Your reverse mortgage questionnaire

Are you married? Yes No

Your date of birth Format: mm/dd/yyyy

Co-borrower date of birth Leave blank if there is no co-borrower.

If you do not know a figure, enter 0 rather than guessing.

Tick everything that applies. This is your own description — we do not pull credit from this form.

Street address

Type of home Choose one Single family residence Condo (FHA approved condos only) 2-4 units Modular PUD Manufactured

Is this for a purchase? Yes No

Do you currently have a reverse mortgage on the property? Yes No

If yes, have you refinanced it in the past? Yes No

Are you doing any renovations to the property? Yes No

Will a power of attorney be used? Yes No

Is the property vested in a trust? Yes No

Is this a refinance of an existing reverse mortgage? Yes No

Is this loan being transferred from another reverse lender? Yes No

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