Respa Changed Circumstance Certification - American Financial Resources, Inc
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1RESPA Changed Circumstance Certification
Originating Company Name: _______________________________________________________________________________
Applicant(s) Names(s): _________________________________________
_________________________________________
_________________________________________
_________________________________________
Property Address: __________________________________________________________________________________________
AFR Loan #: ___________________________________________________
Information was obtained regarding the borrower’s loan that will result in a changed circumstance as defined
under RESPA Section 3500.2
Changed circumstances as defined in §3500.2 are (1) Acts of God, war, disaster or other emergency;
(2) Information particular to the borrower or transaction that was relied on in providing the GFE is found to be
inaccurate after the GFE has been provided, which may include information about the credit quality of the
borrower, the amount of the loan, the estimated value of the property, or any other information that was
used in providing the GFE; (3) New information particular to the borrower or transaction that was not relied on
in providing the GFE; or (4) Other circumstances that are particular to the borrower or transaction, including
boundary disputes, the need for flood insurance, or environmental problems.
Check all applicable boxes for changed circumstances(s).
Borrower has requested a change in loan terms and/or product types.
Description of borrower’s request: ____________________________________________________________
Date of request: _____________________________________________________________________________
Property Type Change (i.e. changed property type such as Single Family to Condo)
Credit Quality Change due to new information received (i.e. FICO Score, DTI, Income)
Legal Address Error (i.e. Misspelling, Directional error, Avenue vs. Street *Does not include change in
legal address)
Property Value Change
Loan Amount Change
Request from Float GFE to Lock GFE
Rate lock on the above referenced loan has expired
Date of lock expiration: ______________________________________________________________________
Other/Describe: ____________________________________________________________________________________
Amount of Fee Due to
Fee Name
Amount of Previous Fee Disclosed
Changed Circumstance
$
$
$
$
$
$
$
$
Date the Originating Company was advised of Change of Circumstance: ____________________________________
The re-disclosed GFE was sent to the Applicant(s) on: _____________________
The undersigned employee of the Originating Company certifies the information is accurate and has personal
knowledge of the information listed above.
Signature: ________________________________________________________ Date: __________________________________
Name: (print) _____________________________________________________ Title: ___________________________________
Title 18 U.S.C. 1014 provides in part that whoever knowingly and willfully makes or uses a document containing
false, fictitious, or fraudulent statements on any document submitted in connection with a mortgage loan
application shall be fined not more than $1,000,000 or imprisoned for not more than 30 years or both. Violations
may also result in civil liability for damages suffered by AFR.
American Financial Resources, Inc. /RESPA Changed Circumstance Certification/Revised 6/05/2013
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