+--------------------------+-----+-------------+------------+----+----+
| ###### COM               |     | NAME OF     |            |    |    |
| PTROLLER OF THE CURRENCY |     | BANK        |            |    |    |
|                          |     |             |            |    |    |
| **HOME LOAN DATA         |     |             |            |    |    |
| SUBMISSION**             |     |             |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
|                          |     | CHARTER     | \_\_\_\_   |    |    |
|                          |     | NUMBER      | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     | DECISION    | \_\_\_\_\_ |    |    |
|                          |     | CENTER NO.  | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     |             |            |    |    |
|                          |     |             | \_\_\_\_   |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
|                          |     |             | \_\_\_\_\_ |    |    |
+--------------------------+-----+-------------+------------+----+----+
| (Enter dollar amounts as |     |             |            |    |    |
| whole dollars)           |     |             |            |    |    |
|                          |     |             |            |    |    |
| #### APPLICATION FORM    |     |             |            |    |    |
|                          |     |             |            |    |    |
|   --------------         |     |             |            |    |    |
| ---------- ------------- |     |             |            |    |    |
| ------------------------ |     |             |            |    |    |
| ------------------------ |     |             |            |    |    |
| --------------------- -- |     |             |            |    |    |
|   1\. Applicat           |     |             |            |    |    |
| ion File     \_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_      |     |             |            |    |    |
|   Number                 |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   2\. Amount o           |     |             |            |    |    |
| f Loan       \$\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_    |     |             |            |    |    |
|   Requested              |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   3\. Number o           |     |             |            |    |    |
| f Months     \_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_      |     |             |            |    |    |
|   Requested to           |     |             |            |    |    |
|  Maturity                |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   4\. County             |     |             |            |    |    |
|              \_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_      |     |             |            |    |    |
|                          |     |             |            |    |    |
|   5\. State              |     |             |            |    |    |
|              \_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_      |     |             |            |    |    |
|                          |     |             |            |    |    |
|   6\. Number o           |     |             |            |    |    |
| f Units      1  2  3  |     |             |            |    |    |
|  4                      |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   7\. Year Hou           |     |             |            |    |    |
| se Was Built \_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_\_\_\ |     |             |            |    |    |
| _\_\_\_\_\_\_\_\_\_      |     |             |            |    |    |
|                          |     |             |            |    |    |
|   8\. Purpose            |     |             |            |    |    |
| of Loan 1               |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   Purchase 2            |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   Construction           |     |             |            |    |    |
| ‑Permanent 3             |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|    Refinance            |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   --------------         |     |             |            |    |    |
| ---------- ------------- |     |             |            |    |    |
| ------------------------ |     |             |            |    |    |
| ------------------------ |     |             |            |    |    |
| --------------------- -- |     |             |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
| ####### Applicant        |     | 11\.        |            |    |    |
|                          |     | **Co-A      |            |    |    |
|                          |     | pplicant?** |            |    |    |
|                          |     |             |            |    |    |
|                          |     | 1  Yes 2  |            |    |    |
|                          |     | No          |            |    |    |
|                          |     |             |            |    |    |
|                          |     | (If #11 is  |            |    |    |
|                          |     | No, proceed |            |    |    |
|                          |     | to #14)     |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
| ####  9. Age             | ##  | #           |            | #  |    |
|                          | ##  | ### 12. Age |            | ## |    |
|                          |     |             |            | #  |    |
+--------------------------+-----+-------------+------------+----+----+
| #### 10. Marital Status  | ##  | #           |            | #  |    |
|                          | ##  | ### 13. Mar |            | ## |    |
|                          |     | ital Status |            | #  |    |
+--------------------------+-----+-------------+------------+----+----+
| 1 Married 2  Separated | ##  | 1 Married  |            | #  |    |
|                          | ##  | 2          |            | ## |    |
| ####  3                  |     | Separated   |            | #  |    |
|  Unmarried (includes si |     |             |            |    |    |
| ngle, divorced, widowed) |     | 3           |            |    |    |
|                          |     | Unmarried  |            |    |    |
|                          |     | (includes   |            |    |    |
|                          |     | single,     |            |    |    |
|                          |     | divorced,   |            |    |    |
|                          |     | widowed)    |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
