| 1.
Lender Information: |
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Lender's
Name:
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Phone:
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Fax:
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Address:
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City:
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State:
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Zip:
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County:
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Administrative
Contact:
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Title:
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Executive
Contact:
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Title:
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Year
Established:
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Number
of offices other than above:
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| 2.
Loan Portfolio Information: |
| A. |
Residential:
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Total
number of loans:
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Maximum
outstanding loan balance:
$
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B.
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Commercial:
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Total number of loans:
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Maximum
outstanding loan balance:
$
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| C. |
Mobile
Homes
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Total number of loans:
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Total
number of escrowed loans:
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| D. |
Any
loans in excess of $1 Million dollars?:
If so, please
provide a detailed list below:
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| E. |
Are
there any unusual exposures (i.e. condemned property, property with
existing damage, incomplete construction projects, etc?:
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If
yes, please describe:
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| F. |
Largest
geographical concentration of loans:
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| G. |
Percentage
of loans in first tier counties (counties that border the seacoast):
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| H. |
Are you
expecting any changes in your loan portfolio during the next 12
months?:
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If yes,
pease provide details:
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| I. |
Are there
any special needs that you would like to have met with your new
insurance program?:
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| 3.
Foreclosed Properties: |
| A. |
Number
of foreclosures in the last 12 months:
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Number |
%
Vacant |
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Residential
dwellings (1-4 units): |
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Apartments
(over 4 units): |
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Small
Business: |
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Manufacturing: |
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| B. |
Do you
use a property manager?: |
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If yes,
please provide name of company:
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If yes,
do you require Errors/Omissions Coverage:?
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If not,
who is in charge of the foreclosed property?:
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Do you
inspect for unsafe conditions?:
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| C. |
If
property is vacant, do you take the following actions to protect
your interest? |
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1. Property
secured against entry:
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2. Heat
maintaned or water disconnected and system drained:
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3. Ensure
previous owner has no access:
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4. Property
inspected (Select frequency):
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5. In
the event of a foreclosure, what steps (if any) does the lender
take to avoid vacancy?:
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6. From
lender's recent experience, what is the average length of time that
properties have remained vacant?
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| 7. |
Do you
have any properties in a deteriorated condition, or with existing
damage?:
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| 8. |
Do you
have any properties with unrepaired damage caused by fire or vandalism?:
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If yes,
please describe: |
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| 4.
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Current
Plan Information: |
| A. |
Present
carrier for force placed property: |
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Policy
expiration date: |
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| B. |
Present
carrier for foreclosed REO property: |
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Policy
expiration date: |
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| C. |
Does the
foreclosed property policy include coverage?:
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If not,
list carrier: |
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| D. |
Have you
ever had insurance declined or canceled in the past 3 years?:
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If yes,
please provide details: |
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| 5. |
Property
and liability losses on force placed or REO plan for the last 3
years (please provide insurance company summary of premium and claim
history if available). |
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Applicant
Name: |
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Agent,
Broker Name: |
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Date: |
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*
Required |
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