(If joint application, read singular pronouns in the plural.) I warrant the truth of the information contained in this application and that all statements made in this application are made for the purpose of obtaining the loan applied for. Lender, its agents, successors, and assigns, will rely on the information contained in this application, and I have a continuing obligation to amend and supplement the information provided in this application if any of the material facts I represented should change before closing. If I have left any spaces in the application blank, Lender, its agents, successors, and assigns may assume the information requested is adverse. I authorize Lender, its agents, successors, assigns, and employees to investigate and verify all information I provided to Lender, its agents, successors, and assigns. I understand that it is my sole and exclusive responsibility to determine all the tax effects of the loan and acknowledge that Lender, its agents, successors, and assigns have not provided tax advice to me. Lender, its agents, successors, and assigns can give information about my loan to credit reporting agencies and others who may properly receive that information. If lender approves this application and Lender, its agents, successors, and assigns, are required to report the amount of interest paid on the loan to the Internal Revenue Service. I understand that Lender, its agents, successors, and assigns, will report using the Social Security Number (tax identification number) shown above. I understand that if the Social Security Number is incorrect, that I may be subject to Internal Revenue Service penalties. u0003I understand Lender, its agents, successors, and assigns, will keep this application whether or not my credit request is approved.
Income derived from alimony, child support, or separate maintenance payments need not be revealed if the applicant does not want the bank to consider the information in determining the applicant's creditworthiness.
I understand that Lender will check my credit history with certain credit bureaus and specifically instruct them to do such.
This notice does not mean that we will be reporting Negative Information about you, only that we may report such Negative Information about customers that have not done what they are required to do under their loan agreements. After providing this notice, additional Negative Information may be submitted without providing another notice. We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.
CERTIFICATION: I certify that the information provided in this application is true and correct as of the date set forth opposite my signature on this application and acknowledge my understanding and intentional or negligent misrepresentations of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sections 1001, et seq., and liability for monetary damages to the Lender, its agents, successors, and assigns, insurer and any other person who may suffer any loss due to reliance upon any misrepresentation I made in this application or any other manner.
