VA Questionnaire

Name*

First Last

Have you had a prior VA loan?*

Yes
No

Do you have a VA benefit-related indebtedness to your knowledge?*

Yes
No

Have you filed a claim for VA disability benefits prior to discharge from active duty service (I am presently still on active duty)?*

Yes
No

Are you currently receiving VA disability benefits?*

Yes
No

Would you be entitled to receive VA disability benefits if you did not receive retirement pay?*

Yes
No

Have you received VA disability benefits in the past?*

Yes
No

Are you a surviving spouse of a veteran who died on active duty or as a result of a service connected disability?*

Yes
No

Are you a member of the Reserves/National Guard?*

Yes
No

During the past five years, have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?*

Yes
No

Are you presently delinquent or in default on any debt to the federal government? (e.g., Public Health Service, U.S. GuaranteedStudent Loan, GI Bill Education Benefits, etc.) ?*

Yes
No

Do you currently pay childcare?*

Yes
No

If yes, how much per month?

Please complete the following information for your nearest living relative (not living with you)

Their Name*

First Last

Their relationship to you*

Their Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Their Phone Number*

If refinancing a VA Loan, please also complete below.

What is the interest rate on your current mortgage loan?

What is the term on your current mortgage loan?

30 years
15 years
Other

VA Loan Questionnaire