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ABILITY TO REPAY



800-847-1653

Current/Reasonably Expected Income or assets (Excluding the value of the dwelling and any attached real property)

|Source of Income: _____________________________ |Verification Document: ____________________________ |

Employment Status (If relying on employment income; may be verified orally if record made for file)

|Employer/Self Employed: _______________________ |Verification: _____________________________________ |

Monthly Mortgage Payment

|Amount: _____________________________________ |Verification Document: ____________________________ |

Monthly Simultaneous Loan Payment(s) (loans secured by the same property)

|Amount: _____________________________________ |Verification Document: ____________________________ |

Monthly Mortgage-Related Obligations/Payments (property taxes, HOA fees, hazard & flood ins.)

|Taxes: _______________________________________ |Verification Document: ____________________________ |

|Hazard Insurance: ______________________________ |Verification Document: ____________________________ |

|Flood Insurance: _______________________________ |Verification Document: ____________________________ |

|Other: _______________________________________ |Verification Document: ____________________________ |

|Total: _______________________________________ | |

Current Debt Obligations (installment, credit card, alimony, child support)

|Total Amount: ________________________________ |Verification Document(s): __________________________ |

Monthly Debt to Income Ratio and/or Residual Income

|DTI: ____________ RI: ____________ | Verification Document: ____________________________ |

Credit History

|Comments: ___________________________________ |Verification Document: ____________________________ |

Type of Loan:

|_____ Non-QM |_____ Standard QM |_____ Special QM |

|_____ HUD (FHA) QM |_____ Small Creditor Portfolio QM |_____ Small Creditor Balloon QM |

Lender Comments: ______________________________________________________________________________________________________________________________________________________________________________________________________

|Lender: ________________________________________ | Date: _____________________________ |

This worksheet is intended to satisfy the minimum Ability to Repay requirements under §1026.43(c) of Regulation Z. Additional forms may be necessary to accommodate multiple applicants.

2/1/2014

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