REVERSE MORTGAGE APPLICATION (Please be very thorough in completing this information) * Required BORROWER Name: SSN: DOB: MARRIEDUNMARRIEDDIVORCEDWIDOWEDNot Selected CO-BORROWER Name: SSN: DOB: MARRIEDUNMARRIEDDIVORCEDWIDOWEDNot Selected HOME Home Phone: Cell: Email address: HOME ADDRESS: Please list any repairs that need to be done to your home: Have you been declined for a Reverse Mortgage transaction? YesNoNot Selected If so, why? How many years have you lived in your home? Do you have an unpermitted addition or a garage conversion? YesNoNot Selected Do you have Solar Panels on your home? YesNoNot Selected Is your property in a Family Trust? YesNoNot Selected Have your property taxes and home insurance been on time over the last 24 months? YesNoNot Selected Do you own other properties? YesNoNot Selected If so, please list the addresses: Do you pay any Home-Owners Association Dues? YesNoNot Selected If yes, provide HOA name: and Phone #: If yes, how much are your monthly HOA dues? ($) If yes, have you been late on your HOA dues in the last 24 months? YesNoNot Selected Mortgage or Reverse Mortgage Company Mortgage or Reverse Mortgage Company: Loan #: Phone #: Home Insurance Company Home Insurance Company: Agent Name: Policy #: Phone #: Approximately how much are your annual home insurance dues? Updated Emergency Contact Information (someone who doesn’t live with you) Name: Phone #: Relationship: Address: Misc Have you had any late payments that would show on your credit report in the last 2 years? YesNoNot Selected Do you have credit card debt? YesNoNot Selected If so, approximately how much? Do you have any outstanding auto loans? YesNoNot Selected If so, how much are the payments? Are you currently employed full time or part time? Full timePart timeNot employedNot Selected Are you self-employed? YesNoNot Selected Household Income & Assets Please list the sources and amounts of all household income including but not limited to Social Security, Disability, Pension, Retirement, IRA distributions, Employment, Self- Employment, Annuity, … etc: How much are your total estimated liquid assets in the form of Checking, Savings, Retirement Accounts, Annuity…etc…? This will only be referred to as a Compensating Factor in the rate case that your income is not enough to qualify.