A reverse mortgage is a specific type of loan taken out against your home that subsequently allows you to convert a specific percentage of your equity into tax-free money without the additional burden of monthly loan payments. Program I'm Applying For*Select OptionAll Reverse Mortgage - For My Present HomeAll Reverse Mortgage - For a New Home PurchaseAll Reverse Mortgage - JumboHave you closed on any mortgages in the last 12 months? (Refinance, private mortgage, equity line etc.)* Yes No Did the refinance result in any cash amount to you in excess of $500? Yes No Your Funds*I want all funds available (Full Draw)Undecided on amount of fundsI want a specific amount upfront(If you choose an adjustable rate program you can choose to take only a portion of your available funds and leave the rest as a credit line etc.)Amount*Do you intend to buy a financial product (annuity, etc) with your funds?* Yes No Name and cost of the financial product Secondary Borrower Yes No Will there be a secondary/co-borrower?Is secondary borrower your spouse? Yes No 1. General Information In this section we must have your complete legal name (as stated on your photo ID documentation). We also need your exact date of birth and sex as these are requirements for the application. We must have your Social Security Number to complete your loan application as HUD defines that in order for an application to be complete under guidelines it must contain the SSN of all borrowers.Name First Last Immigration Status**US CitizenLawful Perm, Resident AlienOtherSocial Security Number* Date of Birth* MM slash DD slash YYYY Marital Status*MarriedSingleWidowed, DivorcedSex* Male Female Race*Americal Indian/ Alaska nativeAsianBlack / African AmericanHispanic / LatinoNative Hawaiian / Pacific IslanderWhiteI will not discloese my raceOtherNot Applicable2. Financial Informationion In this section, we need to input your financial information. Please separate the monthly income, real estate assets and available assets for all applicants.Required to bring money to closing Yes No Did you borrow the moneyYesNoPrimary Borrower, please check each source of income which applies to you:* Pension/Retirement Self Employed Social Security Employment Overtime Bonuses Rental Home Social Security Disability VA Disability Benefits Private Disability Benefits Annuities Other Public Assistance Automobile Allowance Subject Property Rental Investment Income Capital Gains and Losses Expected Income Trust Accounts Alimony /Child Support Notes Receivable Government Non Cash Military Income Available AssetsHow many homes do you own?1 Home - My primary residence2 homes3 homes4 homes5 homesMonthly property taxMonthly homeowners insuranceNumber of years you have lived at your current address Total number of people (including yourself) who live at your current address 3. Credit InformationHere we need to get a general idea of your credit history. Including any late payments on credit, mortgage, and other obligations.Have you been late on your mortgage in the last 24 months? Yes No Please list each time you were late and and for how long below:Have you been late on any consumer debt in the last 24 months? this includes (Car loans, Credit cards, etc.) Yes No Please list each item and how long you were late below:Please list each item and how long you were late below:Have you been late on your property tax payments in the last 24 months? Yes No Please list each time you were late and for how long below:Please list each time you were late and for how long below:Do you have any other delinquent credit that will be reported in the last 24 months? (i.e. Judgment, Tax Lien, Collections, Bankruptcy or Foreclosure) Yes No Please list each instance below:Please list each instance below:Do you have any deferred student loans or taxes that may not show up on credit? Yes No Please list each instance below:Please list each instance below:Have you maintained homeowners insurance on your home consecutively for the past 24 months? Yes No Please provide an explanation for any lapses in coverage below:Is your home located in an Homeowner's Association(HOA)? Yes No How much are the monthly dues?What is your total combined minimum credit card payments per month:What is the total combined amount paid to auto loans or other personal loans per month:4. Legal InformationIn this section you are acknowledging if any of these following items apply to you. For example, if you were involved in bankruptcy currently, here is where you would check the box acknowledging you were in BK and then your Loan Officer would need to go over that with you.Your InformationBorrower cannot sign, is incapacitated Yes No Borrower is incompetent Yes No Are there outstanding judgments Yes No Unresolved Bankruptcy Yes No Party to a Lawsuit Yes No Default on Federal Debt Yes No Co-maker or Endorser on a Note Yes No 5. Property InformationHere we need you to fill in all the information about your home. If you have a separate mailing address such as a PO Box because you live in an area where the Post Office does not deliver, please indicate so in the notes section. We need your estimate of your home's value along with any mortgages that need to be paid off belonging to the property.Info About Your Home (Primary Residence)Year Built Property Type2 to 4 FamilyCondominiumCo-operativeFarmManufatured HomeMulti-Family 4+Single FamilyTown HouseSquare Footage Living Units:234Street Address Property Has a Well Yes No City Property Has a Septic Tank Yes No State Property Has Solar Panels Yes No Estimated Property ValueExisting Mortgage AmountTitle is currently heldIn my NameIn the name of my family trustIs the property in foreclosure? Yes No Sale date if given by lender Is this property your primary residence? Yes No Will you continue to occupy this property as your primary residence? Yes No 6. Contact InformationWe need contact information for all parties. The Reverse Mortgage program also requires that we have an alternate contact for every applicant as well.Your InformationHome Phone*Email Address* Mobile Phone (not required)* Alternate Contact This should not be a spouse or co-borrower but rather a close friend or family member. This alternate contact will only be contacted in situations in which we can not get in touch with you regarding important matters relating to your reverse mortgage Name First Last Relationship Home Phone Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 7. Counseling InformationionReverse mortgage counseling is required in order to complete the loan process. If you have not yet completed the counseling we will provide you with a list of qualified 3rd parties which can help you with counseling after you submit this application.Have you received your HUD Required Counseling? Yes No Was there a Fee? Yes No Would you like a copy of this application sent to the primary borrower's email address? (Please Note That Social Security Data Will Not Be Sent) Yes No
