93201 Application for Mortgage Insurance

OMB Approval No. 2502-0141 (Exp. 02/28/2014)

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

Application for
Mortgage Insurance

Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may
not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
This collection of information is necessary for HUD to analyze specific information including financial data, cost data, and drawings an specifications before determining whether a cooperative or condominium project mortgage should be insured. This information is necessary on the application for mortgage insurance and is required to obtain benefits. This information is considered non-sensitive; no assurance of confidentiality is provided.
Project Name:

Mortgage Amount:

Date:

Project Number:

* Cooperative Housing - Condominium Housing
Section 213
Section 221
Section 234

SAMA
Feasibility

Conditional
Firm

A. Location and Description of Property
1. Street Nos.

2. Street

3. Municipality

7. Type of Project

4. Census Tract

8. No. Stories

Elevator
Detached

Row (T.H.)
10.

9.a. Basement Floor

Slab on
Grade

12. No. of Bldgs.

Full
Bsmt.

Partial
Bsmt.

13. List of Accessory Bldgs. and Area

Site Information

Crawl
Space

Structural
Slab

Slab on
Grade

13.a. List Recreation Facilities and Area

Building Information

14. Dimensions:

16. Yr. Built

ft. by

6. State and Zip Code

9. Foundation

Walkup
Semi-Detached

11. Number of Units
Revenue
Non-Rev.

Proposed
Existing

5. County

ft. or

16.a.

Manufactured Housing
Modules

sq. ft.

15. Zoning: (If recently changed, submit evidence)

16.b. Exterior Finish

17. Structural System

Conventionally Built
Components
17.a. Floor System 18. Heating-A/C
System

B. Information Concerning Land or Property
19. Date
Acquired

25. Utilities—
Water

20. Purchase
Price

21. Additional Costs
Paid or Accrued

22. If Leasehold
Ground Rent

23. Total Cost

$

$

$

$

Public

Community

Sewers

26. Unusual Site Features —
Cuts
Fills
Poor Drainge
Other (Specify)

24. Relationship-Business, Personal or
Other Between Seller and Sponsor

Rock Formations
High Water Table

Erosion
Retaining Walls
None

C. Unit Composition and Charges
27. No.
Units

Unit
Type

No.
Rms.

Liv. Area
(Sq. Ft.)

Composition of Unit

Contemplated**
Down Payment

$

Unit Charge**
Per Month

$

Total Monthly
Charge**

Total
Annual

$

28.

Total Estimated Charges for All Family Units**

$

$

$

$

29. No. Parking Spaces:

Attended
Self Park

Open Spaces

@$

per month

Covered Spaces

@$

per month

Area-Ground Level

Sq. Ft. @ $

per sq. ft./mo.

Other Levels

Sq. Ft. @ $

per sq. ft./mo.

30. Commercial

31.

Total Estimated Accessory Income at 100% Occupancy
*Cooperative only. ** Condominum only
Previous editions are obsolete.

Page 1 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)

32. Gross Floor Area-

33. Net Rentable Residential Area-

34. Net Rentable Commercial Area-

Sq. Ft.

Sq. Ft.

Sq. Ft.

Non-Revenue Producing Space

35.

Type of Employee

No. Rms.

Composition of Unit

Location of Unit in Project

D. Equipment and Services Included in Charges: (Check Appropriate Items)
36. Equipment:
Ranges-Original (Gas or Electric)

37. Services:
Gas:
Heat

Disposal

Ranges-Replace. (Gas or Electric)

Dishwasher

Refrig.-Original (Gas or Electric)

Carpet

Refrig.-Original (Gas or Electric)

Drapes

Elec:

Air Conditioning (Equip. Only)

Hot Water

Cooking

Air Conditioning

Heat

Hot Water

Cooking

Air Conditioning

Lights, etc., in Unit

Kitchen Exhaust Fan

Other Fuel:

Heat

c. Annual Payment $

Hot Water

Water

Other __________________________________________

Other ______________________________________

Grounds Maint.

