J. B. Lloyd & Associates, LLC

Mortgage Protection Insurance

PLEASE COMPLETE ALL PARTS OF THIS APPLICATION

Part 1: General Questions for Applicant

Note policies will be issued in the joint name of the applicant and any ‘servicing’ subsidiary schedule below. Please answer all questions.

1. Name of Applicant:

2. Address:

City: State: Zip:

Phone: EMail:

3. Year established: Charter: State Federal National Fax:

4. Type of Institution: Savings and Loan, Member of Savings and Loan League, Federal Savings Bank, Commercial Savings Bank, National Savings Bank, Mortgage Bank, or other

5. List major affiliations: National Savings and Loan League, State Savings and Loan Association, or other. If

None, please state none.

6. List name and address of servicing subsidiary company(ies). If none, please state none.

Part 2: Questions concerning the Applicant’s mortgage portfolio (Questions 1 – 17)

Note: ‘Applicant is to be understood as applicant plus servicing subsidiary named in Part 1.

‘Value’ should where possible exclude the value of loans secured solely by land.

For the purpose of this Insurance ‘Mortgages’ include ‘Home Equity Loans’ and ‘2^nd Mortgages’:

1. Does Applicant’s standard mortgage agreement require borrower to procure and maintain insurance in an amount of not less than the amount of Applicant’s mortgagee interest and in compliance with any co-insurance clause in such insurance for perils of:

Fire, Extended Coverage? Yes No Vandalism Yes No

All Risk/Package Type Policy/Mobile Homeowners form? Yes No

2. What type of coverage is most often obtained by borrowers?

3. For construction loans, does Applicant require borrower to carry builders full All Risk Policy?

Yes No

4. Do you require hazard policies for mortgage properties to be provided by insurance companies with a

rating of at least A+, A or B from Best’s policyholder ratings? Yes No

5. Do you check that insurance required of the mortgagor is in force:

(a) at loan closing Yes No

(b) and at Policy anniversary Yes No

If (b) is ‘yes’ what type of system so you employ?

6. Does Applicant carry a ‘forced placement’ program which automatically provides coverage on a property

on which Applicant is aware there is no existing insurance of the type that is required in the mortgage

document? Yes No

If ‘yes’ name carrier:

7. Average number and value of foreclosures during past 2 years. Number Value $

8. BREAKDOWN OF ALL MORTGAGES (INCLUDING COMMERCIAL, 2NDS AND HOME EQUITY LOANS) for the Applicant

(a) Number of mortgages serviced by Applicant for own interest

(wholly owned or part owned) Number Value $

(b) Number of mortgages serviced by Applicant for others (no

Mortgage interest) Number Value $

For mortgage Backed Securities Number Value $

(d) Number of mortgages serviced by others for Applicant’s interest

(wholly or partly owned) Number Value $

(e) Total Number of mortgages both owned and non-owned

But serviced (i.e. (a) + (b) + (c) + (d) Number Value $

9. Approximate percentage of loans serviced by applicant for others (no mortgage interest) per 8 (b) are located in:

California % Florida % Gulf Coast States % Eastern Seaboard %

10. Commercial Mortgages Only (applicant) Number Value $

11. 2^ndMortgages and Home Equity Loans Number Value $

(a) Of the above number, on how many does the applicant hold the first mortgage?

(b) Of those which the assured does not hold the first mortgage, what procedures, if any, are followed to determine the existence and maintenance of hazard insurance.

12. State approximate percentage of serviced loans subject to VA, FHA, SBA or other Mortgage Guarantee

Insurance %

13. What procedures are followed to give proper notice of delinquency or mortgage guarantors?

14. State approximate number of loans on which Applicant ‘escrows’ for:

(a) Hazard Insurance (b) Life & Disability (c) Real Estate Taxes

15. What procedures do you employ to monitor payment of Real Estate Taxes?

16. Does the Applicant, provide mortgages in California? Yes No

17. Does the Applicant provide mortgages in areas designated as flood prone in accordance with the Flood Disaster

Protection Act of 1973? Yes No

If ‘yes’ explain what procedures are followed to make certain borrowers have obtained a Federal Flood Policy or

suitable as required at closing and each anniversary thereafter:

Part 3: Geographic breakdown of loans for Applicant

Notes: Include in the following those loans in which the Applicant has a mortgage interest (wholly or part owned) only.

