HECM Pre-Application Form

BORROWER INFORMATION
Borrower Name*

First NameLast Name
Phone Number*
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Gender*

MaleFemaleOther
Marital Status*

MarriedUnmarriedOther
Ethnicity*

Not Hispanic or LatinoHispanic or LatinoNot Disclosed
Race*

American IndianAsianBlack/African AmericanPacific IslanderWhiteNot Disclosed

Special Conditions*

	Yes	No
Power of Attorney
Borrower Competency ~ Mental Condition
Borrower Incapacitated ~ Physical Condition

*If The Borrower is Married We Must Know the Spouse’s DOB Unless the Spouse Does Not Reside in the Subject Property

SPOUSE OR RESIDENTIAL CO-BORROWER INFORMATION
Spouse or Co-Borrower Name

First NameLast Name
Please Select One

Spouse/Applicant will be Co-BorrowerSpouse is not a Co-BorrowerNot Applicable
Phone Number
Date of Birth

MonthDayYear
Date
Email
example@example.com
Gender

MaleFemaleOther
Marital Status

MarriedUnmarriedOther
Ethnicity

Not Hispanic or LatinoHispanic or LatinoNot Disclosed
Race

American IndianAsianBlack/African AmericanPacific IslanderWhiteNot Disclosed

Special Conditions

	Yes	No
Power of Attorney
Borrower Competency ~ Mental Condition
Borrower Incapacitated ~ Physical Condition

Cash Value & Obligations*

	Cash Value (USD)
Estimated Property Value
Mortgage Balance (Existing)
Mortgage Payment (Monthly Minimum)
Additional Liens (Total Pay-Off)
Property Tax (Total Amount)
Hazard Insurance (Total Amount)

Property Data*

INCOME, ASSETS & DEBT INFORMATION
Borrower Income*
Monthly Gross Income
Co-Borrower Income
Monthly Gross Income
Total Assets Combined*
Total of All Cash Value (i.e. Checking, Savings, IRA, 401k, 403b, Stocks, Bonds, etc.)
Debt Monthly Minimum Payments (w/o Mtg)*
Enter the Total of Your Monthly Minimum Payment(s)

Other Debt Obligations*

	Yes	No
Outstanding Judgments
Default on Federal Debt

HECM LOAN PROCESS FLOW
1 Proposal -4 2 Counseling -4
3 Application -44 FHA Case # Request -4
5 Order Services (Appraisal) -4
6 Submit to Underwriting
Please trace the drawing to prove that you are NOT an A.I. Orwellian Cyber-Bot bent on global domination and control of humankind!*
Should be Empty:

Home Equity Conversion Mortgage