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					                                                                                   AHP Set-aside Program - Intake Certification
                                                                                                                     ** Note: All Grayed areas require user input.
                                                                                                                        Other cells require drop-down selections.
 Section I: Member Information
 Member Institution Name:                                                         Set-aside Registration #:


 Section II: Borrower(s) and Household Information
   Household                                                                                                                        Full-time
                 Name (First and Last)                  Borrower Type                Relationship to Borrower       Over 18?                           Veteran?
    Member                                                                                                                          student?
       1              Please Input Here                    Borrower                            Self                   YES                -
            2
            3
            4
            5
            6
            7
            8
        Total                  1


 Section III: Income & Assets
                                                                   Income Documentation
                    A VOE is required as documentation for earned income. Supplemental Documentation is required for all other income.
                     A Zero Income Affidavit is required for all non-working household members over age 18 (including full time students).
   Household     Household Member                                                                                                                     Avg Hours
                                                     Income Description                      Amount                     Pay Frequency
    Member               (Auto-Fills)                                                                                                                  Weekly




                                                                     Asset Documentation
                        List all Assets for each Household Member. Asset Documentation must be dated within 90 days of submission.
                  A Zero Assets Affidavit is required for all household members over age 18 that have no assets (including full-time students).
   Household     Household Member
                                                      Asset Description                    Asset Type             Asset Value     Interest Rate
    Member               (Auto-Fills)
                                                                                              Other




April 24, 2012                                                              Page 1 of 21                                                     Household Income Certification
                                                                               AHP Set-aside Program - Intake Certification
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 Section IV: Homebuyer(s) Certification - PURCHASE PRODUCTS ONLY

           Initial(s):   1. I / We understand that funds are available on a first-come, first-served basis and cannot be reserved or guaranteed.
                         2. I / We have completed, or will complete prior to funding, the required counseling program provided by the Bank's
           Initial(s):   prescribed debt management and default prevention program provider.
                         3. I / We recognize that any funding disbursed through the AHP set-Aside Program is contingent upon my / our intent to
           Initial(s):   occupy the property.
                         4. I / We agree to execute the AHP Set-aside Program security instrument, which secures the five year affordability
                         provisions of the program. I / We further understand that failure to occupy the property for a period of five years will result in
           Initial(s):   the enforcement of the recapture provision stipulated by the Bank and the return of funds awarded to the homebuyer(s).
                         5. I / We certify that the information provided, including supporting documentation, is accurate and complete for income of all
           Initial(s):   household members over the age of 18, and for assets for all household members regardless of age.
                         First Time Homebuyers Only (FHP ONLY):              Mark "N/A" if Not Applicable.
                         1. I / We meet the definition of a first-time homebuyer as defined by the Cranston-Gonzales National Affordable Housing Act
           Initial(s):   of 1990, expanded to include recovering victims of catastrophic loss or natural disaster.


 Section V: Homeowner(s) Certification - REHABILITATION PRODUCTS ONLY

           Initial(s):   1. I / We understand that funds are available on a first-come, first-served basis and cannot be reserved or guaranteed.
                         2. I / We have completed, or will complete prior to funding, the required counseling program provided by the Bank's
           Initial(s):   prescribed debt management and default prevention program provider.
                         3. I / We recognize that any funding disbursed through the AHP set-Aside Program is contingent upon my / our intent to
           Initial(s):   occupy the property.

           Initial(s):   4. I / We have at least one year of current ownership by life estate or a full interest in the fee title.

           Initial(s):   5. I / We confirm that the purchase date is at least 1 year prior to the application date.


                         6. I / we agree to execute the AHP Set-aside Program security instrument, which secures the five year affordability provisions
                         of the program. I / We further understand that failure to occupy the property for a period of five years will result in the
           Initial(s):   enforcement of the recapture provision stipulated by the Bank and the return of funds awarded to the homeowner(s).

                         7. Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors,
                         attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this
                         application is true and correct as of the date set forth opposite my signature and that any intentional or negligent
                         misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to
                         any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or
                         in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States
                         Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or
                         deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose
                         or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the
                         property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the
                         original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents,
                         brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application,
                         and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I
                         have represented herein should change prior to closing of the

                         Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns
                         may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account
                         information to one or more consumer reporting agencies; (9) neither Lender nor its agensts, brokers, insurers, servicers,
                         successors, or assigns has made any representation or warranty, express or implied, to me regarding the property or the
                         condition or value of the property; and (10) my transmission of this application as an "electronic record" containing my
                         "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video
                         recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective,
           Initial(s):   enforceable and valid as if a paper version of this application were delivered containing my original written signature.
                         8. Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors
                         and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to
                         the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer
           Initial(s):   reporting agency.




April 24, 2012                                                          Page 2 of 21                                                       Household Income Certification
                                                                                        AHP Set-aside Program - Intake Certification
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                                                                                                                                Other cells require drop-down selections.

 Section VI: Homebuyer(s)/Homeowner(s) Signatures

                         Homebuyer/Homeowner Name                                               Homebuyer/Homeowner Signature                                       Date



                         Homebuyer/Homeowner Name                                               Homebuyer/Homeowner Signature                                       Date




     Notarization Required for:
     • All Rehab Applications
     • Purchase applications where the applying member is                       Witness Required for:
     not the first mortgage lender                                              • All applications
 GIVEN under my hand and seal of office, this ____ date of                                            Witness Signature                                             Date
 _____________________, 20___.


                                                                                                      Witness Signature                                             Date
 Notary Public
 My Commission Expires _____________


 Section VII: Non-Occupant Co-Borrower Certification                                                     Mark "N/A" on the Initials line if Not Applicable


                                     1. I / We are the co-borrower(s) of the Promissory Note associated with the first mortgage loan that is being made to the
           Initial(s):               above Homebuyer(s).

           Initial(s):               2. I / We attest that my (our) income(s) is (are) being taken into account for loan underwriting purposes only.
                                      3. I / We affirm that I (we) co-signed the Promissory Note as a guarantor to provide additional assurance that the loan will be
           Initial(s):               repaid in the case of default by the homebuyer(s)


           Initial(s):               4. I / We certify that my (our) income will not be used to assist the homebuyer(s) in making regular monthly loan payments.

           Initial(s):               5. I / We certify that my (our) income will not be given to the homebuyer(s) to supplement the Household income.


                             Co-Borrower Name                                                       Co-Borrower Signature                                           Date



                             Co-Borrower Name                                                       Co-Borrower Signature                                           Date




 Do not Remove
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