Do not include loans owned by other than the Applicant.

Regarding GNMA or other fully modified ‘pass throughs’ or similar vehicles originated by the Applicant, ‘if an insurable interest exists and Section B protection is required. Do not include FNMA modified ‘pass throughs’ where the Applicant is an investor only.

‘Value’ should where possible exclude the value of loans secured solely by land.

1. Total number of mortgages (wholly or partially owned) numbered in Part 2 Q.8 (a) + (c) (if required) and (d)

2. Total value of mortgages (wholly or partially owned) numbered in Part 2 Q.8 (a) + (c) (if required) and (d)

3. Area division of mortgages numbered and valued above:

(a) All States – excluding those States set out below

(For loans in California please complete supplementary sheet)

Total value: $ Number

(b) Maine, New Hampshire, Massachusetts, Connecticut, New York, New Jersey, Rhode Island, Virginia,

Maryland and Delaware:

Total value: $ Number

(d) Texas, Louisiana, Mississippi and Alabama

Total value: $ Number

(e) Hawaii, Alaska, Puerto Rico, other (please specify)

Total value: $ Number

Part 4: Mobile Homes concerning Applicant’s loan portfolio

Does question 8 under Part 2 of the proposal indicate any Mobile Home Loans? Yes No

Whether the answer is yes or no, please provide details as follows:

Number of Mobile Homes Mortgage Loans

The total outstanding mortgage balance $

The States these Mobile Homes are situated

Has the insured suffered any losses with respect of Mobile Homes? Yes No

If ‘Yes’ please give full details

Part 5: Coverage required

Section A	Limit	US$	Deductible	US$
Section B	Limit	US$	Deductible	US$
Section C (1)	Limit	US$	Deductible	US$
Section C (2)	Limit	US$	Deductible	US$
Section C (3)	Limit	US$	Deductible	US$
Section C (4)	Limit	US$	Deductible	US$
Section C (5)	Limit	US$	Deductible	US$
Section C (6)	Limit	US$	Deductible	US$
Section C (7)	Limit	US$	Deductible	US$
Section C (8)	Limit	US$	Deductible	US$
Section D	Limit	US$	Deductible	US$
Section E	Limit	US$	Deductible	US$
Other (specify)	Limit	US$	Deductible	US$

Part 6: Previous Mortgage Protection Policy Info for Applicant

Carrier:

Limit of Liability:

Deductible

Policy Period:

Premium:

Part 7: Declaration by Applicant

1. Has the Applicant made application for insurance under any of the sections of the Policy and been declined

Yes No

If yes, state circumstances

2. Has the Applicant suffered any losses during the past five years or is the Applicant aware of any circumstances

Likely to give rise to a loss under Sections A, B, C, D or E of the Policy?

Yes No

3. Has the Applicant suffered any losses during the past ten years under Section C of the Policy?

Yes No

If yes give details

I/We hereby declare that the above statements and particulars are true, that I/we have not suppressed or misstated any material facts and I/we agree that this Proposal Form shall be the basis of the Contract with Underwriters.

_______________________________________ ____________________________

(Signature and title of Officer) (Date)

Printed Name:

SUPPLEMENT SHEET – CALIFORNIA COUNTIES

(e) California Counties, including:

(NOTE: Coverage will not be bound unless following are completed correctly)

(i) San Francisco, San Mateo

Total value: $ Number

(ii) Contra Costa, Alameda

Total value: $ Number

(iii) Del Norte, Humboldt, Lake, Marin, Mendocino, Napa, Solano and Sonoma

Total value: $ Number

(iv) Monterey, San Benito, Santa Cruz, Santa Clara

Total value: $ Number

(v) Los Angeles

Total value: $ Number

(vi) Orange

Total value: $ Number

(vii) Kern, St. Luis Obispo, Santa Barbara, Ventura

Total value: $ Number

(viii) San Diego

Total value: $ Number

(ix) Alpine, Imperial, Inyo, Mono, Riverside, San Bernadino

Total value: $ Number

All other counties not included in (I) to (ix) above

Total value: $ Number

J. B. Lloyd & Associates, L.L.C.

5228 Village Creek Drive, Suite 101, Plano, TX 75093-4431

800-964-0360 972-248-2433 Fax:972-248-7066 Fax: 888-661-9805

Jim@lloyd-ins.com