Mortgage Forms and Fees

All applications, amendments, cancellations, and other filings (such as MU1, MU2, MU3, and MU4) are submitted through the Nationwide Multistate Licensing System & Registry (NMLS). In addition, checklists are available on the website to assist applicants and current licensees and registrants. 

North Carolina specific forms are available below.  The forms are downloadable in Adobe Acrobat "PDF" format, unless otherwise indicated. You may "complete the fields and save your data" in these forms using Adobe Reader 7 or higher. Download the free Adobe Reader.

Form Name Form # Applies To Purpose
Exclusive Mortgage Broker (EMB) Surety Bond Exclusive Mortgage Broker (EMB) Surety Bond Exclusive Mortgage Brokers To secure the faithful performance of the obligations of the licensee.  NCGS 53-244.103(c)
Claim of Exemption to the NC SAFE Act or Claim of Non-Profit Status MLA04

Banks and eligible subsidiaries.  See NCGS 53-244.030(29).  

Credit unions and their eligible subsidiaries should contact the North Carolina Credit Union Division to claim an exemption. 

Non-profit organizations acting as mortgage lenders or mortgage servicers as defined in the NC SAFE Act, but not for compensation or gain.  NCGS 53-244.030(11), 12 CFR 1008.103(e)(7)(i), and 12 CFR 1008.103(e)(7)(ii)

To claim exemption from licensure.  NCGS 53-244.050(g) and (h).  

 To claim non-profit status (see references in preceding column).   

Note: Mortgage Loan Originators employed by exempt persons or non-profits  are not required to be licensed and should not submit a claim of exemption. 

Notice of Amortization Information & Examples MLA09 Mortgage Lenders, Mortgage Brokers Required notice for NC home loans. NCGS 24-1.1A(a1).
Verification of Deposit Account MLA17 Mortgage Brokers To comply with 04 NCAC 03M .0401(a).
Model Mortgage Broker Disclosure Form MLA18 Mortgage Brokers Model form that can be used to comply with NCGS 53-244.109(5).
Branch Attestation Form Complete in NCCOB Online Mortgage Lenders, Mortgage Brokers Prohibited Branch Arrangement Attestation
Mortgage Origination Support Registrant (MOSR) Attestation Form Complete in NCCOB Online MOSR Form used to attest MOSR responsibilities
Reverse Mortgage Lender Surety Bond Reverse Mortgage Lender Surety Bond $100,000 Mortgage Lenders To comply with 04 NCAC 03K .0302
Additional Information
NC SAFE Act Fee Schedule Fee Schedule All Overview of fees.
Authorization Form NCCOB-001 Regulated persons and complainants Authorization for third parties to receive confidential information.