LOAN ORIGINATOR APPLICATION INSTRUCTIONS Each person that meets the definition of an originator and who is not employed by a residential mortgage lender exempt under Section 1087(A), (B) or (C)(1) of the Residential Mortgage Lending Act (RMLA) LSA-R.S. 6:1081 et seq., must complete a Loan Originator Application. Originators must be either the owner of a company, a W-2 employee or a 1099 subcontractor under exclusive written agreement. Originator means a natural person who is an employee of one or more mortgage brokers or mortgage lenders who is not acting as a mortgage broker as defined in Paragraph (4) of Section 1083 or as a mortgage lender as defined in Paragraph (5) of Section 1083 and whose activity is limited to interviewing the consumer in connection with the consumer's application for a residential mortgage loan and who must sign the loan application on behalf of the mortgage broker or mortgage lender by whom the originator is employed. "Originator" does not include employees of a licensed mortgage broker or mortgage lender, or employees of a person who is exempt from licensure under the provisions of Part II of Chapter 14, who perform clerical duties in connection with residential loan transactions. The person who interviews the consumer must also sign the application. You can not circumvent the law by allowing one person to interview the consumer and a different person sign the application. Originators must be employed and supervised by a licensed or exempt mortgage lender or mortgage broker. An Originator can only originate loans for one company. Application fees are fully earned when the application is submitted. A change in employment during the application process requires a new application and application fee. The application fee for a new originator is $100. For licensed originators transferring to a new company, the fee is $50. Question 1. Name Χ Originator s full legal name. Χ Complete home address, including street, city, state, and zip code. Χ Home telephone number, business telephone number at which you can be contacted, and business fax machine telephone number. Χ Provide your social security number, date of birth and city in which you were born. Question 2. Principal office address Provide the municipal or physical address of the principal office location from which you will be working. Question 3. Office address of other locations You are not permitted to originate loans from a location not specifically stated on this application. List the municipal or physical address of any location from which you will be originating loans in addition to the principal location listed in question 2. Question 4. Employer As an originator you are allowed to originate for only one company. Provide the name, complete municipal address (including municipal street address, city, state and zip code) and license/exempt registration number of the company by which you are employed and supervised. If you have executed a branch agreement or employment agreement, include a signed copy. OFI (03/02) 1
Question 5. Past History Self explanatory Question 6. Criminal Record Self explanatory Question 7. Personal Resume New applicants must submit a resume that includes work experience for the past 10 years. The applicant must sign the Loan Originator Application. ATTACHMENTS: FEES: For new originators, please remit $100 application fee. For transferring originators, please remit $50 application fee. RESIDENTIAL MORTGAGE TEST This test is to be taken by all new applicants prior to submitting their application. Evidence of a passing grade, which will be given to you at the testing site, must be included with the application. Contact PSI Examination Services at 800-733-9267 in order to schedule an examination. EMPLOYER CERTIFICATION FORM The employer must complete the employer certification form to be submitted for each employee that originates loans. The form must be signed by the employer representative authorized to act on behalf of the company and it must be notarized by a licensed Notary Public. AUTHORITY TO OBTAIN INFORMATION FROM OUTSIDE SOURCES FORM This form must be completed and signed by each loan originator applicant and notarized. ORIGINATOR CONTRACT FORM FOR 1099 INDEPENDNT CONTRACTORS If the originator is a 1099 independent contractor, include the following: An Originator Contract Form (signed by both the originator and authorized employer representative). Written verification from the employer s surety bond company that this 1099 employee/subcontractor is covered under the company s surety bond, if applicable. PHOTO IDENTIFICATION Attach a legible copy of a photo identification such, as a drivers license, that shows your signature and personal information. OFI (03/02) 2
