HUD-92900-A Addendum to URLA

HUD/VA Addendum to Uniform Residential Loan Application
Part I - Identifying Information
1.

VA Application for

Home Loan Guaranty

(mark the type of application)

OMB Approval No. VA: 2900-0144
HUD:
(XX/XX/2007)
HUD: 2502-0059
2502-0059(exp
(exp.
9/30/2007)

2. Agency Case No. (include any suffix) 3. Lender’s Case No.

4. Section of the Act
(for HUD cases)

HUD/FHA Application for Insurance

under the National Housing Act

5. Borrower's Name & Present Address (Include zip code)

6. Property Address (including name of subdivision, lot & block no. & zip code)

7. Loan Amount (include the UFMIP if 8. Interest Rate
9. Proposed Maturity
for HUD or Funding Fee if for VA)
$
%
yrs.
mos.
10. Discount Amount 11.Amount of Up Front 12a.Amount of Monthly12b.Term of Monthly
(only if borrower is
Premium
Premium
Premium
permitted to pay)
/ mo.
months
$
$
13. Lender's I.D. Code

15. Lender's Name & Address

14.Sponsor / Agent I.D. Code

16. Name & Address of Sponsor / Agent

(include zip code)

17. Lender's Telephone Number

Type or Print all entries clearly
VA: The veteran and the lender hereby apply to the Secretary of Veterans Affairs for Guaranty of the loan described 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

Homebuyer?

a.
b.

19. VA Only

Yes
No

Title will be Vested in:

20. Purpose of Loan

(blocks 9 - 12 are for VA loans only)

Veteran

1)

Purchase Existing Home Previously Occupied

7)

Veteran & Spouse

2)
3)

Finance Improvements to Existing Property
Refinance (Refi.)

8)

4)
5)

Purchase New Condo. Unit
Purchase Existing Condo.Unit

6)

Purchase Existing Home Not Previously Occupied 12)

Other (specify)

9)
10)
11)

Construct Home (proceeds to be paid out during construction)
Finance Co-op Purchase
Purchase Permanently Sited Manufactured Home
Purchase Permanently Sited Manufactured Home & Lot
Refi. Permanently Sited Manufactured Home to Buy Lot
Refi. Permanently Sited Manufactured Home/Lot Loan

Part II - Lender’s Certification
21. The undersigned lender makes the following certifications to induce the E. The Uniform Residential Loan Application and this Addendum were signed
Department of Veterans Affairs to issue a certificate of commitment to
by the borrower after all sections were completed.
guarantee the subject loan or a Loan Guaranty Certificate under Title 38, U.S. F. This proposed loan to the named borrower meets the income and credit
Code, or to induce the Department of Housing and Urban Development requirements of the governing law in the judgment of the undersigned.
Federal Housing Commissioner to issue a firm commitment for mortgage G. To the best of my knowledge and belief, I and my firm and its principals: (1)
insurance or a Mortgage Insurance Certificate under the National Housing Act.
are not presently debarred, suspended, proposed for debarment, declared
A. The loan terms furnished in the Uniform Residential Loan Application and
ineligible, or voluntarily excluded from covered transactions by any Federal
this Addendum are true, accurate and complete.
department or agency; (2) have not, within a three-year period preceding
B. The information contained in the Uniform Residential Loan Application and
this proposal, been convicted of or had a civil judgment rendered against
them for (a) commission of fraud or a criminal offense in connection with
this Addendum was obtained directly from the borrower by an employee
obtaining, attempting to obtain, or performing a public (Federal, State or
of the undersigned lender or its duly authorized agent and is true to the best
local) transaction or contract under a public transaction; (b) violation of
of the lender’s knowledge and belief.
C. The credit report submitted on the subject borrower (and co-borrower , if
Federal or State antitrust statutes or commission of embezzlement, theft,
any) was ordered by the undersigned lender or its duly authorized agent
forgery, bribery, falsification or destruction of records, making false statedirectly from the credit bureau which prepared the report and was received
ments, or receiving stolen property; (3) are not presently indicted for or
directly from said credit bureau.
otherwise criminally or civilly charged by a governmental entity (Federal,
D. The verification of employment and verification of deposits were requested
State or local) with commission of any of the offenses enumerated in
and received by the lender or its duly authorized agent without passing
paragraph G(2) of this certification; and (4) have not, within a three-year
through the hands of any third persons and are true to the best of the
period preceding this application/proposal, had one or more public translender’s knowledge and belief.
actions (Federal, State or local) terminated for cause or default.
Items "H" through "J" are to be completed as applicable for VA loans only.
H. The names and functions of any duly authorized agents who developed on behalf of the lender 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 affirmatively certifies that all information and supporting credit data were obtained directly by the lender.
I. The undersigned lender understands and agrees that it is responsible for the omissions, errors, or acts of agents identified in item H as to the functions
with which they are identified.
J. The proposed loan conforms otherwise with the applicable provisions of Title 38, U.S. Code, and of the regulations concerning g
guaranty or insurance of loans
to veterans.
Signature of Officer of Lender

