
Describe Improvements
made
to be made
Acquired
$
$
Cost: $
Title will be held in what Name(s)
Manner in which Title will be held
Estate will be held in:
Fee Simple
Leasehold
(show
expiration date)
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
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 Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School
Social Security Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School
(not listed by
(not listed by
Dependents
Dependents
Married (includes registered domestic partners)
Married (includes registered domestic partners)
Co-Borrower)
Borrower)
Unmarried (includes single, divorced, widowed)
No.
Unmarried (includes single, divorced, widowed)
No.
Separated
Ages
Separated
Ages
Present Address (street, city, state, ZIP/ country)
Own
Rent
No. Yrs.
Present Address (street, city, state, ZIP/ country)
Own
Rent
No. Yrs.
/ United States
/ United States
Mailing Address, if different from Present Address
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP)
Own
Rent
No. Yrs.
Former Address (street, city, state, ZIP)
Own
Rent
No. Yrs.
Former Address (street, city, state, ZIP)
Own
Rent
No. Yrs.
Former Address (street, city, state, ZIP)
Own
Rent
No. Yrs.
Borrower
Uniform Residential Loan Application
Co-Borrower
Freddie Mac Form 65
7/05 (rev. 6/09)
Fannie Mae Form 1003 7/05 (rev. 6/09)
Page 1
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Calyx Form - Loanapp1.frm (11/09)
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