F. Annual Fixed Charges

E. Estimate of Annual Common Expense
Administrative
* 1. Apartment Resale Expense $ _____________
2. Management
$ _____________
3. Other
_____________
4.
Total Administrative
$ _____________
Operating
5. Elevator Main. Exp.
$ _____________
6. Fuel (Heating and Domestic Hot Water)
_____________
7. Lighting & Misc. Power
_____________
8. Water
_____________
9. Gas
_____________
10. Garb. & Trash Removal
_____________
11. Payroll
_____________
12. Other
_____________
13.
Total Operating
$ _____________
Maintenance
14. Decorating
$ _____________
15. Repairs
_____________
16. Exterminating
_____________
17. Insurance
_____________
18. Ground Expense
_____________
19. Other
_____________
20.
Total Maintenance
$ _____________
21. Replacement Reserve (0.0060 or 0.0040 x) Total
structures from Line 50
$ _____________
22. Total Common Expense (Except Taxes)
$ _____________

*Cooperative only. ** Condominum only
Previous editions are obsolete.

Non-Prepayable
b. Principal Balance $
d. Remaining Term ________Years

Laundry Facilities

Taxes
23. Real Estate Est. Assessed
*
Val. $ ________________ at
$ __________ per $1000- $ _____________
24. Personal Prop. Est. Assessed
*
Val. $ ________________ at
$ __________ per $1000- $ _____________
25. Empl. Payroll Tax
26. Other
27. Other
28.
Total Taxes
29. Total Common Expense

38. Special Assessments:
a.
Prepayable

30.
*
31.
* 32.
* 33.
34.

Interest Plus Curtail ___%
$ _____________
(Call Insuring Office for Rate)
Mortgage Insurance (0.5%)
(Omit in 221 BMIR and 236 Cases)
$ _____________
Operating Revenue (3.0%) Vac. Res. (2%)
$ _____________
Total Annual Fixed Charges
$ _____________
(Include Annual Ground Rent, if any)
Total Gross Ann. Exp. and Fixed Chgs
$ _____________

G.Net Common Expense & Fixed Charges
35. Tot. Gross Ann. Exp. & Fixed Chgs
36. Estimate of Accessory
Rental Income
$ _____________
37. Less Vacancy (_____%)
$ _____________
38. Effective Accessory Rental Income
39. Total Ann. Net Common Expense & Fixed
Charge (after deducting common income)
40. Fixed Monthly Net Common Expense &
Fixed Charge
41. Total Monthly Net Common Expense & Fixed
Charger per SF
42. Total Monthly Net Common Expense & Fixed
Charger Per Room (_______ Rooms)

$ _____________

$ _____________
$ _____________
$ _____________
$ _____________
$ _____________

_____________
_____________
_____________
$ _____________
$ _____________

Page 2 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)

H. Estimated Replacement Cost
43. Unusual Land Improvements

$ ____________

44. Other Land Improvements

$ ____________

45. Total Land Improvements

Carrying Charges & Financing
62. Int. ____________ Mos.

Structures
46. Main Buildings

$ ____________

at %

on $ _________________

$ _____________

$ ____________

63. Taxes

____________

64. Insurance

____________

47. Accessory Buildings

____________

65. FHA Mtg. Ins. Fee (0.5%)

____________

48. Garages

____________

66. FHA Exam. Fee (0.3%)

____________

49. All other buildings

____________

67. FHA Inspec. Fee (0.5%)

____________

$ _____________

68. Financing Fee (

____________

$ _____________

69. Other Fees (

50.

Total Structures

51. General Requirements

%)
%)

____________

70. FNMA or FNMA Fee (

Fees
52. Builder's Gen. Oh. (

%) $ ____________

71. Title & Recording

%)

(

%)

____________

72.

54. Arch. Fee-Design (

%)

____________

Legal Organization & Marketing

55. Arch. Fee-Supvr. (

%)

53. Builder's Profit

____________
____________

Total Carrying Chgs. & Financing

$ _____________

____________

73. Legal

56. Bond Premium

____________

74. Organization

____________

57. Other Fees

____________

75. Marketing

____________

58.

Total Fees

59. Tot. for all Imprmts. (Lines 45,50,51+58)

$ ____________

$ _____________

76.

Total Legal, Organ. & Mktg.

