Form Hud-11701 - Application For Approval Fha Lender And/or Ginnie Mae Mortgage-Backed Securities Issuer - 2003 Page 4
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5Section B. History and Business Status
Please check the appropriate answer for each question below. If any of the questions require a "Yes" answer, provide an explanation on a separate sheet.
Yes No
Yes No
1.
Is the applicant the subject of any assessments, or contingent
4.
Have any mortgage insurance companies, secondary
liabilities not disclosed in its financial statements?
marketing agencies or warehouse lenders, or broker/
dealers denied the applicant approval in the three
2.
Has the applicant or any of its principals, officers,
previous fiscal years being reported? Provide the date
individuals serving on the Board of Directors, or
and reasons for each denial.
individuals acting as authorized signatories, ever
been, or are any presently suspended, terminated,
5.
Has the applicant been subject to any past or present
debarred, sanctioned, fined, convicted, denied approval,
action by HUD, VA, Fannie Mae, Freddie Mac, or other
or refused a license by any Federal, State, or local
government-related entity to indemnify the entity
government agency, or a government-related entity,
against loss?
where the action is related to the responsibilities that are
6.
Is the applicant currently subject to regulatory or super-
commensurate with those of the financial services industry?
visory action by any regulatory agency? Regulatory
3.
Is the applicant or any of it principals, officers, individu-
actions include, but are not limited to, supervisory
als serving on it's Board of Directors, individuals acting
agreements, cease and desist orders, notices of deter-
as authorized signatories, or employees currently in-
mination, memorandum of understanding, unresolved
volved in a proceeding or subject to an investigation
audits, and investigations.
Supervisory actions in-
that could result, or has resulted, in suspension, fine, or
clude, but are not limited to, the appointment of a
disbarment by a Federal, State, or local government
trustee, conservator, or managing agent.
agency, conviction in a criminal matter, bankruptcy or
7.
Has the applicant or any owner, principal, or managing
denial of fidelity insurance or mortgagee’s errors and
executive been involved, through ownership or other-
omissions insurance coverage?
wise, with a previously defaulted Ginnie Mae issuer(s)?
Section C: FHA Title I and Title II only
1. Premium Address Check if same as:
Geographic
Mailing
5. Lender/Mortgagee Type
6. Institution Type
Attention (Use a title, not an individual's name)
Government
Federal
State
Street Address /P.O. Box
Local
Supervised *
Credit Union
City
State
Zip Code
(not Loan Correspondent)
Bank
Savings Bank
2. Payee Address Must be completed for all FHA applications
Savings and Loan
Attention (Use a title, not an individual's name)
Non-supervised
Insurance Company
(not Loan Correspondent)
Mortgage Co./Finance Co.
Street Address /P.O. Box
Loan Correspondent
Mortgage Co./Finance Co.
(Supervised/Non-supervised)
Supervised Loan Corr.*
City
State
Zip Code
Investing Mortgagee
For-Profit
Not-for-Profit
3. CHUMS Address Check if same as:
Geographic
Mailing
Premium
Payee
Reserved
Attention (Use a title, not an individual's name)
Service Provider
Service Provider
Street Address /P.O. Box
Servicing Agent
5. Lender/Mortgagee
6. Institution Type
City
State
Zip Code
Type Code (HUD use)
(HUD use)
4. Endorsement Address Check if same as:
Geographic
Mailing
Premium
Payee
CHUMS
Attention (Use a title, not an individual's name)
* 7. Examined and Supervised
7. Examined and
Supervised Code
Federal Reserve System
(HUD use)
Street Address /P.O. Box
Federal Deposit Insurance Corp.
Office of Thrift Supervision
City
State
Zip Code
National Credit Union Admin.
Other (specify)
11. Fiscal Year End (month)
10. Origination/Service
8. Sponsor Home Office Lender/Mortgagee ID
(HUD use)
(10 digits)
12. Financial Statement Date (HUD use)
Title I Property Improvement
9. Applicant Taxpayer Identifying Number
Manufactured Housing
13a. Title I Home Office Lender ID,
(9 digits)
if prior approval (10 digits)
Title II 1-4 Family Mortgages
Multifamily Mortgages
13b. Title II Home Office Mortgagee ID,
if prior approval (10 digits)
Previous editions are obsolete.
form HUD-11701 (07/2003)
Replaces HUD-92001, 92001-D and LD
ref Handbooks 5500.3, Rev. 1 and 4060.1
Page 2 of 3
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