E Sign Policy Page 2

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Third Party E-Sign Application
Customer Name: _________________________________________
Date: _____________________
For consideration, provide the following:
Fully completed application
The following information is only required if you are using a vendor that is NOT listed
as one of MiMutual’s Approved Vendors (one of the additional eligible vendors):
o Example of Disclosure Tracking Summary, which must include:
Loan identifying information
Date disclosures were electronically sent and date the e-disclosures
were accepted by the borrower(s)
Evidence of Borrower(s)’ IP Address
List of documents sent
o Example of a signed borrower consent form for e-sign for each borrower on the
loan
1. What e-Sign vendor will be used for the E-sign program and how long have you utilized the
vendor?
_________________________________________
Start Date________________________
2. Who completes the Quality Control reviews of E-Sign loans (in-house or outsourced)?
____________________________________________________________________
Explain the Quality Control process for E-Signed loans (i.e., sample size, frequency of audits,
etc.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Please list the individual to contact in the event any documents are needed.
NAME: ________________________________________________________________________
TITLE: _________________________________________________________________________
Phone Number: __________________ Fax Number: ______________ Email: ______________
Signature: ___________________________________
Title:____________________________
Submit to Client Relations ()
For Internal Use Only
Approved By: ________________________
Date: ____________________
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