____________________________________

Loan Officer: _________________________Loan Amount: ______________       

Borrower Nationality: ___________________Property Country: _______________

Title Held as: Individual [ ] Corporation [ ]

Borrowers Information

Borrower: _________________________Co-Borrower: ________________________

Address: __________________________Address: ___________________________

Home Phone: ______________________Home Phone: ________________________

Cell Phone: ________________________Cell Phone: _________________________

Work Phone: _______________________Work Phone: ________________________

E-mail: ___________________________E-mail: _____________________________

Date of Birth: ______________________Date of Birth: ________________________ 

Social Sec. #: _____________________Social Sec. #: ________________________

Subject Property Information

Occupancy: 2nd Home [ ] Investment [ ] Type of Property: SFR [ ] Condo [ ]

Transaction Type: Purchase [ ] Cash out [ ] Construction to Perm [ ]

Market Value: _______________Year Built: _____ Purchase Price: ______________

Annual Taxes: _______________Annual Insurance: __________________________

Address: ___________________Existing Lien on Lot: ________________________

Cost to Construct: _____________Construction Period: _______________________

Primary Residence

Market Value: ________________Years Owned: ______________

1st Mortgage: __________________     2nd Mortgage: ________________________ 

1st Mortgage Holder: _______________2nd Mortgage Holder: ___________________

Annual Taxes: ____________________Annual Insurance: ______________________

Employment

Employer: ________________________Employer: __________________________ 

Position: _________________________Position: ____________________________

Address: _________________________Address: ____________________________

Years at Job: ______________________Years at Job: _________________________

Annual Income: ____________________Annual Income: ________________________

Self-employed: yes [ ] no [ ] Self-employed: yes [ ] no [ ]

Assets Information

Liquid Assets

Institution Name: ____________________Institution Name: ______________________

Acct # / Balance: ____________________Acct # / Balance: ___________________    

Institution Name: ____________________Acct # / Balance: ______________________ Business Assets

Institution Name: ___________________  Institution Name: ______________________

Acct # / Balance: ___________________Acct # / Balance: ______________________

Institution Name: ____________________Institution Name: ______________________

Acct # / Balance: ___________________Acct # / Balance: ______________________

·          Stocks, Bonds, Certificate of Deposit, Checking Account, Money Market Fund, Mutual Fund and Savings Account*

Real Estate Owned Information

Property 1

Address: ____________________________________Years Owned: ____________

Mortgage Holder: __________________________  Mortgage Balance: ___________

Property 2

Address: _____________________________________Years Owned: ___________

Mortgage Holder: ___________________________Mortgage Balance: ___________

Property 3

Address: ____________________________________Years Owned: ____________

Mortgage Holder: ___________________________Mortgage Balance: ___________

Property 4

Address: ____________________________________Years Owned: _____________

Mortgage Holder: ___________________________Mortgage Balance: ___________

Property 5

Address: ____________________________________Years Owned: _____________

Mortgage Holder: ___________________________Mortgage Balance: ___________