Form Va 26-6681 - Application For Fee Or Roster Personnel Designation Page 2

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15. Geographic Area(s) of Practice (List your appraisal/inspection area(s), by state)

16. Provide an estimate of the number of principal assignments (appraisals or inspections as applicable) during at least the past 5 years. If less than 5 years, provide an

explanation (i.e., not licensed for past 5 years) Attach additional sheet as necessary.

Period (mm/dd/yyyy)

Number of Assignments

Names of Clients or Organizations

17. Employment History During Past 10 Years (attach additional sheet as necessary)

Dates (mm/dd/yyyy)

Occupation

Name of Employer

Address

From

18. HUD requires applicants to list three reference contacts only. For VA, List and Submit at least 3 letters attesting to your qualifications

References

Occupation

Address

19. To be completed by HUD applicants only: To avoid the possibility of any conflict of interest and to ensure compliance with HUD appraisal and/ or

inspector roster standards, the following certifications are to be completed by personnel qualified to receive assignments from HUD or HUD approved

lending institutions for HUD/FHA mortgage insurance applications. The term “interest” refers to direct interest as well as any “interest” held by relatives,

business associates, or other controlled persons.

Note: Any of the following items that have been struck out and initialed are exempted from this certificate and are to be explained truthfully in an attached

letter.

(a) I certify that I do not own more than 10% interest in any lender doing business with HUD in the local HUD office jurisdiction.

(b) I certify that I do not actively engage in the management or operation of a lending institution doing business with HUD.

(d) I certify that I am not currently suspended, debarred, or in any way disqualified from participating in HUD programs.

(e)

For appraisers, I certify that I will comply with HUD Handbook 4150.2, "Valuation Analysis for Home Mortgage Insurance for Single Family One- to

Four-Unit Dwellings" (with particular emphasis on Appendix D, “Valuation Protocol”), any updates to the Handbook, Mortgagee Letters, and all other

instructions and standards, in performing all appraisals on properties that will be security for HUD/FHA insured mortgages.

(f)

For Inspectors, I certify that I have a minimum of three years experience in one or more construction-related fields and that such experience has

equipped me with a thorough familiarity and understanding of residential construction techniques as related to new construction and repairs of a

structural nature. I certify I will conduct my inspections in accordance with HUD/FHA requirements. I further certify that if licensing or certification is

required by the state or local jurisdiction(s) in which I will operate, I will maintain such licensing or certification in good standing with the applicable

jurisdiction for the duration of my tenure on the FHA Inspector Roster. I further certify that I have read and fully understand the inspection

requirements, including any update to those requirements, including Mortgagee Letters, in performing all inspections on properties that will be

security for HUD/FHA insured mortgages and contained in the following documents:

(i)

HUD Handbook 4905.1 REV-1 (Requirements for Existing Housing, One to Four Family Units);

(ii)

HUD Handbook 4910.1 (Minimum Property Standards for Housing);

(iii) HUD Handbook 4145.1 REV-2 (Architectural Processing and Inspections for Home Mortgage Insurance);

(iv) HUD Handbooks 4150.1 REV-1 (Valuation Analysis for Home Mortgage Insurance) and 4150.2 CHG-1 (Valuation Analysis for Home Mortgage

Insurance for Single Family One to Four Unit Dwellings);

(v)

Permanent Foundations Guide for Manufactured Housing (formerly known as HUD Handbook 4930.3G, Permanent Foundations Guide for