Appendix D to Part 1024 - Affiliated Business Arrangement Disclosure Statement Format Notice
12:8.0.2.1.19.5.1.1.52 : Appendix D
Appendix D to Part 1024 - Affiliated Business Arrangement
Disclosure Statement Format Notice To: From: (Entity Making
Statement) Property: Date:
This is to give you notice that [referring party] has a
business relationship with [settlement services
provider(s)]. [Describe the nature of the relationship between
the referring party and the provider(s), including percentage of
ownership interest, if applicable.] Because of this relationship,
this referral may provide [referring party] a financial or
other benefit.
[A.] Set forth below is the estimated charge or range of charges
for the settlement services listed. You are NOT required to use the
listed provider(s) as a condition for [settlement of your loan on]
[or] [purchase, sale, or refinance of] the subject property. THERE
ARE FREQUENTLY OTHER SETTLEMENT SERVICE PROVIDERS AVAILABLE WITH
SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU
ARE RECEIVING THE BEST SERVICES AND THE BEST RATE FOR THESE
SERVICES.
[
provider and settlement service] [
charge or range of
charges]
[B.] Set forth below is the estimated charge or range of charges
for the settlement services of an attorney, credit reporting
agency, or real estate appraiser that we, as your lender, will
require you to use, as a condition of your loan on this property,
to represent our interests in the transaction.
[
provider and settlement service] [
charge or range of
charges] ACKNOWLEDGMENT
I/we have read this disclosure form, and understand that
referring party is referring me/us to purchase the
above-described settlement service(s) and may receive a financial
or other benefit as the result of this referral.
Signature [INSTRUCTIONS TO PREPARER:] [Use paragraph A for
referrals other than those by a lender to an attorney, a credit
reporting agency, or a real estate appraiser that a lender is
requiring a borrower to use to represent the lender's interests in
the transaction. Use paragraph B for those referrals to an
attorney, credit reporting agency, or real estate appraiser that a
lender is requiring a borrower to use to represent the lender's
interests in the transaction. When applicable, use both paragraphs.
Specific timing rules for delivery of the affiliated business
disclosure statement are set forth in 12 CFR 1024.15(b)(1) of
Regulation X). These INSTRUCTIONS TO PREPARER should not appear on
the statement.]