MortgageDepot /CGAP, NMLS# 1133788
HUD/VA Addendum to Uniform Residential Loan Application
OMB Approval No.
VA: 2900-0144 (exp. 11/30/2019)
HUD: 2502-0059 (exp. 03/31/2019)
Part I - Identifying Information
2. Agency Case No: (include any suffix)
3. Lender/Mortgagee Case No.
4. Section of the Act
(mark the type of application)
(for HUD cases)
VA Application for
Application for Insurance
Home Loan Guaranty
under the National Housing Act
5. Borrower's Name & Present Address (Include zip code)
7. Loan Amount (include the UFMIP if
8. Interest Rate
9. Proposed Maturity
for HUD or Funding Fee if for VA)
10. Discount Amount
11. Amount of Up
12a. Amount of Monthly
12b.Term of Monthly
(only if borrower is
permitted to pay)
6. Property Address
(including name of subdivision, lot & block no. & zip code)
13. Lender/Mortgagee I.D. Code
14. Sponsor/Agent I.D. Code
16. Name & Address of Sponsor/Agent
15. Lender/Mortgagee Name & Address (include zip code)
17. Lender/Mortgagee Telephone Number
Type or Print all entries clearly
Name of Loan Origination Company
Tax ID of Loan Origination Company
NMLS ID of Loan Origination Company
The veteran and the lender hereby apply to the Secretary of Veterans Affairs for Guaranty of the loan descri bed here under Section 3710, Chapter 37, Title 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.
18. First Time
19. VA Only:
20. Purpose of Loan (blocks 9 - 12 are for VA loans only)
Title will be Vested in:
Purchase Existing Home Previously Occupied
Construct Home (proceeds to be paid out during construction)
Veteran & Spouse
Purchase Existing Home Not Previously Occupied
Finance Co-op Purchase
Finance Improvements to Existing Property
Purchase Permanently Sited Manufactured Home
Purchase Permanently Sited Manufactured Home & Lot
Purchase New Condo. Unit
Refi. Permanently Sited Manufactured Home to Buy Lot
Purchase Existing Condo. Unit
Refi. Permanently Sited Manufactured Home/Lot Loan
HUD Instructions: The capitalized terms used in this form refer to those terms as used in the relevant sections of the current
version of Single Family Housing Policy Handbook, HUD 4000.1.
Part II - Lender/Mortgagee Certification
21. The undersigned lender/mortgagee makes the following certifications to induce the Department of Veterans Affairs to issue a certificate of commitment to guarantee the subject loan or a Loan Guaranty
Certificate under Title 38, U.S. Code, or to induce the Department of Housing and Urban Development - Federal Housing Commissioner to issue a firm commitment for mortgage insurance or a Mortgage
Insurance Certificate under the National Housing Act.
A. The loan terms furnished in the final Uniform Residential Loan Application and this Addendum are true, accurate and complete.
B. (1) The information contained in the initial Uniform Residential Loan Application and this Addendum was obtained from the Borrower by an employee of the undersigned lender/mortgagee or its duly
authorized agent and to the best of lender/mortgagee’s knowledge is complete and accurately represents the information obtained by the lender/mortgagee as of the date the Borrower provided the
information to the undersigned lender/mortgagee or its duly authorized agent.
(2) The information contained in the final Uniform Residential Loan Application, which was signed by the Borrower at the time of settlement, was obtained by an employee of the undersigned
lender/mortgagee or its duly authorized agent and to the best of lender/mortgagee’s knowledge is complete and accurately represents the information obtained by the lender/mortgagee as of the date
verified by the lender/mortgagee.
C. The credit report submitted on the subject Borrower (and Co-Borrower, if any) was ordered by the undersigned lender/mortgagee or its duly authorized agent from the credit agency which prepared
the report and was received directly from said credit agency.
D. The Verifications of Employment, Deposit, Rent and Mortgage, as applicable, were requested and received by the lender/mortgagee or its duly authorized agent without passing through the hands of
the Borrower or any Interested Third Party and are to the best of lender/mortgagee’s knowledge accurate.
E. To the best of my knowledge, neither I nor any other Participant (as that term is clarified in HUD Handbook 4000.1, II.A.1.b.ii. (B)) in this Covered Transaction (as that term is clarified at 2 C.F.R. §180.
200) is suspended, debarred, under a limited denial of participation, or otherwise restricted under 2 C.F.R. part 2424 or 24 C.F.R. part 25, or under similar procedures of any other federal agency.
Items "F" through "H" are to be completed as applicable for VA loans only.
F. The names and functions of any duly authorized agents who developed on behalf of the lender/mortgagee 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/mortgagee affirmatively certifies that all information and supporting credit data were obtained directly by the lender/mortgagee.
The undersigned lender/mortgagee understands and agrees that it is responsible for the omissions, errors, or acts of agents identified in item F as to the functions with which
they are identified.
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 to veterans.
Signature of Officer of Lender/Mortgagee
Title of Officer of Lender/Mortgagee
WARNING: This warning applies to all certifications made in this document.
The knowing submission of a false, fictitious, or fraudulent certification may be subject to criminal and civil penalties, including confinement for up to 5 years, fines, and civil penalties. 18 U.S.C. §§ 287,
1001 and 31 U.S.C. §3729
Form HUD-92900-A (08/01/2016)
Calyx Form - 92900A1.frm (08/2016)
VA Form 26-1802a (06/2016)