VA Form 26-6705b Credit Statement of Prospective Purchaser

OMB Approved No. 2900-0029
Respondent Burden: 20 Minutes
Expiration Date: XXXXXXXX

CREDIT STATEMENT OF PROSPECTIVE PURCHASER
Privacy Act Notice: VA and the Service Provider will not disclose information collected on this form to any source other than what has been authorized under the Privacy
Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., This form will serve as an application for credit from VA in connection with an offer to
purchase a VA-acquired property, as authorized by law (38 U.S.C. 1820(a)(5)).) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium
and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan Applicant Records - VA, and published in the Federal
Register. Your obligation to respond is required to obtain or retain benefits. VA may conduct computer matches to verify the information you will furnish. Under the
financial privacy act of 1978, VA may obtain financial records held by financial institutions in connection with the consideration or administration of assistance to you. Such
financial records will be available to VA without further notice or authorization.
Respondent Burden: We need this information to consider your offer to purchase a VA acquired property. Title 38, United States Code, allows us to ask for this information.
We estimate that you will need an average of 20 minutes to review the instructions, find the information, and complete this form. VA and the Service Provider cannot
conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number
is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to
get information on where to send comments or suggestions about this form.

GENERAL INFORMATION

1A. APPLICANT(S) NAME(S) AND MAILING ADDRESS

2. VA PROPERTY IDENTIFIER

3. VA PROPERTY ADDRESS
1B. HOME TELEPHONE NO.
4. DOWN PAYMENT

5. REQUESTED LOAN

$

6. REHABILITATION AMOUNT
$

$
8. APPLICANT HOME STATUS

7. TERM AND INTEREST
YEARS

PERCENT

RENT
%

10. AGES OF DEPENDENTS OTHER THAN SPOUSE

9. MARITAL STATUS

YEARS

MARRIED

SEPARATED

UNMARRIED

OWN

12. NEAREST RELATIVE NOT LIVING WITH APPLICANT

11. ATTACHMENTS
ALL INCOME DOCUMENTS

SEPARATE CREDIT STATEMENT FROM

NAME:
STREET:

OTHER (Specify)
(A Co-applicant who is not the spouse of the
Applicant named in Item 1)

CITY:
STATE:

ZIP CODE:

TELEPHONE NO.:
13. IF ANY OF THE FOLLOWING THREE STATEMENTS APPLIES TO THE REQUESTED LOAN, THEN CREDIT INFORMATION CONCERNING THE SPOUSE WILL BE
NECESSARY TO EVALUATE THE CREDIT RISK. PLEASE MARK THE STATEMENTS THAT APPLY TO THE REQUESTED LOAN:
THE APPLICANT IS MARRIED AND RESIDES IN, OR THE PROPERTY IS LOCATED IN, A COMMUNITY PROPERTY STATE
THE APPLICANT WILL RELY ON INCOME FROM ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE OR ON THE INCOME OR ASSETS OF A SPOUSE TO
REPAY THE LOAN
THE APPLICANT WILL BE JOINTLY OBLIGATED WITH THE SPOUSE TO REPAY THE LOAN
14A. DATE OF BIRTH

APPLICANT

14B. SOCIAL SECURITY NUMBER
14D. DATES (From-To)

14C. EMPLOYER NAME AND MAILING ADDRESS

15A. DATE OF BIRTH

SPOUSE/CO-APPLICANT

15B. SOCIAL SECURITY NUMBER

15C. EMPLOYER NAME AND MAILING ADDRESS

15E. MONTHLY
INCOME

14E. MONTHLY
INCOME
SELF-EMPLOYED

$

14F. JOB TITLE/TYPE OF BUSINESS

$

SELF-EMPLOYED

14G. BUSINESS TELEPHONE

15D. DATES (From-To)

15F. JOB TITLE/TYPE OF BUSINESS

15G. BUSINESS TELEPHONE

NOTE - If working for more than one employer, or employed at present job less than two years, continue to furnish job or training
information to cover the latest two-year period. Use a separate sheet, if necessary.
16A. PREVIOUS EMPLOYER'S NAME AND MAILING
ADDRESS

16B. DATES (From-To)

17A. PREVIOUS EMPLOYER'S NAME AND MAILING
ADDRESS

16C. MONTHLY
INCOME
SELF-EMPLOYED

17C. MONTHLY
INCOME
SELF-EMPLOYED

$

16D. JOB TITLE/TYPE OF BUSINESS

16E. BUSINESS TELEPHONE

17B. DATES (From-To)

$

17D. JOB TITLE/TYPE OF BUSINESS

17E. BUSINESS TELEPHONE

18. COMBINED ASSETS AND CASH/MARKET VALUES
A. OTHER LOAN/GIFT TO BUY THIS PROPERTY

$

F.

