This Disclosure has been made on this ______ day of ____________ (month) in year ___________ by loan agent ____________________________________ on behalf of ____________________________________ (mortgage company), Loan Number #_________________. The highlights below are extracted from your official loan documents and are not estimates. These are terms that we have actually secured for you and are part of your loan.

Borrower Name(s): ________________________________________________________________________

Property Address: ________________________________________________________________________

We hereby remind you that your loan is a Potential Negative Amortizing Loan, which means that if you make only the minimum payments based on the Initial Interest Rate, your loan balance will gradually increase over time instead of decreasing with each payment. While you will be charged an initial interest rate of ___.___%, this rate is good for only _______ month(s) at which time it will rise by at least _____%. As a result, you will be charged a much higher interest rate even though you may continue making the low initial payments. The difference between your minimum payments based on the low initial interest rate and the higher payments expected of you based on the higher interest you will be charged (not the initial interest rate) will be added on your loan and will raise your balance each month.

If the paragraph above is crossed-out, not filled-in/completed, I certify that you do NOT have a Negative Amortizing loan, otherwise, you can count on the information above.

Agent Signature: _________________________ Date: ___/___/___

Your Loan Is Fully Amortized:

Your First loan is a Fully Amortized loan, which means that when you make your minimum payments each month, part of every payment will reduce your Loan Balance.

Agent Signature: _________________________ Date: ___/___/___

Your loan may carry a prepayment penalty for a period of _______ years ( _______ months). This means that if you chose to refinance your loan, or sell your property, before the end of that time period you may incur a penalty that may amount to thousands of dollars.

If blanks above are not completed, then your Loan Does NOT carry a prepayment penalty.

Agent Signature: _________________________ Date: ___/___/___

The financing on your home is composed of a FIRST Loan in the amount of $____________.00, and a SECOND Loan in the amount of $____________.00.

FIRST LOAN: FIXED / ADJUSTABLE

Your First loan is amortized over ______ years and has an INITIAL INTEREST RATE of ___.___%. This INITIAL interest rate is Fixed for _______ year(s) ( ______months). Your FIRST loan DOES / DOES NOT have a Balloon payment feature. If it does, then it is more fully described in your loan documents.

Agent Signature: _________________________ Date: ___/___/___

SECOND LOAN is FIXED / ADJUSTABLE

Your SECOND loan is amortized over ______ years and has an INITIAL INTEREST RATE of ___.___%. This INITIAL interest rate is Fixed for _______ year(s) ( ______months). Your SECOND loan DOES / DOES NOT have a Balloon payment feature. If it does, then it is more fully described in your loan documents.

Agent Signature: _________________________ Date: ___/___/___

Your loan WILL / WILL NOT require Mortgage Insurance for the benefit of the lender. This mortgage insurance protects the interests of the lender to cover the risks typically associated with reduced down payments. You will have to pay approximately $_______/month for mortgage insurance.

Agent Signature: _________________________ Date: ___/___/___

As a condition for securing your loan you WILL / WILL NOT be required to sign one or more of the IRS forms above. These forms allow a lender to verify with the IRS, at their own discretion, if the income information you have provided as part of your application matches with the income filed on the tax returns you have filed with the IRS. In case of a discovered discrepancy a lender may accelerate your loan, which means that you may have to payoff your loan immediately (typically within 30 days). Your lender may even have to disclose the discovered discrepancy to the IRS. As a result, the IRS may audit the discrepancy and find that you owe back taxes.

Agent Signature: _________________________ Date: ___/___/___

As part of your loan application you must have received a Good Faith Estimate within 3 days of completing your loan application. You must also receive a Mortgage Loan Disclosure Statement, which also indicates the closing costs you will be incurring. These estimates should be consistent. By signing below the loan agent acknowledges giving you a good faith estimate.

Buyer Acknowledgement of receipt: Buyer: _________________________ Date: ___/___/___

Agent Signature: _________________________ Date: ___/___/___

You are entitled to receive a copy of the Appraisal Report for the property being financed since you have paid for it. This is an important document that you may want for your records and it will also indicate the appraiser’s opinion of value. By signing below I acknowledge that we have provided you with a copy.

Buyer Acknowledgement of receipt: Buyer: _________________________ Date: ___/___/___

Agent Signature: _________________________ Date: ___/___/___