Title of Officer of Lender

Date (mm/dd/yyyy)

Part
- Notices
to Borrowers.
Public reporting
for this
collection
of information
estimated
to average
6 minutes to
peraverage
response,6including
time
forreviewing
instructions,
PartIII III
- Notices
to Borrowers.
Publicburden
reporting
burden
for this
collectionis of
information
is estimated
minutesthe
per
response,
including
the searching
time for
Part
III - Notices
to Borrowers.
reporting burden
for needed,
this collection
of information
estimated the
to average
6 minutes
per response,
the time
forreviewing
instructions,
existing
data sources,
gatheringPublic
and maintaining
the data
and completing
andis reviewing
collection
of information.
This including
agency may
not conduct
or sponsor,
and asearching
person isexisting
not
data
sources,
gathering
maintaining
the data unless
needed,
andcollection
completing
and reviewing
the collection
of information.
This agency
may
notInternet
conductpage
or sponsor,
and a person is not required to respond
required
to respond
to, and
a collection
information
that
displays
a valid OMB
control number
can be located
on the
OMB
at http://www.whitehouse.gov/omb/library/
to,
a collection information unless that collection displays a valid OMB
number
caninformation
be located requested
on the OMB
page Residential
at http://www.whitehouse.gov/omb/library/OMBINV.LIST.OF.AGENCIES.
OMBINV.LIST.OF.AGENCIES.html#list_OF_AGENCIES’.Privacy
Act control
Information.
The
onInternet
the Uniform
Loan Application and this Addendum is authorized by 38
html#LIST_OF_AGENCIES.
Act1701
Information.
information The
requested
on the Uniform
and
this Addendum
is authorized
38 U.S.C. 3710
DVA)and
U.S.C. 3710 (if for DVA)and Privacy
12 U.S.C.
et seq. (if The
for HUD/FHA).
Debt Collection
Act ofResidential
1982, Pub.Loan
Law Application
97-365, and
HUD’s
Housing and
CommunitybyDevelopment
Act(if
offor
1987,
42U. 12
U.S.C.
1701require
et seq.persons
(if for HUD/FHA).
The
Debt Collection
1982, Pub.
Lawto97-365,
and HUD’s
Housing
and
Community
Act of all
1987,
3543, requireincluding
persons your
applying
for a
S.C. 3543,
applying for
a federally
insuredAct
or of
guaranteed
loan
furnish his/her
social
security
number
(SSN).Development
You must provide
the 42U.S.C.
requestedinformation,
SSN.
federally
insured
or guaranteed
to furnish
his/her
social
security
number
YouHUD
mustand/or
provide
the requestedinformation,
including
your SSN.
HUD
VA may conduct
a computer
match
HUD and/or
VA may
conduct a loan
computer
match
to verify
the
information
you(SSN).
provide.
VAallmay
disclose certaininformation
to Federal,
State
andand/or
local agencies
when relevant
to civil,
to
verify the
informationinvestigations
you provide. and
HUDprosecutions.
and/or VA mayIt disclose
certaininformation
to Federal,
Stateoutside
and local
agencies
when
relevant
to civil, and
criminal,
or regulatory
and
prosecutions.
criminal,
or regulatory
will not otherwise
be disclosed
orreleased
of HUD
or VA,
except
as required
permitted
by law. investigations
The information
will
be used
Ittowill
not otherwise
be disclosed
outsideAnydisclosure
of HUD or VA, of
except
as required
andVA
permitted
by law.will
The
willpermitted
be used tobydetermine
whether
you qualify
mortgagor.information,
Anydisclosure
determine
whether
you qualifyorreleased
as a mortgagor.
information
outside
or HUD/FHA
be information
made only as
law. Failure
to provide
any ofas
thea requested
of
information
outside
VA
or
HUD/FHA
will
be
made
only
as
permitted
by
law.
Failure
to
provide
any
of
the
requested
information,
including
SSN,
may
including SSN, may

