Physician Loan Mini ApplicatioO PRINT APPLICATION

I. Borrower Information
Borrower Co-Borrower

Borrower’s Name (include Jr. or Sr. if applicable) Borrower’s Name (include Jr. or Sr. if applicable)

Social Security No. Hm./Cell Phone No. DOB MM/DD/YYYY Social Security No. Hm./Cell Phone No. DOB MM/DD/YYYY

Marital Status Dependents Marital Status Dependents

No. Ages No. Ages

Present Address (Street, City, St, Yrs. Present Address (Street, City, St, Yrs.
Zip) Zip)

Mailing Address, if different from Present Address (Street, City, St, Zip) Mailing Address, if different from Present Address (Street, City, St, Zip)

II. Employment Information

Borrower Co-Borrower

Employer Employer

Address Address

Start Date Position Start Date Position

Income/Projected Income/Projected
Amount Amount
If < 2 years, please complete below If < 2 years, please complete below

Employer Employer

Address Address

Position Position

Start Date End Date Start Date End Date

Previous Income Previous Income

III. School Information

Borrower Co-Borrower

University University

Address Address

Start Date End Date Start Date End Date

IV. Asset Information

Borrower Co-Borrower

Checking Institution Checking Institution

Savings Institution Savings Institution

401K/IRA Institution 401K/IRA Institution

Gift Funds Source(s) Gift Funds Source(s)

Other Institution Other Institution

*

I/we warrant and confirm that the information given is true and correct and I/we understand that it is being used to determine my/our credit responsibility and to evaluate and respond to my/our
request for mortgage financing. You are authorized to obtain any information you may require for these purposes from other sources (including, for example, credit bureaus) and each source is
hereby authorized to provide you with such information. I/we also understand, acknowledge and agree that the information given in the mortgage application form as well as other information
you obtain in relation to my/our credit history may be disclosed to potential mortgage lenders, mortgage insurers, life and/or disability insurance providers, other service providers, organizations
providing technological or other support services required in relation to this application and any other parties with whom I/we propose to have a financial relationship.

Your privacy is important. We are committed to respecting and protecting your privacy and security.

BORROWER: __________________________________ Date: _____________________________

03/19/2018

CO-BORROWER: _______________________________ Date: __________________________

03/19/2018