LOAN ORIGINATOR APPLICATION Residential Mortgage Lending Act (Any changes to this form may result in the application being returned.) 1. Complete Legal Name: Home Address: Phone Number: Home ( ) Business ( ) Fax ( ) Social Security Number: Date of Birth: Place of Birth: 2. Principal Office Address: 3. Office address of all other locations from which you may originate residential mortgage loans. (Attach additional page if necessary) 4. Employer: Name: Address: Employment and/or Branch Agreement: Yes No (If yes, attach a signed copy.) RML License number or Exempt Registration Number: 5. Have you ever been refused a license or registration to do business under the provisions of a similar law or has your license or registration ever been revoked or suspended in this state or any other state? ( ) Yes ( ) No 6. Have you ever been convicted of a felony under any state or federal law? As used herein, convicted means a finding of guilty, including a pleas of guilt or of nolo contendere, or imposition of sentence, or both. ( ) Yes ( ) No If the response to question 5 or 6 is yes, provide complete details on a separate sheet. 7. Submit a personal resume detailing your work experience for the past 10 years (Signature of applicant) (Date) (Print or type name of applicant) OFI (03/02) 3
EMPLOYEE CERTIFICATION FORM LOAN ORIGINATOR (Must be completed by an authorized representative of the employer.) I hereby affirm or attest that is the owner, a W-2 employee or subcontractor receiving form 1099* of and will be acting on the Residential Mortgage Lender s behalf as a loan originator. I also affirm that he/she ONLY originates for this business. I further affirm that he/she is covered under the company s surety bond or other form of financial responsibility, as required by LSA-R.S. 6:1088(C). Please check one: Owner W-2 1099 * If the originator is a 1099 employee, include an Originator Contract (one is included with this application). Also include a letter from the surety bond company indicating that this 1099 employee is covered under the company s surety bond, if applicable. NOTE: If you have executed an employment agreement or branch agreement with this originator, you must submit a copy of the signed agreement(s) with this application. Signed this day of, 20. Employee Information: SS#: Signature (Signature of authorized Company Representative) Date of Birth: Home Address: (Print name and title) * * * * * * * * * * * * * * * * * * * * * * STATE OF PARISH OR COUNTY OF Before me, the undersigned authority, personally came and appeared (Company Officer s name) who, first being duly sworn, declared under oath that he/she is the (Title) (Company name) of the and that all statements and representations made in the foregoing registration are true and correct to the best of his/her knowledge and belief. Sworn to and subscribed before me on this day of,, at,. (City) (State) (Signature of Notary Public) (Print name of Notary Public) OFI (03/02) 4
AUTHORITY TO OBTAIN INFORMATION FROM OUTSIDE SOURCES Name: Social Security #: Home Address, City, State, Zip Code Date of Birth: Home Telephone No: Read the following questions carefully. If the answer is yes to any of the questions, attach a full written explanation. Include names, dates, court name and address, case number, judgement amounts. Have any civil judgments been entered against you ( ) Yes, attach explanation ( ) No during the past 10 years? Are there any civil proceedings pending against you or ( ) Yes, attach explanation ( ) No civil judgements entered against you which involve fraud or dishonesty? Have you been convicted of or entered a plea of Nolo ( ) Yes, attach explanation ( ) No Contendere to a felony? Have you been convicted of any misdemeanor involving ( ) Yes, attach explanation ( ) No theft, fraud, or dishonesty? Have you been the subject of a bankruptcy, assignment for the benefit of creditors, receivership, ( ) Yes, attach explanation ( ) No conservatorship, or any similar proceeding? Have you been subject to any enforcement proceedings by any State or Federal government agency involving ( ) Yes, attach explanation ( ) No the revocation or suspension of any business, fines or penalties? Have you been discharged for cause or been requested to resign from any employment position? ( ) Yes, attach explanation ( ) No I hereby certify that the information above is, to the best of my knowledge complete and accurate. Signature I hereby authorize the licensing authority, to make inquiries from any financial institution, credit bureau or law enforcement agency for the purpose of determining his/her financial responsibility, character and fitness in connection with an application for a license or registration. SUBSCRIBED BEFORE ME ON THIS day of, 20 AT:, (CITY) PRINT NAME OF NOTARY PUBLIC: (STATE or COMMONWEALTH) SIGNATURE OF NOTARY PUBLIC: OFI (03/02) 5
ORIGINATOR CONTRACT FORM (FOR 1099 INDEPENDENT CONTRACTORS) I hereby affirm or attest that originates Mortgage loans exclusively for and will be acting on the Residential Mortgage Lender s behalf as a loan originator. I also affirm that he/she ONLY originates for this business. I further affirm that he/she is covered under the company s surety bond or other financial responsibility, as required by LSA-R.S. 6:1088(C). Signed this day of, 20. Signature (Signature by authorized Company Representative) (Print name and title) * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * I, originate residential mortgage loans exclusively for. I only originate mortgage loans for this company and no other. SS#: Date of Birth: Home Address: Signature (Signature of 1099 independent contractor) PLEASE NOTE: Signing this form does not relieve either party from complying with federal or other state agencies laws, rules, or regulations. OFI (03/02) 6