The Citizens Bank

UNIFORM RESIDENTIAL LOAN APPLICATION

To apply for a mortgage loan from The Citizens Bank, you must do so in person at one of our local branch locations. We have made the application available here if you want to fill it out ahead of time. When finished, simply select PRINT at the bottom of the form and bring the signed and printed form into your local branch for further assistance.


* indicates a required field

I. Type of Mortgage and Terms of Loan

This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable. Co-Borrower must also be provided (and the appropriate box checked) when the income of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

Mortgage Applied for:



Agency Case Number
Lender Case No.
*Amount
*Interest Rate
*No. of Months
Amortization Type:



II. Property Information and Purpose of Loan

*Subject Property Address (street, city, state & zip code)
No. of Units
Legal Description of Subject Property (attach description if necessary)
Year Built
Purpose of Loan



Property will be

Complete this section if construction or construction-permanent loan.

Year Lot Acquired
Original Cost
Amount Existing Liens
(a) Present Value of Lot
(b) Cost of Improvements
Total (a + b)

Complete this section if this is a refinance loan.

Year Acquired
Original Cost
Amount Existing Liens
Purpose of Refinance
Describe Improvements  

Cost
Title will be held in what Name(s)
Manner in which Title will be held
Estate will be held in
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

III. Borrower Information

Borrower

*Borrower's Name (include Jr. or Sr. if applicable)
*Social Security Number
*Home Phone (incl. area code)
*DOB (MM/DD/YYYY)
Yrs. School
Marital Status
Dependents (not listed by Co-Borrower) no. ages
Present Address(street, city, state, zip code)
Do You?

No. Yrs.
Mailing address if different from Present Address

If residing at present address for less than two years, complete the following.

Former Address(street, city, state, zip code)
Do You?

No. Yrs.

Co-Borrower

Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone (incl. area code)
DOB (MM/DD/YYYY)
Yrs. School
Marital Status
Dependents (not listed by Borrower) no. ages
Present Address(street, city, state, zip code)
Do You?

No. Yrs.
Mailing address if different from Present Address

If residing at present address for less than two years, complete the following.

Former Address(street, city, state, zip code)
Do You?

No. Yrs.

IV. Employment Information

Borrower

Name & Address of Employer
Yrs. on this job
Yrs. in this line of work / profession
Position/Title/Type of Business
Business Phone(incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name & Address of Employer
Dates (from-to)
Monthly Income
Position/Title/Type of Business
Business Phone(incl. area code)
Name & Address of Employer Self Employed
Dates (from-to)
Monthly Income
Position/Title/Type of Business
Business Phone(incl. area code)

Co-Borrower

Name & Address of Employer
Yrs. on this job
Yrs. in this line of work / profession
Position/Title/Type of Business
Business Phone(incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name & Address of Employer
Dates (from-to)
Monthly Income
Position/Title/Type of Business
Business Phone(incl. area code)
Name & Address of Employer Self Employed
Dates (from-to)
Monthly Income
Position/Title/Type of Business
Business Phone(incl. area code)

V. Monthly Income and Combined Housing Expense Information

Gross Monthly Income Borrower Co-Borrower
Base Empl. Income*
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other**
Combined Monthly Housing Expense Present Proposed
Rent  
First Mortgage (P&I)
Other Financing (P&I)
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Assn. Dues

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
** before completing, see the notice in "describe other income," below

Describe Other Income

(Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.)

B/C Describe Other Income Monthly Amount

VI. Assets and Liabilities

This statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.

Completed:

Assets

Cash deposit toward purchase held by:
Cash or Market Value

List checking and savings accounts below


Name and address of Bank, S&L or Credit Union
Acct. no.
Cash or Market Value

Name and address of Bank, S&L or Credit Union
Acct. no.
Cash or Market Value

Name and address of Bank, S&L or Credit Union
Acct. no.
Cash or Market Value

Name and address of Bank, S&L or Credit Union
Acct. no.
Cash or Market Value

Stocks & Bonds (Company name/number & description)
Acct. no.
Cash or Market Value

Life Insurance net cash value Face Amount:
Cash or Market Value

Subtotal Liquid Assets

Real Estate owned (enter market value from schedule of real estate owned)

Vested Interest in retirement fund

Net worth of business(es) owned (attach financial statement)

Automobiles owned (make & year)
Cash or Market Value

Other Assests (itemize)
Cash or Market Value

Liabilities

Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Name and address of Company
Monthly Payment
Months Left to Pay
Unpaid Balance
Acct. no.

Alimony/Child Support/Separate Maintenance Payments Owed for

Job Related Expenses (child care, union dues, etc.)

Schedule of Real Estate Owned

(If additional properties are owned, use continuation sheet.)

(enter S if sold, PS if pending sale or R if rental being held for income)

Property Address Type of Property Present Market Value Amount of Mortgages and Liens Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc. Net Rental Income
 
 
 

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name Creditor Name Account Number

VII. Details of Transaction

a. Purchase Price
b. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
g. PMI, MIP, Funding Fee
h. Discount (if Borrower will pay)
i. Total costs (add items a through h)
j. Subordinate financing
k. Borrower's closing costs paid by Seller
l. Other Credits
m. Loan amount
(exclude PMI, MIP, Funding Fee financed)
n. PMI, MIP, Funding Fee financed
o. Loan amount (add m & n)
p. Cash from/to Borrower (subtract j,k,l & o from i)

VIII. Declaration

If you answer "yes" to any questions a through l, please use continuation sheet for explanation. Borrower Co-Borrower
a. Are there any outstanding judgements against you?    
b. Have you been declared bankrupt within the past 7 years?    
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?    
d. Are you party to a lawsuit?    
e. Have you directed or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond or loan guarantee. If "Yes", provide details, including date, name and adddress of Lender, FHA or VA case number, if any, and reasons for the action.)    
f. Are you presently deliquent or in default on any Federal debt or any other loan, mortgage, financial, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.    
g. Are you obligated to pay alimony, child support, or separate maintenance?    
h. Are you a co-maker or endorser on a note?    
i. Are you a U.S. citizen?    
j. Are you a permanent resident alien?    
k. Do you intend to occupy the property as your primary residence? If "Yes", complete question below.    
l. Have you had an ownership interest in a property in the last three years?    
(1) What type of property did you own -- principal residence (PR), second home (SII), or investment property (IP)?
(2) How did you hold title to the home -- solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)

IX. Acknowledgement and Agreement

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or and electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agenciesl (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containng my original written signature.

Achnowledgement. Each of the undersigned hereby achknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any informaiton contained in this application or obtain any informaiton or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.


X. Information for Government Monitoring Purpose

The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

BORROWER
Ethnicity:  
Race:



Sex:
CO-BORROWER
Ethnicity:  
Race:



Sex:

Continuation Sheet/Residential Loan Application

Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower.

Borrower:
Agency Case Number:
Co-Borrower:
Lender Case Number:


* indicates a required field

Once you have filled out this form and are ready to bring it to your local branch for further assistance, print it and then sign and date it.