Fillable Request For And Certificate Of Eligibility - Form Cg-5501 printable pdf download

U.S. DEPARTM ENT O F

REQUEST FOR AND CERTIFICATE OF ELIGIBILITY

HOMELAND SECURITY

U.S. COAST GUARD

(See Privacy Act Statement Attached)

CG -5501 (6-04)

PART I - REQUEST FOR CERTIFICATE OF ELIGIBILITY

(To be completed by serviceman)

1. NAME OF SERVICEMAN (Last, First, Middle Initial)

2. GRADE

3. SOCIAL SECURITY NO.

4. ORGANIZATI ON AND ADDRESS TO WHICH ASSIGNE D

4. ORGANIZATION AND ADDRESS TO WHICH ASSIGNED

5. MILITARY SERVICE

6. HAVE YOU PREVIOUSLY BEEN ISSUED OR TRANSFERRED A CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE

FOR SERVICEMEN?

YES

(If answer is yes indicate status of prior certificates, i.e., surrendered, transferred, lost, or destroyed and the date of disposition.)

I hereby agree that in the event I am issued a certificate of Eligibility and subsequently obtain financing pursuant to the provisions of Section

222, National Housing Act, as amended, I will immediately notify my commanding officer in writing when I sell or otherwise dispose of the

property so financed. In the event I fail to notify my commanding officer, I further agree that any liability incurred by the Military Service, of

which I am a member, on mortgage insurance premiums paid subsequent to the date of such sale or disposal, will be reimbursed by me. Also,

I understand that in the event I dispose of property, I should seek a release of personal liability from the holder of the note; otherwise, I may

subsequently be required to make payments on the loan or possibly be subjected to legal action for a deficiency judgement.

I CERTIFY THAT I AM CURRENTLY ON ACTIVE

DATE

SIGNATURE OF SERVICEMAN

DUTY, HAVE COMPLETED OVER TWO YEARS (2) OF

ACTIVE SERVICE, AND I REQUIRE HOUSING OR

HAVE ASSUMED A MORTGAGE INDEBTEDNESS.

PART II - CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE FOR SERVICEMAN

(To be completed by Military Service)

THIS CERTIFICATE MUST ACCOMPANY THE SERVICEMAN'S APPLICATION FOR LOAN

THIS IS TO CERTIFY THAT THE ABOVE-NAMED SERVICEMAN MEETS THE ELIGIBILITY REQUIREMENTS SET FORTH IN SECTION

222, NATIONAL HOUSING ACT, AS AMENDED (12 U.S.C. 1715M)

THIS CERTIFICATE IS VALID UNTIL (Date)

9. DATE

10. TYPED NAME, TITLE, ORGANIZATION AND

11. SIGNATURE OF CERTIFYING OFFICER

ADDRESS OF CERTIFYING OFFICER

PART III - TO BE COMPLETED BY MORTGAGEE

12. PROPERTY ADDRESS AND LOCATION

13. NAME AND ADDRESS OF MORTGAGEE OR SERVICER

PART IV - NOTIFICATION OF FHA ACTION

(To be completed by FHA)

14. FHA CASE NO.

15. FHA ACTION AND DATE

16. AMOUNT OF MORTGAGE,

17. SIGNATURE OF AUTHORIZED AGENT

TERM, AND INTEREST

INDORSED

RATE

(Date)

TRANSFERRED TO SECTION

222 EFFECTIVE

(Date)

OFFICE:

18. RETURN TO (Return address of military service)

COMMANDANT (G-WPW-1)

U.S. COAST GUARD

2100 2ND STREET, S.W.

WASHINGTON, DC 20593-0001

PRIVACY ACT STATEMENT: Solicitation of the above information is authorized by 12 U.S.C. 1215m and E.O. 9397 to determine eligibility for

FHA 222 mortgage insurance. Disclosure of this information is voluntary, however, non-disclosure may result in suspension of premium payments.

(This form replaces DD-802)

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Request For And Certificate Of Eligibility - Form Cg-5501

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