Real Estate Uniform Residential Loan Application Form

Please fill out this form as accurately and completely as possible. This information will help us process your loan application efficiently. If you have any questions or require assistance, please contact our support team.

Applicant Information

Full Name:
Social Security Number:
Date of Birth:
Phone Number:
Email Address:
Current Address:
Years at Current Address:
Marital Status:	Single Married Separated Divorced Widowed
Number of Dependents:
Ages of Dependents:

Employment Information

Employer Name:
Employer Address:
Phone Number:
Position/Title:
Type of Business:
Years Employed:
Monthly Income:

Loan and Property Information

Type of Loan:	Purchase Refinance Construction Home Equity
Loan Amount Requested:
Purpose of Loan:
Type of Property:	Single Family Multi-family Condominium Other

Declarations

Questions	Answers
Have you been declared bankrupt in the last 7 years?	Yes No
Are there any outstanding judgments against you?	Yes No
Have you been foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No
Are you a party to a lawsuit?	Yes No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	Yes No

Consent and Signature

I hereby declare that the information provided in this application is true, complete, and correct to the best of my knowledge. I understand that providing false information may result in the denial of my loan application or further legal action.

[Month, Day, Year]

Thank you for choosing [Your Company Name] for your home financing needs.