Form Hud-92900-A - Hud/va Addendum To Uniform Residential Loan Application

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HUD/VA Addendum to Uniform Residential Loan Application

OMB Approval No.

VA: 2900-0144

HUD: 2502-0059 (exp 02/28/2014)

HUD: 2502-0059 (exp. 9/30/2007)

Part I - Identifying Information

2. Agency Case No. (include any suffix) 3. Lender’s Case No.

4. Section of the Act

(mark the type of application)

(for HUD cases)

HUD/FHA

Application for

Application for Insurance

Home Loan Guaranty

under the National Housing Act

7. Loan Amount (include the UFMIP if 8. Interest Rate

9. Proposed Maturity

Home Loan Guaranty

under the National Housing Act

for HUD or Funding Fee if for VA)

Borrower's Name & Present Address

(Include zip code)

yrs.

mos.

10. Discount Amount

11.Amount of Up Front 12a.Amount of Monthly12b.Term of Monthly

(only if borrower is

Premium

permitted to pay)

/ mo.

months

Property Address

(including name of subdivision, lot & block no. & zip code)

13. Lender's I.D. Code

14.Sponsor / Agent I.D. Code

16. Name & Address of Sponsor / Agent

Lender's Name & Address

15.

(include zip code)

17. Lender's Telephone Number

Type or Print all entries clearly

The veteran and the lender hereby apply to the Secretary of Veterans Affairs for Guaranty of the loan described here under Section 3710, Chapter 37, Title

VA:

38, United States Code, to the full extent permitted by the veteran’s entitlement and severally agree that the Regulations promulgated pursuant to Chapter

37, and in effect on the date of the loan shall govern the rights, duties, and liabilities of the parties.

First Time

VA Only

Purpose of Loan

(blocks 9 - 12 are for VA loans only)

18.

19.

20.

Homebuyer?

Title will be Vested in:

Purchase Existing Home Previously Occupied

Construct Home

(proceeds to be paid out during construction)

Yes

Veteran

Finance Co-op Purchase

Finance Improvements to Existing Property

Veteran & Spouse

Purchase Permanently Sited Manufactured Home

Refinance (Refi.)

Other (specify)

10)

Purchase Permanently Sited Manufactured Home & Lot

Purchase New Condo. Unit

Purchase Existing Condo.Unit

11)

Refi. Permanently Sited Manufactured Home to Buy Lot

12)

Refi. Permanently Sited Manufactured Home/Lot Loan

Purchase Existing Home Not Previously Occupied

Part II - Lender’s Certification

21. The undersigned lender makes the following certifications to induce the

E. The Uniform Residential Loan Application and this Addendum were signed

Department of Veterans Affairs to issue a certificate of commitment to

by the borrower after all sections were completed.

guarantee the subject loan or a Loan Guaranty Certificate under Title 38, U.S.

F. This proposed loan to the named borrower meets the income and credit

Code, or to induce the Department of Housing and Urban Development -

requirements of the governing law in the judgment of the undersigned.

Federal Housing Commissioner to issue a firm commitment for mortgage

G. To the best of my knowledge and belief, I and my firm and its principals: (1)

insurance or a Mortgage Insurance Certificate under the National Housing Act.

are not presently debarred, suspended, proposed for debarment, declared

A. The loan terms furnished in the Uniform Residential Loan Application and

ineligible, or voluntarily excluded from covered transactions by any Federal

this Addendum are true, accurate and complete.

department or agency; (2) have not, within a three-year period preceding

B. The information contained in the Uniform Residential Loan Application and

this proposal, been convicted of or had a civil judgment rendered against

them for (a) commission of fraud or a criminal offense in connection with

this Addendum was obtained directly from the borrower by an employee

of the undersigned lender or its duly authorized agent and is true to the best

obtaining, attempting to obtain, or performing a public (Federal, State or

local) transaction or contract under a public transaction; (b) violation of

of the lender’s knowledge and belief.

C. The credit report submitted on the subject borrower (and co-borrower , if

Federal or State antitrust statutes or commission of embezzlement, theft,

any) was ordered by the undersigned lender or its duly authorized agent

forgery, bribery, falsification or destruction of records, making false state-

directly from the credit bureau which prepared the report and was received

ments, or receiving stolen property; (3) are not presently indicted for or

directly from said credit bureau.

otherwise criminally or civilly charged by a governmental entity (Federal,

D. The verification of employment and verification of deposits were requested

State or local) with commission of any of the offenses enumerated in

and received by the lender or its duly authorized agent without passing

paragraph G(2) of this certification; and (4) have not, within a three-year

through the hands of any third persons and are true to the best of the

period preceding this application/proposal, had one or more public trans-

lender’s knowledge and belief.

actions (Federal, State or local) terminated for cause or default.