| 14\. Applicant Gross     |     | \$          |            |    |    |
| Monthly Income           |     | \_          |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
| 15\. Co‑Applicant Gross  |     | _\_\_\_\_\_ |            |    |    |
| Monthly Income           |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
| 16\. Proposed Monthly    |     | \_\_\_\_\_\ |            |    |    |
| Housing Payments         |     | _\_\_\_\_\_ |            |    |    |
|                          |     |             |            |    |    |
| 17\. Purchase/Sales      |     | \$          |            |    |    |
| Price                    |     | \_          |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
| 18\. Other Total Monthly |     | _\_\_\_\_\_ |            |    |    |
| Payments                 |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     |             |            |    |    |
|                          |     | \$          |            |    |    |
|                          |     | \_          |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     |             |            |    |    |
|                          |     | \$          |            |    |    |
|                          |     | \_          |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     |             |            |    |    |
|                          |     | \$          |            |    |    |
|                          |     | \_          |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
|                          |     | \_\_\_\_\_\ |            |    |    |
|                          |     | _\_\_\_\_\_ |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
| #### Applicant           |     | **Co-A      |            |    |    |
|                          |     | pplicant?** |            |    |    |
| 19\. Race:               |     | (If none,   |            |    |    |
|                          |     | proceed to  |            |    |    |
| 1  American Indian or   |     | #23)        |            |    |    |
| Alaskan Native           |     |             |            |    |    |
|                          |     | 21\. Race:  |            |    |    |
| 2  Asian or Pacific     |     |             |            |    |    |
| Islander                 |     | > 1         |            |    |    |
|                          |     | > American |            |    |    |
| 3 Black, not of         |     | > Indian or |            |    |    |
| Hispanic origin          |     | > Alaskan   |            |    |    |
|                          |     | > Native    |            |    |    |
| 4 White, not of         |     |             |            |    |    |
| Hispanic origin          |     | 2 Asian or |            |    |    |
|                          |     | Pacific     |            |    |    |
| 5 Hispanic              |     | Islander    |            |    |    |
|                          |     |             |            |    |    |
| 6 Other                 |     | 3 Black,   |            |    |    |
|                          |     | not of      |            |    |    |
| 20\. Sex: 1  Female 2   |     | Hispanic    |            |    |    |
| Male                    |     | origin      |            |    |    |
|                          |     |             |            |    |    |
|                          |     | 4 White,   |            |    |    |
|                          |     | not of      |            |    |    |
|                          |     | Hispanic    |            |    |    |
|                          |     | origin      |            |    |    |
|                          |     |             |            |    |    |
|                          |     | 5 Hispanic |            |    |    |
|                          |     |             |            |    |    |
|                          |     | 6 Other    |            |    |    |
|                          |     |             |            |    |    |
|                          |     | 22\. Sex: 1 |            |    |    |
|                          |     |  Female 2  |            |    |    |
|                          |     | Male       |            |    |    |
+--------------------------+-----+-------------+------------+----+----+
| 23\. Bank Relationship   |     |             |            |    |    |
| at Subject Bank          |     |             |            |    |    |
|                          |     |             |            |    |    |
|   -----                  |     |             |            |    |    |
| --------- -------------- |     |             |            |    |    |
|                          |     |             |            |    |    |
|  1  Current    2  Past |     |             |            |    |    |
|   Banking        Banking |     |             |            |    |    |
|   Rel                    |     |             |            |    |    |
| ationship   Relationship |     |             |            |    |    |
|                          |     |             |            |    |    |
|   3                     |     |             |            |    |    |
| No Banking 4  Unable to |     |             |            |    |    |
|                          |     |             |            |    |    |
| Relationship   Determine |     |             |            |    |    |
|   -----                  |     |             |            |    |    |
| --------- -------------- |     |             |            |    |    |
+--------------------------+-----+-------------+------------+----+----+

+--------------------------------+---------------------------+---------+
| #### Appraisal                 | \_\_\_\_\_\_\_\_\_        |         |
|                                | \_\_\_\_\_\_\_\_\_\_\_\_\ |         |
| 24\. Census Tract              | _\_\_\_\_\_\_\_\_\_\_\_\_ |         |
|                                |                           |         |
| 25\. Appraised Value           | \$                        |         |
|                                | \_\_\_\_\_\_\_\_\_        |         |
|                                | \_\_\_\_\_\_\_\_\_\_\_\_\ |         |
|                                | _\_\_\_\_\_\_\_\_\_\_\_\_ |         |
+--------------------------------+---------------------------+---------+

+-----------------------------+---+------------------------------------+
| **Action Taken**            |   |                                    |
+-----------------------------+---+------------------------------------+
| 26\. Description of Action  |   |                                    |
+-----------------------------+---+------------------------------------+