(xx/xx/2007)
VA Form 26-1802a (9/0)

page 1

form HUD-92900-A (XX/XX/2007)
(06/2005)

result in disapproval of your loan application. This is notice to you as required by the Right to Financial Privacy Act of 1978 that VA or HUD/FHA has a right of accessto financial records held by
financial institutions in connection with the consideration or administration of assistance to you. Financial records involving yourtransaction will be available to VA and HUD/FHA without further
notice or authorization but will not be disclosed or released by this institution to another GovernmentAgency or Department without your consent except as required or permitted by law.Caution.
Delinquencies, defaults, foreclosures and abuses of mortgage loans involving programs of the Federal Government can be costly and detrimental to yourcredit, now and in the future. The lender in
this transaction, its agents and assigns as well as the Federal Government, its agencies, agents and assigns, areauthorized to take any and all of the following actions in the event loan payments
become delinquent on the mortgage loan described in the attached application: (1)Report your name and account information to a credit bureau; (2) Assess additional interest and penalty charges
for the period of time that payment is not made; (3)Assess charges to cover additional administrative costs incurred by the Government to service your account; (4) Offset amounts owed to you
under other Federalprograms; (5) Refer your account to a private attorney, collection agency or mortgage servicing agency to collect the amount due, foreclose the mortgage, sell theproperty and
seek judgment against you for any deficiency; (6) Refer your account to the Department of Justice for litigation in the courts; (7) If you are a current orretired Federal employee, take action to offset
your salary, or civil service retirement benefits; (8) Refer your debt to the Internal Revenue Service for offset againstany amount owed to you as an income tax refund; and (9) Report any resulting
written-off debt of yours to the Internal Revenue Service as your taxable income. Allof these actions can and will be used to recover any debts owed when it is determined to be in the interest of the
lender and/or the Federal Government to do so.

of these actions can and will be used to recover any debts owed when it is determined to be in the interest of the lender and/o

Part IV - Borrower Consent for Social Security Administration to Verify Social Security Number

I authorize the Social Security Administration to verify my Social Security number to the Lender identified in this document and HUD/FHA, through a computer
match conducted by HUD/FHA.
I understand that my consent allows no additional information from my Social Security records to be provided to the Lender, and HUD/FHA and that verification of
my Social Security number does not constitute confirmation of my identity. I also understand that my Social Security number may not be used for any other
purpose than the one stated above, including resale or redisclosure to other parties. The only other redisclosure permitted by this authorization is for review
purposes to ensure that HUD/FHA complies with SSA's consent requirements.
I am the individual to whom the Social Security number was issued or that person's legal guardian. I declare and affirm under the penalty of perjury that the
information contained herein is true and correct. I know that if I make any representation that I know is false to obtain information from Social Security records, I
could be punished by a fine or imprisonment or both.
This consent is valid for 180 days from the date signed, unless indicated otherwise by the individual(s) named in this loan application.
Signature(s)
of Borrower(s)
- Read accuracy
consent carefully.
of social
security
birthapplication.
dates provided on
Read consent
carefully. Review
of social Review
securityaccuracy
number(s)
and birth
datesnumber(s)
providedand
on this

Signature(s) of Borrower(s)

Date Signed

Signature(s) of Co - Borrower(s)

Date Signed
Date signed

Part V - Borrower Certification
22. Complete the following for a HUD/FHA Mortgage .
22a.Do you own or have you sold other real estate within the

Yes

No

Is it to be sold? 22
22b. Sales Price
Yes
No $

22c. Original Mortgage Amt
22

$

past 60 months on which there was a HUD/FHA mortgage?
22d. Address
22e. If the dwelling to be covered by this mortgage is to be rented, is it a part of, adjacent or contiguous to any project subdivision or group of concentrated

rental properties involving eight or more dwelling units in which you have any financial interest?

22f. Do you own more than four dwellings ?

Yes

No

Yes

No

If “Yes” give details.

If “Yes” submit form HUD-92561.

23. Complete for VA-Guaranteed Mortgage . Have you ever had a VA home Loan?

Yes

No

24. Applicable for Both VA & HUD. As a home loan borrower, you will be legally obligated to make the mortgage payments called for by your mortgage loan contract.