$ _____________

$ _____________

77. Other
78. Total Est. Development Cost
(Lines 59, 72, 76, 77)
79. Land (Est. Market Price of Site)
__________ sq. ft. at $ __________ per sq. ft.$
80. Total Estimated Replacement Cost
of Project (Add 78 & 79)
__________ sq. ft. at $ __________ per sq. ft.$

$ _____________

60. Cost Per Gross Sq. Ft.

$ _____________

61. Estimated Construction Time

________ Months

$ _____________
_____________
$ _____________
_____________

I. Estimated Expenses Not Included in Carrying Charges or Common Expense
Type No. 1

Type No. 2

Type No. 3

Type No. 4

Type No. 5

**Real Estate Taxes,
Individual Per Month

$

$

$

$

$

**Insurance, if Paid
Individually Per Month

$

$

$

$

$

Estimated Personal Benefit Expenses To Be Paid Individually By Residents
Heating
Electricity
Water
Gas
Decorating
Repairs
Other
Total Annual Personal
Benefit Expense

$

$

$

$

$

Total Monthly Personal
Benefits Expense**

$

$

$

$

$

*Cooperative only. ** Condominum only
Previous editions are obsolete.

Page 3 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)

J. Total Requirements For Settlement

K. Estimated Annual Operating Statement

1. Development Cost

$ ________________

2. Land Indebtedness (or Cash required for
land acquisition)

$ ________________

3. Subtotal (Line 1 + Line 2)

$ ________________

4. Mortgage Amount

$ ____________

5. Fees paid by other than cash

$ ____________

2. Garage Rent

________________

3. Commercial Income

________________

4. Other (Specify)

________________

__________________________________________________________

$ ________________

7. Cash Invest. Required (Line 3 - Line 6)

$ ________________

8. Initial Operating Deficit

$ ________________

9. Anticipated Discount

$ ________________
$ ________________

5. Estimated Gross Income Assuming
100% Occupancy

$ ________________

6. Less Vacancies Assumed(
%) on garages
$ ____________
(
%) on other
Non-dwelling Income ____________________
7. Total Vacancy Deduction

$ ________________

8. Total Estimated Gross Income After
Vacancy Deduction

$ ________________

9. Annual Expense & Fixed Charges
Total Expense per annum
$ ____________
Total fixed charges per annum $ ____________

11. Add Off-site construction costs $ ________________
12. Total Estimated Cash Requirement
(Lines 7 + 8 + 9 + 10 + 11)

$ ________________

__________________________________________________________

6. Line 4 + Line 5

10. Working Capital

1. Dwelling Change (From Schedule C)

$ ________________

10. Total Annual Expense and Fixed Charges

________________

11. Excess of Income Over All Charges

$ ________________

L. Attachments: (Required Exhibits)
1.

Location Map

8.

2.

Evidence of Site Control (option or purchase) and Legal Description of
Property

9.

Personal Financial & Credit Statement of Sponsors

10.

Form HUD-2530 Previous Participation Certification

3.

Form HUD-92010 Equal Employment Opportunity Certification

11.

Survey

4.

Form HUD-3433 Eligibility as Non-Profit Corporation

12.

Evidence of Architect E&O Insurance Coverage

5.

Photographs of Improvements on Site & Adjacent Site

13.

Copy of Owners and Architects Agreement

6.

Architectural Exhibits - Preliminary

14.

Form FHA-2328 Contractor's and/or Mortgagor's Cost Breakdown

7.

Architectural - Exhibits - Final

15.

Form HUD-935.2 Affirmative Fair Housing Marketing Plan

Sketch Plan of Site

M. Names, Addresses and Telephone Numbers of the Following: (Indicate Cash Investment from each Sponsor)
1. Sponsor(s)

2. General Contractor

3. Architect

4. Sponsor's Attorney

For HUD Use Only
Date Rec.

Amount
Code
Schedule

Rec. By
*Cooperative only. ** Condominum only
Previous editions are obsolete.

