Form HUD-92403 Application for Insurance of Advance of Mortgage Proceed

Application for Insurance
of Advance of Mortgage
Proceeds

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

OMB Approval No. 2502-0097
                   (exp. 12/31/2016)

Public reporting burden for this collection of information is estimated to average 2 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. The form is used by mortgagors for funds expended or obligated for construction related items; by mortgagees to request
mortgage insurance for funds so advanced. The information will be used by the Department to as its certificate of mortgage insurance for
funds it approves for advance. This is a requirement under Section 207, 213, 220, 221, 231, 232, 234(d), 236, 241, 242 and 810 of the
National Housing Act, P.L. 479 48 Stat. 1246 U.S.C. et. seq. Furnishing of this information is required to obtain benefits, and failure to
provide it may result in your not receiving your benefits.
Privacy Act Notice - The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to
solicit the information requested in this form by virtue of Title 12, United States Code, Section 1701 et. seq., and regulations promulgated
thereunder at Title 12, Code of Federal Regulations. While no assurances of confidentiality is pledged to respondents, HUD generally
discloses this data only in response to a Freedom of Information request. This agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless that collection displays a valid OMB control number.
Name of Project

Project Number

Advance Number

Request for Payment
Instructions to Mortgagor: This request is to be submitted to your mortgagee in triplicate. All items requested shall be clearly identified by description. No
item shall be applied for until payment is due. A request covering construction cost shall show one entry for the total payment requested to meet the net amount
due according to the Contractor's Requisition (form HUD-92448) attached hereto. The request for the first payment on account of the Architect's cash fee shall
be accompanied by the Mortgagor's and Architect's Certificate (form HUD-92403.1) attached hereto.
To Mortgagee: The undersigned mortgagor hereby requests the mortgagee identified below to advance funds as provided for by the Building Loan Agreement
heretofore executed on (mm/dd/yyyy) _____________________ as indicated by the total amount of the individual payments set forth in the schedule below.
Item Number and Description
1. Construction cost per form HUD-92448
2. Interest from (mm/dd/yyyy) (
3. Architect's Fee
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

(A) Amount Claimed

) to (mm/dd/yyyy) (

(B) HUD-Approved Amt.

$

$

$

$

)

Total Due on This Requisition

The undersigned hereby certifies that all of the above items have been paid or will be paid within five (5) days of receipt of the requisitioned funds. We
hand you herewith full supporting invoices and/or receipts, as required, covering such items enumerated, to be forwarded with this request to HUD for
review. With respect to any item of interest enumerated above, we herewith authorize you to advance same and charge our account therewith. The undersigned
further certifies that all prior work, labor, and materials to be paid for under this request are satisfactory and are in accordance with the contract drawings.
Name of Mortgagor

Replaces FHA-2403 which is obsolete
Previous versions of HUD-92403 are obsolete

By: Signature of Authorized Mortgagor Official

Page 1 of 2

Date (mm/dd/yyyy)

form HUD-92403 (5/2001)
ref. Handbook 4480.1

For Use by Mortgagee
Instructions: This request is to be submitted to HUD in triplicate (original and all copies must be signed).
To HUD: To the best of our knowledge, information and belief, the sum requested above is now payable. We intend to disburse said sum
within five (5) days following the date of your approval. $ ____________________ will be advanced from mortgage proceeds; and the
undersigned, therefore, requests that you issue a certificate approving the amount of such advance for mortgage insurance. The
undersigned certifies that hazard insurance as required by the Department of Housing and Urban Development is in full force and effect
upon whatever improvements are now upon the mortgage premises including, but not limited to, materials stored on the site for which an
advance is being requested. You are further advised that after the payment herein first mentioned is made, a total sum of
$___________________ will have been disbursed from mortgage proceeds and that the total sum of $ _________________________
will have been disbursed from the mortgagor's cash escrow funds required, if any, over mortgage proceeds to complete the project.
Warning: 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)
Name and Address of Mortgagee

By: Signature of Authorized Mortgagee Official

Certificate of Mortgage Insurance

Date (mm/dd/yyyy)

For Use by HUD

To Above Mortgagee: You are hereby notified that the amounts shown in Column (B) above have been approved for advance in
accordance with the provisions of the Building Loan Agreement applicable to the project. Of the above total, $ _______________ is hereby
approved for mortgage insurance if advanced by you from mortgage proceeds in accordance with the above request, and this amount,
when advanced, will thereupon constitute principal of that certain mortgage dated (mm/dd/yyyy)_________________ ; signed by the
above named mortgagor and covering the subject project, which mortgage has been endorsed by the undersigned for insurance to the
extent of advances approved by the Federal Housing Commissioner and this certificate does hereby constitute the approval of the Federal
Housing Commissioner for mortgage insurance under Section __________ of the National Housing Act and Regulations thereunder for
the amount set forth herein, within the meaning of the aforesaid contract of insurance evidenced by such endorsement; provided, that if
the above advance constitutes the final advance to be made under the terms of said Building Loan Agreement, this advance shall not be
considered insured nor shall the original credit instrument be finally endorsed for insurance unless said instrument is first presented to
HUD together with an original and two (2) conformed copies of a Request for Final Endorsement of Credit Instrument (form HUD-92023)
completed and executed by both Mortgagor and Mortgagee, and if there are any items of construction still incomplete, as per attached list, the
sum of $ _________________ shall have been placed in escrow under the provisions of an Escrow Deposit Agreement (form HUD-2456).
Explanation of Disallowed Amounts: (Attach additional sheets if required.)

Mortgage Credit Examiner

Replaces FHA-2403 which is obsolete
Previous version of HUD-92403 are obsolete

By: Signature of Authorized HUD Official

Page 2 of 2

Date (mm/dd/yyyy)

form HUD-92403 (5/2001)
ref. Handbook 4480.1