Va Form 29-8636 - Veterans Mortgage Life Insurance Statement Page 2
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3INSTRUCTIONS FOR COMPLETING STATEMENT
This statement should be completed and returned as soon as possible.
If you are eligible and want the insurance, complete Part A, Items 1 through 16 only - otherwise see Part B below.*
If the information requested in any item is not readily available, insert "unknown". The Department of Veterans Affairs will secure
the information from other sources or, if necessary, write to you again.
Please print or type the information to be inserted. Return the completed statement to the address shown on Page 1.
Items 1 - 5 - Self-explanatory.
Item 6 - If veteran is incompetent, show address of guardian.
Item 7 - Self-explanatory.
Item 8 - Self-explanatory. (For the purpose of establishing the insurance correctly, the Department of Veterans Affairs will write to
this company or individual.) NOTE: If house is under construction, send photocopies of construction contract and mortgage loan
commitment with this application.
Item 9 - Enter any mortgage, account, or identification number assigned to your mortgage by the company or individual to whom
payments are made.
Item 10 - Self-explanatory.
Item 11 - Enter original dollar amount of your mortgage, at the time the mortgage was granted and the present unpaid balance.
Item 12 - Enter the amount of your monthly payment for principal and interest, excluding any amount for taxes, insurance, etc.
Item 13 - Enter the agreed annual rate of interest of your mortgage.
Item 14 - Show the date the first payment was due under the mortgage and the duration as of that date, such as 20, 25, or 30 years,
or 20 years 10 months, etc.
Item 15 - If your home is under construction, please indicate so in Block 15A. If you want coverage to begin prior to completion of
the home, indicate so in Block 15B. Please provide a copy of your construction commitment. Premiums will be based on your
construction commitment amount, but could be adjusted when you make final settlement.
Items 16 & 17 - Sign full name and enter date. If signed by guardian please indicate. In any other case in which veteran's signature
does not appear, please explain.
*Part B - If you do not want the insurance, please enter your name and VA file number, check the appropriate box, sign, and date.
To Contact Us:
Mailing address:
VAROIC
P.O. Box 7208 (VMLI)
Philadelphia, PA 19101
Toll-free 1-800-669-8477 Voice Response System (24 hours, 7 days a week)
Representatives on duty Monday - Friday 8:30 AM - 6:00 PM EST
The best days to call are Wednesday and Thursday.
Fax Service (215) 381-3156
Web site address -"
E-mail address -" vainsurance@vba.va.gov"
VA FORM 29-8636, AUG 2011
PAGE 2
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