| 1  Withdrawn Before Terms  |  | (If checked, skip remaining        |
| Were Offered                |   | questions)                         |
+-----------------------------+---+------------------------------------+
| 2  Denied                  |   |                                    |
+-----------------------------+---+------------------------------------+
| 3  Withdrawn After Terms   |  | (If checked, complete remaining    |
| Were Offered                |   | questions)                         |
+-----------------------------+---+------------------------------------+
| 4  Approved and Loan       |   |                                    |
| Closed                      |   |                                    |
+-----------------------------+---+------------------------------------+
| #### Terms of Mo            |   |                                    |
| rtgage or of Mortgage Offer |   |                                    |
|                             |   |                                    |
| +--------+--------------+   |   |                                    |
| | 27\.   |              |   |   |                                    |
| | Comm   |              |   |   |                                    |
| | itment |              |   |   |                                    |
| | Date   |              |   |   |                                    |
| | \_     |              |   |   |                                    |
| | \_\_/\ |              |   |   |                                    |
| | _\_\_/ |              |   |   |                                    |
| | \_\_\_ |              |   |   |                                    |
| |        |              |   |   |                                    |
| | MM D D |              |   |   |                                    |
| | Y Y    |              |   |   |                                    |
| +--------+--------------+   |   |                                    |
| | 28\.   |              |   |   |                                    |
| | Type   |              |   |   |                                    |
| | of     |              |   |   |                                    |
| | Mo     |              |   |   |                                    |
| | rtgage |              |   |   |                                    |
| +--------+--------------+   |   |                                    |
|                             |   |                                    |
| +---------+------+------+   |   |                                    |
| | > 1    | 2   |      |   |   |                                    |
| | > S     | Vari |      |   |   |                                    |
| | tandard | able |      |   |   |                                    |
| | > Fixed | Rate |      |   |   |                                    |
| | >       |      |      |   |   |                                    |
| | Payment |      |      |   |   |                                    |
| +---------+------+------+   |   |                                    |
| | > 3    | 4   | 5   |   |   |                                    |
| | > Gr    | R    | O    |   |   |                                    |
| | aduated | oll‑ | ther |   |   |                                    |
| | >       | Over |      |   |   |                                    |
| | Payment |      |      |   |   |                                    |
| +---------+------+------+   |   |                                    |
|                             |   |                                    |
|   ------------------------  |   |                                    |
|   29\. Private Mortgage     |   |                                    |
|   Insurance Required?       |   |                                    |
|                             |   |                                    |
|   ------------------------  |   |                                    |
|                             |   |                                    |
| 1  No 2  Yes              |   |                                    |
|                             |   |                                    |
|   ------ ---------          |   |                                    |
| ---- ---------------------- |   |                                    |
| --------------------------- |   |                                    |
| ----------------------- --- |   |                                    |
|   30\.   Loan A             |   |                                    |
| mount   \$                  |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|         \_\_\_\_\_\_\_\_\_\ |   |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_    |   |                                    |
|                             |   |                                    |
|   31\.   Note (             |   |                                    |
| Simple) \_\_\_\_\_\_\_\_\_\ |   |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_ %  |   |                                    |
|          Intere             |   |                                    |
| st Rate                     |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|   32\.   Points             |   |                                    |
|  to     \_\_\_\_\_\_\_\_\_\ |   |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_    |   |                                    |
|          Buyer              |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|   33\.   Months             |   |                                    |
|  to     \_\_\_\_\_\_\_\_\_\ |   |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_    |   |                                    |
|          Maturi             |   |                                    |
| ty                          |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|   34\.   Downpa             |   |                                    |
| yment   \$                  |   |                                    |
|                             |   |                                    |
|                             |   |                                    |
|          Amount             |   |                                    |
|         \_\_\_\_\_\_\_\_\_\ |   |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_    |   |                                    |
|   ------ ---------          |   |                                    |
| ---- ---------------------- |   |                                    |
| --------------------------- |   |                                    |
| ----------------------- --- |   |                                    |
+-----------------------------+---+------------------------------------+