Uniform Residential Loan Application Form Page 3
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4VI. ASSETS AND LIABILITIES
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-borrowers if their assets and liabilities are sufficiently joined
so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section
was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed by that spouse or other person also.
Completed
Jointly
Not Jointly
Cash or
ASSETS
Liabilities and Pledged Assets.
List the creditor's name, address and account number for all outstanding
Description
Market Value
debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support,
Cash deposit toward
stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be
$
purchase held by:
satisfied upon sale of real estate owned or upon refinancing of the subject property.
Monthly Payment &
Unpaid Balance
LIABILITIES
Months Left to Pay
List checking and savings accounts below
Name and address of Company
$ Payment/Months
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Company
$ Payment/Months
$
Acct. no.
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Company
$ Payment/Months
$
Acct. no.
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Company
$ Payment/Months
$
Acct. no.
$
Stocks & Bonds (Company
$
name/number description)
Acct. no.
Name and address of Company
$ Payment/Months
$
Life insurance net cash value
$
Face amount: $
Subtotal Liquid Assets
$
Acct. no.
Name and address of Company
$ Payment/Months
$
$
Real estate owned (enter market value
from schedule of real estate owned)
Vested interest in retirement fund
$
Net worth of business(es) owned
$
(attach financial statement)
Acct. no.
Automobiles owned (make and year)
$
Alimony/Child Support/Separate
$
Maintenance Payments Owed to:
Other Assets (itemize)
$
Job-Related Expense (child care, union dues, etc.) $
Total Monthly Payments
$
=>
Net Worth
Total Liabilities b.
$
$
Total Assets a.
$
(a minus b)
(if additional properties are owned, use continuation sheet)
Schedule of Real Estate Owned
Insurance,
Property Address (enter S if sold, PS if pending
Type of
Present
Amount of
Gross
Mortgage
Maintenance,
Net
sale or R if rental being held for income)
Property
Market Value
Mortgages & Liens
Rental Income
Payments
Taxes & Misc.
Rental Income
$
$
$
$
$
$
Totals
$
$
$
$
$
$
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name
Creditor Name
Account Number
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 3
of 4
Calyx Form - Loanapp3.frm (11/09)
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