Page 4 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)

Sponsor Certification

To: Federal Housing Commissioner:

SAMA

Feasibility

Conditional

Firm

I request a loan in the principal amount of $ ____________________ to be insured under the provision of Section __________ of
the National Housing Act, said loan to be secured by a first mortgage on the property hereinafter described.
As the principal sponsor of the proposed mortgagor, I certify that I am familiar with the provisions of the Regulations of the Federal
Housing Commissioner under the above identified Section of the National Housing Act and that to the best of my knowledge and belief
the mortgagor has complied, or will be able to comply with all of the requirements thereof which are prerequisite to insurance of the
mortgage under such Section.
I further certify that to the best of my knowledge and belief no information or data contained herein or in the exhibits or attachments
listed herein are in any way false or incorrect and that they are truly descriptive of the project or property which is intended as the security
for the proposed mortgage and that the proposed construction will not violate zoning ordinances or restrictions of record.
I agree with the Department of Housing and Urban Development, Federal Housing Administration, that pursuant to the requirements
of Title VII of the Civil Rights Act of 1968, Title VI of the Civil Rights Act of 1964, Executive Order 11063, and Departmental
regulations, (a) neither he nor anyone authorized to act for him will decline to sell, rent or otherwise make available any of the property
or housing in the multifamily project to a prospective purchaser or tenant because of race, color, religion, or national origin, (b) I will
comply with federal, state and local laws and ordinances prohibiting discrimination, (c) I will affirmatively market this project to attract
buyers or tenants of all minority and majority groups, and (d) my failure or refusal to comply with the requirements of either (a), (b) or
(c) shall be a proper basis for the Commissioner-Secretary to reject requests for future business with which the sponsor is identified or
to take any other corrective action deemed as necessary.
The type of firm commitment eventually to be requested, is checked below, I have read and understand the applicable form of
Commitment for insurance and the FHA forms referred to therein.
* I intend to form or cause to be formed a nonprofit cooperative housing corporation or negotiate with an independently formed
cooperative corporation in order to bring about the construction or the purchase of a cooperative housing project with the assistance of
an FHA insured mortgage loan.
** I intend to form or cause to be formed a condominium, and to convert the project to such condominium, all in accordance with
the pertinent FHA Regulations. (Of the last two statements, strike out whichever is not applicable.)
Sponsor's Signature and Date

X
Request for Conditional Commitment

To: Federal Housing Commissioner:
Pursuant to the provisions of the Section of the National Housing Act identified in the foregoing application and HUD Regulations
applicable thereto, request is hereby made for the issuance of a conditional commitment to insure a mortgage covering the property
described above.
After examination of the application and the proposed security, the undersigned considers the project to be desirable and is
interested, subject to the issuance of a firm commitment by HUD, in making a loan in the principal amount of $ ____________________
which will bear interest of ________ %, will require repayment of principal over a period of _______ months according to an
amortization plan to be agreed upon.
The type of firm commitment eventually to be requested, is checked below.
It is understood that the financing expense in the amount of $ ____________________ is subject to adjustment so that the total will
not exceed _______ % of the amount of your commitment.
Herewith is check for $ ______________________________ , which is in payment of the application fee required by HUD
Regulations.
** The undersigned certifies that the law of the jurisdiction will permit the project to be converted to a plan of apartment ownership
consistent with the requirements of the HUD Regulations.
Proposed Mortgagee's Signature and Date

Proposed Mortgagee's Address:

X

*Cooperative only. ** Condominum only
Previous editions are obsolete.

Page 5 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)

Request for Conditional Commitment

To: Federal Housing Commissioner
Pursuant to the provisions of the Section of the National Housing Act identified in the foregoing application and FHA Regulations
applicable thereto, request is hereby made for the issuance of a form commitment to insure a mortgage covering the property described
above.
After examination of the application and the proposed security, the undersigned considers the project to be desirable and is interested
in making a loan in the principal amount of $ ______________________________ , which bear interest of __________ %, will require
payment of principal over a period of _________ months according to amortization to be agreed upon.
It is understood that the financing expense in the amount of $ ______________________________ is subject to adjustment so that
the total will not exceed __________ % of the amount of your commitment.
Herewith is check for $ ______________________________ , which is in payment of the application and/or commitment fee
required by said FHA Regulations.
Proposed Mortgagee's Signature and Date

Proposed Mortgagee's Address

X
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and
accurate.
HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012;
31 U.S.C. 3729, 3802)
Signature and Date

X

*Cooperative only. ** Condominum only
Previous editions are obsolete.

Page 6 of 6
Submit an original and two copies

form HUD-93201 (11/8/2006)