Items "H" through "J" are to be completed as applicable for VA loans only.

H. The names and functions of any duly authorized agents who developed on behalf of the lender any of the information or supporting credit data submitted are as follows:

Name & Address

Function (e.g., obtained information on the Uniform Residential Loan

Application, ordered credit report, verifications of employment, deposits, etc.)

If no agent is shown above, the undersigned lender affirmatively certifies that all information and supporting credit data were obtained directly by the lender.

If no agent is shown above, the undersigned lender affirmatively certifies that all information and supporting credit data were

If no agent is shown above, the undersigned lender affirmatively certifies that all information and supporting credit data were obtained directly by the lender.

obtained directly by the lender.

I. The undersigned lender understands and agrees that it is responsible for the omissions, errors, or acts of agents identified in

The undersigned lender understands and agrees that it is responsible for the omissions, errors, or acts of agents identified in

item H as to the functions

with which they are identified.

J. The proposed loan conforms otherwise with the applicable provisions of Title 38, U.S. Code, and of the regulations concerning guaranty or insurance of loans

The proposed loan conforms otherwise with the applicable provisions of Title 38, U.S. Code, and of the regulations concerning g

to veterans.

Signature of Officer of Lender

Title of Officer of Lender

Date (mm/dd/yyyy)

Part III - Notices to Borrowers. Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for

Part III - Notices to Borrowers.

Part III - Notices to Borrowers. Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time

Part III - Notices to Borrowers. Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time forreviewing instructions, searching

Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for

for

Part III - Notices to Borrowers. Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct or sponsor, and a person is not

data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct or sponsor, and a person is not required to respond

required to respond to, a collection information unless that collection displays a valid OMB control number can be located on the OMB Internet page at

to, a collection information unless that collection displays a valid OMB control number can be located on the OMB Internet page at OMBINV.LIST.OF.AGENCIES.

OMBINV.LIST.OF.AGENCIES.html#list_OF_AGENCIES’.Privacy Act Information. The information requested on the Uniform Residential Loan Application and this Addendum is authorized by 38

html#LIST_OF_AGENCIES. Privacy Act Information. The information requested on the Uniform Residential Loan Application and this Addendum is authorized by 38 U.S.C. 3710 (if for DVA)and 12

U.S.C. 3710 (if for DVA)and 12 U.S.C. 1701 et seq. (if for HUD/FHA). The Debt Collection Act of 1982, Pub. Law 97-365, and HUD’s Housing and Community Development Act of 1987, 42U.

U.S.C. 1701 et seq. (if for HUD/FHA). The Debt Collection Act of 1982, Pub. Law 97-365, and HUD’s Housing and Community Development Act of 1987, 42U.S.C. 3543, require persons applying for a

S.C. 3543, require persons applying for a federally insured or guaranteed loan to furnish his/her social security number (SSN). You must provide all the requestedinformation, including your SSN.

federally insured or guaranteed loan to furnish his/her social security number (SSN). You must provide all the requestedinformation, including your SSN. HUD and/or VA may conduct a computer match

HUD and/or VA may conduct a computer match to verify the information you provide. HUD and/or VA may disclose certaininformation to Federal, State and local agencies when relevant to civil,

to verify the information you provide. HUD and/or VA may disclose certaininformation to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions.

criminal, or regulatory investigations and prosecutions. It will not otherwise be disclosed orreleased outside of HUD or VA, except as required and permitted by law. The information will be used

It will not otherwise be disclosed orreleased outside of HUD or VA, except as required and permitted by law. The information will be used to determine whether you qualify as a mortgagor. Anydisclosure

to determine whether you qualify as a mortgagor. Anydisclosure of information outside VA or HUD/FHA will be made only as permitted by law. Failure to provide any of the requested information,

of information outside VA or HUD/FHA will be made only as permitted by law. Failure to provide any of the requested information, including SSN, may

including SSN, may

(09/2010)

page 1

form HUD-92900-A (06/2005)

VA Form 26-1802a (3/98)