The fact that you dispose of your property after the loan has been made will not relieve you of liability for making these payments. Payment of the loan in full
is ordinarily the way liability on a mortgage note is ended. Some home buyers have the mistaken impression that if they sell their homes when they move to another
locality, or dispose of it for any other reasons, they are no longer liable for the mortgage payments and that liability for these payments is solely that of the new owners.
Even though the new owners may agree in writing to assume liability for your mortgage payments, this assumption agreement will not relieve you from liability to the
holder of the note which you signed when you obtained the loan to buy the property. Unless you are able to sell the property to a buyer who is acceptable to VA or
to HUD/FHA and who will assume the payment of your obligation to the lender, you will not be relieved from liability to repay any claim which VA or HUD/FHA may be
required to pay your lender on account of default in your loan payments. The amount of any such claim payment will be a debt owed by you to the Federal
Government. This debt will be the object of established collection procedures.

25. I, the Undersigned Borrower(s) Certify that:
(1) I have read and understand the foregoing concerning my liability on the loan and Part
III Notices to Borrowers.
(2) Occupancy: ( for VA only -- mark the applicable box)
(a) I now actually occupy the above-described property as my home or intend to
move into and occupy said property as my home within a reasonable period of time
or intend to reoccupy it after the completion of major alterations, repairs or improvements.
(b) My spouse is on active military duty and in his or her absence, I occupy or intend
to occupy the property securing this loan as my home.
(c) I previously occupied the property securing this loan as my home. (for interest
rate reductions)
(d) While my spouse was on active military duty and unable to occupy the property
securing this loan, I previously occupied the property that is securing this loan as my
home. (for interest rate reduction loans)
Note: If box 2b or 2d is checked, the veteran's spouse must also sign below.
(3) Mark the applicable box (not applicable for Home Improvement or Refinancing Loan)
I have been informed that ($
) is :
the reasonable value of the property as determined by VA or;
the statement of appraised value as determined by HUD / FHA.
Note: If the contract price or cost exceeds the VA "Reasonable Value" or HUD/FHA
"Statement of Appraised Value", mark either item (a) or item (b), whichever is applicable.
(a) I was aware of this valuation when I signed my contract and I have paid or will
pay in cash from my own resources at or prior to loan closing a sum equal to the
difference between the contract purchase price or cost and the VA or HUD/FHA
established value. I do not and will not have outstanding after loan closing any unpaid
contractual obligation on account of such cash payment;

(b) I was not aware of this valuation when I signed my contract but have elected
to complete the transaction at the contract purchase price or cost. I have paid
or will pay in cash from my own resources at or prior to loan closing a sum equal
to the difference between contract purchase price or cost and the VA or HUD/
FHA established value. I do not and will not have outstanding after loan closing
any unpaid contractual obligation on account of such cash payment.
(4) Neither I, nor anyone authorized to act for me, will refuse to sell or rent, after
the making of a bona fide offer, or refuse to negotiate for the sale or rental of,
or otherwise make unavailable or deny the dwelling or property covered by his/
her loan to any person because of race, color, religion, sex, handicap, familial status
or national origin. I recognize that any restrictive covenant on this property relating
to race, color, religion, sex, handicap, familial status or national origin is illegal and
void and civil action for preventive relief may be brought by the Attorney General
of the United States in any appropriate U.S. District Court against any person responsible for the violation of the applicable law.
(5) All information in this application is given for the purpose of obtaining a loan to
be insured under the National Housing Act or guaranteed by the Department of Veterans
Affairs and the information in the Uniform Residential Loan Application and this Addendum is true and complete to the best of my knowledge and belief. Verification may be
obtained from any source named herein.
(6) For HUD Only (for properties constructed prior to 1978 ) I have received information
on lead paint poisoning.
Yes
Not Applicable
(7) I am aware that neither HUD / FHA nor VA warrants the condition or value of
the property

Signature(s) of Borrower(s) -- Do not sign unless this application is fully completed. Read the certifications carefully & review accuracy of this application. Date

Date Signed
Signature(s) of Borrower(s)

Date Signed
Signature(s) of Co - Borrower(s)

( Borrowers Must Sign Both Parts IV & V ) Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance or conspiracy purposed to influence
page 2
theissuance of any guaranty or insurance by the VA Secretary or the HUD/FHA Commissioner.

issuance of any guaranty or insurance by the VA Secretary or the HUD/FHA Commissioner.
(xx/xx/2007)
VA Form 26-1802a (3/98)

page 2

form HUD-92900-A (XX/XX/2007)
(06/2005)