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Application For Mortgage Impairment Protection Insurance Policy

Applicant Information
Proposed Insured: Agent:
Address: Address:
City: City:
State: State:
Zip: Zip:
Contact Name:
Contact E-Mail:
Contact Phone:
Contact FAX:
Type of Institution: Year Established:
Coverage Territory
Requesting Coverage in the following states (choose all that apply):
Policy Type:
Portfolio and Portfolio Performance
MIP ONLY COVERS SUBORDINATE MORTGAGES THAT ARE SECURED BY A 1-4 FAMILY DWELLING THAT IS THE BORROWER’S PRINCIPAL RESIDENCE. MIP DOES NOT COVER PURCHASE MONEY MORTGAGES. MIP DOES NOT COVER FIRST MORTGAGES OR FIRST MORTGAGE REFINANCES. THE INFORMATION REQUESTED BELOW SHOULD ONLY BE PROVIDED WITH RESPECT TO THE PORTFOLIO OF SECOND MORTGAGES AND/OR OTHER SUBORDINATE MORTGAGES INTENDED TO BE COVERED UNDER THE MIP POLICY FOR WHICH THIS APPLICATION IS MADE.
Loans Include (check all that apply):
HELOC Closed End Amortizing Open-End Amortizing
Do your programs include or allow "piggyback" or purchase money second mortgage loans?
Yes No
Real Estate Secured Closed-End Amortizing Real Estate Secured Home Equity Lines Of Credit Real Estate Secured Open-End Amortizing
Total number of loans in current portfolio:
Total dollar amount of loans in current portfolio:
Percentage of loans 30 - 89 days past due (by loan count):
Percentage of loans non-current (by loan count):
Percentage of loans foreclosed in prior 12 months (by loan count):
Percentage of loans foreclosed in prior 24 months (by loan count):
Number of loans $49,999 and less expected to be written in next 12 months:
Number of loans $50,000 and greater expected to be written in next 12 months:
Number of loans $49,999 and less written last 12 months:
Number of loans $50,000 and greater written last 12 months:
Loan Origination Channels
Give percentage of loans originated in each channel for each type of loan in the past 12 months. If none, enter zero. Real Estate Secured Closed-End Amortizing Real Estate Secured Home Equity Lines of Credit Real Estate Secured Open-End Amortizing
Direct Origination
Mortgage Broker
Correspondent
Give percentage of loans that you expect to be originated in each channel for each type of loan in the next 12 months. If none, enter zero.
Direct Origination
Mortgage Broker
Correspondent
Loan Underwriting Requirements
Real Estate Secured Closed-End Amortizing Real Estate Secured Home Equity Lines of Credit Real Estate Secured Open-End Amortizing
What is the minimum FICO score permitted for each type of loan?
For each type of loan, state whether the minimum FICO score is dependent on other loan application variables? Yes No Yes No Yes No
If yes, please provide details:
For each loan type, give the maximum Combined Loan to Value Ratio ("CLTV") that is permitted.
For each loan type, state whether the maximum CLTV is dependent upon other loan application variables. FICO Score
Income Ratio
Other
FICO Score
Income Ratio
Other
FICO Score
Income Ratio
Other
If checked, please provide details:
For each loan type, state whether "reduced documentation" is accepted. Yes No Yes No Yes No
If yes, please identify the matters for which "reduced documentation" is accepted and identify requirement such as minimum FICO score or maximum CLTV that are applicable.
Real Estate Secured Closed-End Amortizing Real Estate Secured Home Equity Lines of Credit Real Estate Secured Open-End Amortizing
For each loan type, state the type of credit evidence that is required? Single Bureau
Two Bureau
Three Bureau
Other - Specify
Single Bureau
Two Bureau
Three Bureau
Other - Specify
Single Bureau
Two Bureau
Three Bureau
Other - Specify
For each loan type, state how the value of the insured property is established. Check all that apply Full Appraisal
Drive-by Appraisal
AVM - Specify

Other

None
Full Appraisal
Drive-by Appraisal
AVM - Specify

Other

None
Full Appraisal
Drive-by Appraisal
AVM - Specify

Other

None
Will Old Republic provide the valuation? Yes No Yes No Yes No
Agreement and Certification
1. It is a condition of the policy that the following procedures be performed when you originate an insured secondary position mortgage. The undersigned Authorized Officer agrees that the insured will perform the following procedures [check the box]:
Verify ownership of the property and the legal description by examination of a recent tax bill or receipt, warranty deed, owner’s policy of title insurance, on-line tax service or other means
Obtain and review a recent credit bureau report current as of no more than 60 days prior to the date of the mortgage origination that lists outstanding mortgages, bankruptcies, judgments, liens, and gives the property address.
Obtain an Owner's Affidavit, in the form provided by Old Republic, signed by all owners of the property, that lists outstanding mortgages, bankruptcies, judgments, liens, and gives the property address.
Obtain a valuation of the secured property.
2. If you did not check each of the above procedures, you must include, in the space provided below, a detailed description of the procedures you propose to use instead of one or more of the above-listed procedures.
3. The Undersigned Authorized Officer hereby agrees on behalf of the Proposed Insured that, if Old Republic approves this application and issues a Policy to the Proposed Insured, this application shall be deemed to constitute a commitment by the Proposed Insured to insure under the Policy all loans described in this application that are originated on or after 30 days of the effective date of the Policy. The Insured shall not have the right to selectively insure under the Policy loans meeting the underwriting criteria set forth in this application. It is the intent of the parties that all loans described in this application and originated by the Insured shall be insured under the Policy. Old Republic shall have the right, on 30 days written notice to the Insured, to review and audit the Insured’s documents and records to assure compliance with this section.
4. The Undersigned Authorized Officer declares and certifies that to the best of his/her knowledge the information provided in this application and any documents submitted herewith or in connection with this application are true, accurate and complete. The undersigned further declares and certifies that if any such information changes between the date of this application and the effective date of the Policy, the undersigned will notify Old Republic as soon as practicable and Old Republic may modify any quotations or agreements to provide insurance. Any intentional misrepresentation or concealment of a material fact in this application shall be grounds for withdrawal or denial of insurance coverage provided.
5. Any person who, with intent to defraud or with knowledge that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud.
6. The Undersigned Authorized Officer agrees and certifies that if this application is approved, the Policy that will be issued by Old Republic will cover only non-purchase money, consumer loans that meet the loan underwriting requirements set forth in this application and that are secured by a subordinate mortgage on owner occupied one to four family residential real property. The undersigned Authorized Officer further acknowledges that the Policy will not provide coverage for loss of intended lien position as a result of any prior lien that is disclosed by the loan application, credit report, and/or owner’s affidavit, nor will the Policy provide coverage in connection with any prior lien of which the Insured had "knowledge" as defined in the Policy. The Undersigned Authorized Officer acknowledges and agrees that nothing in this application shall in any way be construed to expand or reduce, alter, amend, modify, or change in any way the insuring agreements, definitions, exclusions, coverage agreements, and conditions of the Policy.
Yes, I hereby certify that I am authorized by the Proposed Insured to submit this application and to enter into this Agreement on behalf of the Proposed Insured and that the Proposed Insured agrees to be bound hereby and to comply with the certifications, statements, and agreements above.
(check if you agree)
Name of Authorized Officer
Position
Date


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