Appendix II to Part 27 - Information for Government Monitoring Purposes
12:1.0.1.1.24.0.28.8.10 : Appendix II
Appendix II to Part 27 - Information for Government Monitoring
Purposes
The following language is approved by the Comptroller of the
Currency and will satisfy the requirements of 12 CFR part 27. It
may be inserted to complete the “Information for Government
Monitoring Purposes” section of the Residential Loan Application
Form (FHLMC Form 65/FNMA 1003) or may be used separately. This
information may also be provided orally by the applicant.
The following information is requested by the Federal Government
if this loan is related to a dwelling, in order to monitor the
lender's compliance with equal credit opportunity and fair housing
laws. You are not required to furnish this information, but are
encourage to do so. The law provides that a lender may neither
discriminate on the basis of this information, nor on whether you
choose to furnish it. However, if you choose not to furnish it,
under Federal regulations this lender is required to note race and
sex on the basis of visual observation or surname. If you do not
wish to furnish the above information, please initial below.
Borrower
I do not wish to furnish this information (initial)____.
Race/National Origin □ American Indian or Alaskan Native □ Asian or
Pacific Islander □ Black, not of Hispanic origin □ Hispanic □
White, not of Hispanic origin □ Other (specify)____ Sex □ Female □
Male Co-borrower
I do not wish to furnish this information (initial)____.
Race/National Origin □ American Indian or Alaskan Native □ Asian or
Pacific Islander □ Black, not of Hispanic origin □ Hispanic □
White, not of Hispanic origin □ Other (specify)____ Sex □ Female □
Male [59 FR 26415, May 20, 1994]