DC Mortgage Broker License # MLB 4601

Manna

Rebuilding Neighborhoods and Preserving Diversity Through Affordable Housing

Personal Information Questionnaire

This is not a mortgage loan application.

I am interested in:	Purchasing Refinancing
Property Type:	Single Family House/Townhouse Condominium 2-4 Unit Multi-Family Dwelling

Borrower #1

First Name*	Last Name*
Address Line 1*
Address Line 2
City*	State*	Zip*
Home Phone*	Cell Phone
Work Phone	Fax
Email
Marital Status*	Citizenship*

Borrower #2

First Name	Last Name
Relationship to Borrower #1
Address Line 1
Address Line 2
City	State	Zip
Home Phone	Cell Phone
Work Phone	Fax
Email
Marital Status	Citizenship

Employment and Income Information from All Sources for Borrowers 1 & 2 for Past Two Years

Source(s) of Income / Employer Name(s)	Borrower 1 or 2?	Dates of Employment From To		Monthly Income Before Taxes	Annual Income Before Taxes
	1 2
	1 2
	1 2
	1 2
	1 2

List Cash and Savings of Borrowers 1 & 2 (Checking, savings, money market, credit union, brokerage, 401K, 403B, etc.)

Bank or Institution	Borrower 1 or 2?	Estimated Balance	Type of Account (Checking, Savings, 401K, etc.)	Average Monthly Deposit
	1 2

List all Debts for Borrowers 1 & 2 (Car payments, credit cards, personal loans, student loans, furniture bills, etc., as well as monthly debts deducted from your paycheck, co-signed debts like car & home loans, child support, alimony, etc.)

Please list all Other Household Members and their incomes

Name	Relationship	Monthly Income

For Refinances/Current Homeowners Only Current Mortgage

Mortgage Co / Loan Number	Current Balance (estimated)	Total Monthly Payment	Mortgage Start Date

Estimated market value of your home or other property: $

Property Type: Single Family House/Townhouse Condominium 2-4 Unit Multi-Family Dwelling

Annual / Monthly Real Estate Taxes: $

Annual / Monthly Homeowners Insurance: $

Monthly Condominium Fee: $

Other Information Judgments, Tax Liens, Collections, Etc.

Type	Borrower 1 or 2?	Amount
	1 2

Have (either of) you had a bankruptcy in the last 10 years? No Yes

If Yes, Borrower(s) 1 2 Filing Date: Discharge Date:
Type:

Are Borrower 1 AND 2 lived in DC for the past year or more? Yes No

Has Borrower 1 OR 2 owned a home in the last 3 years? Yes No

Borrower 1: Year(s) Month(s) Borrower 2: Year(s) Month(s)

What is your current rent/mortgage payment? $

Average monthly utilities: $

How did you hear about us?

Additional Comments