FURNITURE, HOUSEHOLD GOODS

$

VEHICLE (YEAR AND MODEL)

$

$

G.

C. SAVINGS ACCOUNTS, CERTIFICATES, BONDS

$

H.

OTHER

$

D. STOCKS, OTHER SECURITIES

$

I.

OTHER

$

E. REAL ESTATE OWNED OTHER THAN HOME

$

J.

OTHER

$

B. CASH ON HAND, CHECKING ACCOUNTS

VA FORM
XXX 2014

26-6705b

SUPERSEDES VA FORM 26-6705b, AUG 2008,
WHICH WILL NOT BE USED.

PURCHASE OFFER NO:

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize VA (United States Department of Veterans Affairs) to verify records of my past and present employment and income, as well as financial
accounts and other asset balances, to obtain a consumer and/or business credit report and verify information regarding my past and present credit accounts,
including rental accounts, in order to process my credit statement to VA and the Service Provider. I acknowledge that VA and the Service Provider is in
compliance with the Right to Financial Privacy Act of 1978 (Title XI, Public Law 95-630), in connection with this request for access to financial records. I
request all referenced employers, financial institutions, landlords and other creditors to accept a photocopy of this signed authorization as evidence of my
consent to release the requested information to VA and the Service Provider. I understand that I may revoke this authorization at any time before the
financial records described above are disclosed.

SIGNATURE OF APPLICANT
VA FORM
XXX 2014

26-6705b

DATE SIGNED

SIGNATURE OF SPOUSE/ CO-APPLICANT

SUPERSEDES VA FORM 26-6705b, AUG 2008,
WHICH WILL NOT BE USED.

DATE SIGNED

CONTINUED ON REVERSE

CHECKING, SAVINGS AND INVESTMENT ACCOUNT INFORMATION
19A. BANK, CREDIT UNION OR OTHER DEPOSITORY NAMES AND MAILING ADDRESSES

19B. ACCOUNT NUMBERS AND PURPOSE

19C. BALANCE

$

$

$

$

$

COMBINED MONTHLY HOUSING & OTHER EXPENSES

MONTHLY INCOME
20A. SOURCE OF INCOME AND
GROSS MONTHLY AMOUNTS

20B. APPLICANT
BORROWER

20C. SPOUSE
CO-APPLICANT

21A. COMBINED EXPENSES AND
GROSS MONTHLY AMOUNTS

21B. PRESENT
HOME

21C. REQUESTED
LOAN

(1) BASE SALARY, WAGES

$

$

(1) RENT OR HOME LOAN PAYMENT

$

$

(2) OVERTIME, PART-TIME

$

$

(2) HAZARD INSURANCE

$

$

(3) BONUSES, COMMISSIONS

$

$

(3) REAL ESTATE TAXES

$

$

$

(4) HOMEOWNER ASSOCIATION DUES

$

$

$

$

$

$

(4) INTEREST, DIVIDENDS

$

(5) PENSION, COMPENSATION

$

$

(5) DEPENDENT CARE

(6) REAL ESTATE RENTAL

$

$

(6) OTHER

Disclose the following income only if needed to repay the loan. Send VA
copies of court documents and evidence of payments.
(7) ALIMONY, SEPARATE MAINTENANCE $

$

(8) CHILD SUPPORT

$

$

SELF EMPLOYMENT: Send VA copies of latest tax returns and financial
(profit/loss) statements for the last two years.
RENTAL PROPERTY: Send VA copies of latest list of property
addresses, creditors, loan and rental amounts related to investment real
estate owned.

