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Disclosure Notices

Affidavit of Occupancy: Applicant(s) hereby certify and acknowledge that, upon taking title to the real property described below, their occupancy status will be as follows:

[ ] Primary Residence - Occupied by Applicant(s) within 30 Days of Closing.

[ ] Second Home - To be occupied by Applicant(s) at least 15 days yearly, as a second home (vacation, etc.), while maintaining a principal residence elsewhere.

[ ] Investment Property - Not owner occupied. Purchased as an investment to be held or rented.

The Applicant(s) acknowledge it is a federal crime punishable by fine and/or imprisonment, to knowingly make any false statement concerning this loan application as applicable under the provisions of Title 18, United States Code, Section 1014.

Fair Credit Reporting Act: An investigation will be made as to the credit standing of all individuals seeking credit in this application. The nature and scope of any investigation will be furnished to you upon written request made within a reasonable period of time. In the event of credit denial due to an unfavorable consumer report, you will be advised of the identity of the Consumer Reporting Agency making such report and of your right to request within sixty (60) days, the reason for the adverse action, pursuant to provisions of section 615(b) of the Fair Credit Reporting Act.

USA Patriot Act Requirements, Notification to Customer: Pursuant to requirements of law, including the USA Patriot Act, all financial institutions are required to obtain information and take necessary actions to verify your identity.

Impound Account: Impounds are not always required with all lenders and programs. However, you may elect to have your Property Taxes and Insurance payments included in your monthly mortgage payment. The lender will set up an escrow account for you and pay the Taxes and Insurance when due.

[ ] I/We do not want to impound (LTV should be 80% or less)

[ ] Impound Taxes

[ ] Impound Insurance

Hazard Insurance: Borrower is required to select the agency to write the insurance covering the subject property.

Insurance Company_________________________________________

Agent_______________________________________ Address__________________________________________________

The Borrower(s) acknowledge having read the foregoing disclosures: Name_________________________________________ Name_________________________________________

_________________________________________ Borrower Signature Date _________________________________________ Co-Borrower Signature Date Co-___________________________________________________________________________________ Property Address / City / State / Zip

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CONTACT: Synergy Mortgage, Inc.,
127 Route 94 South, Suite 1, Warwick, NY 10990
Registered Mortgage Broker, New York State Department of Financial Services, All loans arranged with third-party providers
NMLSR: 32146
Phone: (845) 987-1969

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