Borrower’s Certification and Authorization Revised 03/2013
Borrower’s Certification & Authorization
Certification
The undersigned certify the following:
1. I/We have applied for a mortgage loan from Van Dyk Mortgage Corporation. In applying for the loan:
I/We completed a loan application containing various information on the purposes of the loan, the amount and source of the down payment, employment and income information, and assets and liabilities. I/We certify that all of the information is true and complete. I/We made no misrepresentations in the loan application with the employer and/or other documents, nor did I/We omit any pertinent information.
2. I/We understand and agree that Van Dyk Mortgage Corporation reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with the employer and/or the financial institution.
3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this mortgage, as applicable under the provisions of Title 18, United States Code, Section 1014.
Authorization to Release Information
To Whom It May Concern:
1. I/We have applied for a mortgage loan from Van Dyk Mortgage Corporation.
As part of the application process, Van Dyk Mortgage Corporation may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program.
2. I/We understand and agree that Van Dyk Mortgage Corporation reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with the employer and/or the financial institution.
3. Van Dyk Mortgage Corporation or any investor that purchases the mortgage may address this authorization to any party names in the loan application.
4. A copy of this authorization may be accepted as an original.
5. Your prompt reply to Van Dyk Mortgage Corporation or the investor that purchased the mortgage is appreciated.
___________________________________________
Borrower Date
. .
Social Security Number:
___________________________________________
Borrower Date
Social Security Number:
Date of Birth:
Date of Birth:
VanDyk Mortgage Corp
310 Via Vera Cruz, ste 211
San Marcos, CA 92078
NMLS 3035/220268
760-798-7999 office
760-454-3888 fax
Employment Info page Must cover last 2 years
Borrower Co-Borrower
Name & Address of Employer Name & Address of Employer
Date Started: Date Started:
Years employed in this line of work/profession Years employed in this line of work/profession
Self Employed? Yes No Self Employed? Yes No
Percentage of Business Owned: ___________% Percentage of Business Owned: ___________%
Job Position Job Position
Business Phone number for Employment Verification Business Phone number for Employment Verification (main number or HR number) (main number or HR number)
Your work phone number Your work phone number
Prior Employer / Second Job Prior Employer / Second Job
Name & Address of Employer Name & Address of Employer
Dates employed: Dates employed:
from: to: from: to:
Self Employed? Yes No Self Employed? Yes No
Percentage of Business Owned: ___________% Percentage of Business Owned: ___________% Years employed in this line of work/profession Years employed in this line of work/profession
Job Position Job Position
Address History
Full address for last 2 years for last 2 years
rent/ own (include monthly rent amount) rent/ own (include monthly rent amount) Lived at From: To: Lived at From: To:
rent/ own (include monthly rent amount) rent/ own (include monthly rent amount) Lived at From: To: Lived at From: To:
Dependents
Ages: Ages:
Child Care expense per month (for VA Loans only) Child Care expense per month (for VA Loans only)
Declarations:
Borrower Coborrower If you answer Yes to any questions below, please include dates/explanation
Declarations:
A. Are there any outstanding Judgements against you? B. Have you been delcared Bankrupt within the past 7 years? C. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
D. Are you a party to a lawsuit?
E. Have you directly or Indirectly been obligated on any loan which resulted in Foreclosure, Transfer of Title in lieu of Foreclosure, or Judgement?
(this would include such loans as Home Mortgage Loans, SBA Loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes", please provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action).
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?
If "Yes", give details as described in the preceding question
G. Are you obligated to pay Alimony, Child Support, or Separate Maintenance? H. Is any part of the down payment Borrowed?
I. Are you a co-maker or endorser on a note?
---J. Are you a US Citizen?
K. Are you a Permenent Resident Alien?
For Veterans:
Borrower Coborrower
Service type Service type
Regular__________ Reserves/Guard__________ Regular__________ Reserves/Guard__________ Did you receive an honorable discharge? Did you receive an honorable discharge?
Do you have a VA Disability Rating? (add %) Do you have a VA Disability Rating? (add %)
Monthly Child Care Expense Monthly Child Care Expense
Have you ever had a VA Loan? Have you ever had a VA Loan?