LOANS AND OTHER CREDIT ACCOUNT INFORMATION

(List your charge card accounts, installment loans, and other debts you owe. Include present landlord(s) with other creditors and attach a separate sheet, if necessary, to
list and explain additional credit accounts, including any past due amounts, judgments, collections and foreclosures against you, deeds in lieu of foreclosure, bankruptcies
filed within the past seven years and court orders to pay separate maintenance, alimony or child support.)
22A. CREDITOR NAMES AND MAILING ADDRESSES (Include landlord(s)

22B. ACCOUNT NUMBERS AND PURPOSE

22C. BALANCE

22D. PAYMENT PER
MONTH

ACKNOWLEDGMENTS - I acknowledge that the Federal Government, its agents or assigns, are authorized by law to take any and all of the following
actions in the event that payments become delinquent on the loan described in this application: (1) Report my name and account information to a credit
bureau, (2) Charge penalty amounts and additional interest for the period of time that the loan is delinquent, (3) Charge additional amounts to cover
additional administrative costs of servicing the delinquent loan, (4) Offset other amounts owed to me under other Federal programs, (5) Refer my account to
a private attorney, collection agency or servicing agency to conduct computer matches, collect the amount due, foreclose the loan, sell the property and seek
judgement against me for a deficiency, (6) Refer my account to the Department of Justice for litigation in the courts, (7) If I am a current or retired Federal
employee, take action to offset my salary or retirement benefits, (8) Refer my debt to the Internal Revenue Service as my taxable income. These actions
may be used to recover any debt owed, when it is determined to be in the interest of the Federal Government, its agents or assigns, to do so. I understand
that Federal debts include grants, benefit overpayments, delinquent taxes and direct, guaranteed or insured loans for education, business or housing, and
that delinquencies are defined as follows: a grant is delinquent if a disallowed amount has not been repaid or resolved; a direct loan is delinquent if a
scheduled payment is more than 31 days past due; a guaranteed or insured loan is delinquent if the debt has been purchased by the Federal Government
because the loan agreement was breached by the borrower and is in default.
23. ARE YOU DELINQUENT ON ANY FEDERAL DEBT, OR HAVE YOU FILED BANKRUPTCY OR HAD A LOAN FORECLOSED WITHIN THE PAST SEVEN YEARS?
(If "Yes," explain in this box or attach a separate sheet)

YES

NO

AGREEMENTS - Neither I, nor anyone authorized to act for me will restrict the sale or rental of the property covered by this application for credit to any
person because of race, color, religion, sex, handicap, familial status or national origin. I understand that such restriction is illegal. I understand that, if I
obtain a loan from VA to purchase a property acquired through VA Loan Guaranty operations, VA may either retain or sell the rights to collect the payments
and otherwise service the loan. I understand that VA may retain this application and any supporting documents, even if the loan is not approved. I agree to
notify VA if my income or expenses should change prior to closing.
CERTIFICATIONS - I certify that all information contained in this application for credit is true and complete to the best of my knowledge and that verification
may be obtained from any source named herein. I understand that if I give false information, I may be charged penalties or may be subject to criminal
prosecution.
24A. SIGNATURE OF APPLICANT

24B. DATE SIGNED

25A. SIGNATURE OF SPOUSE/CO-APPLICANT

25B. DATE SIGNED

FEDERAL LAW PROHIBITS A CREDITOR FROM DISCRIMINATING ON THE BASIS OF THE FOLLOWING FEDERAL GOVERNMENT MONITORING
INFORMATION, OR THE FACT THAT IT IS NOT FURNISHED. YOU ARE NOT REQUIRED, BUT ENCOURAGED, TO FURNISH THIS INFORMATION.
INITIALS
INITIALS
26. APPLICANT (If you do not wish to complete the
27. SPOUSE/CO-APPLICANT (If you do not wish to
items below, please initial here)
complete the items below, please initial here)
RACE/ETHNIC ORIGIN
ASIAN OR
PACIFIC ISLANDER
AMERICAN INDIAN
OR ALASKAN NATIVE
VA FORM 26-6705b, XXX 2014

RACE/ETHNIC ORIGIN

SEX
BLACK
HISPANIC

WHITE
OTHER

SEX

MALE

ASIAN OR
PACIFIC ISLANDER

BLACK

WHITE

MALE

FEMALE

AMERICAN INDIAN
OR ALASKAN NATIVE

HISPANIC

OTHER

FEMALE