Reverse Mortgage Profile Sheet

(This is not an Application for a loan revised 12/26/06 )

LOAN OFFICERS NAME CONTACT PHONE # DATE

PREFIX FIRST M LAST BIRTHDATE AGE

PREFIX FIRST M LAST BIRTHDATE AGE

PROPERTY STREET ADDRESS

CITY STATE ZIP COUNTY PHONE NUMBER

LEIN #1 LEIN #2 HOME VALUE

CHECK APPROPRIATE BOX

Special Requirements SINGLE FAMILY RESIDENCE (SFR)
Well Yes No CONDO

Septic System Yes No TOWNHOUSE

Oil Tank Under Ground DUPLEX
Yes No
HECM Monthly Annual TRIPLEX
HOMEKEEPER Fannie Mae 4 PLEX
CASH Cr. Line Combo Cash Out CO-OP
Lead Source Seminar Other MANUFACTURED HOME

Is there a Power of Attorney to be used ? Must be Durable- provide copy for review Yes No

Is Home held in a Trust? Yes No Must be Revocable- provide complete copy for review

Is there a pending Bankruptcy? Yes No Type Chapter: 7 11 13 - Provide copy of all documents

Is there a Life Estate Deed ? Yes No Please provide copy for review- Must be with powers

Is there a pending Foreclosure? Yes No Date Action Anticipated:

Included with this are the following supporting documents necessary to prepare a complete application:

1. REVERSE MORTGAGE SUMMARY, 2. GOOD FAITH ESTIMATE, 3. COUNSELING CERTIFICATE

Please Fax required information to:

Reverse Mtg. Dept. 410-735-2068 410-558-4498
CONTACT INFORMATION OFFICE PHONE # FAX #

Loan Consultant Certification: This is to certify that I have personally met with the customer and reviewed each of the questions listed
on this Reverse Mortgage Prospect Profile to assure accuracy. After the customers attended counseling, I addressed with the customer the
importance of their decision to move forward with the application to assure their motivation is their own.

Loan Consultants Signature: Date: