DHS Form CG-5501 Request for and Certificate of Eligibility

Form CG-5501 is a U.S. Department of Homeland Security form also known as the "Request For And Certificate Of Eligibility". The latest edition of the form was released in June 1, 2004 and is available for digital filing.

Download an up-to-date fillable Form CG-5501 in PDF-format down below or look it up on the U.S. Department of Homeland Security Forms website.

ADVERTISEMENT
U.S. DEPARTM ENT O F
REQUEST FOR AND CERTIFICATE OF ELIGIBILITY
HOMELAND SECURITY
U.S. COAST GUARD
(See Privacy Act Statement Attached)
CG -5501 (6-04)
PART I - REQUEST FOR CERTIFICATE OF ELIGIBILITY
(To be completed by serviceman)
1. NAME OF SERVICEMAN (Last, First, Middle Initial)
2. GRADE
3. SOCIAL SECURITY NO.
4. ORGANIZATI ON AND ADDRESS TO WHICH ASSIGNE D
4. ORGANIZATION AND ADDRESS TO WHICH ASSIGNED
5. MILITARY SERVICE
6. HAVE YOU PREVIOUSLY BEEN ISSUED OR TRANSFERRED A CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE
FOR SERVICEMEN?
YES
NO
(If answer is yes indicate status of prior certificates, i.e., surrendered, transferred, lost, or destroyed and the date of disposition.)
7.
I hereby agree that in the event I am issued a certificate of Eligibility and subsequently obtain financing pursuant to the provisions of Section
222, National Housing Act, as amended, I will immediately notify my commanding officer in writing when I sell or otherwise dispose of the
property so financed. In the event I fail to notify my commanding officer, I further agree that any liability incurred by the Military Service, of
which I am a member, on mortgage insurance premiums paid subsequent to the date of such sale or disposal, will be reimbursed by me. Also,
I understand that in the event I dispose of property, I should seek a release of personal liability from the holder of the note; otherwise, I may
subsequently be required to make payments on the loan or possibly be subjected to legal action for a deficiency judgement.
I CERTIFY THAT I AM CURRENTLY ON ACTIVE
DATE
SIGNATURE OF SERVICEMAN
DUTY, HAVE COMPLETED OVER TWO YEARS (2) OF
ACTIVE SERVICE, AND I REQUIRE HOUSING OR
HAVE ASSUMED A MORTGAGE INDEBTEDNESS.
PART II - CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE FOR SERVICEMAN
(To be completed by Military Service)
THIS CERTIFICATE MUST ACCOMPANY THE SERVICEMAN'S APPLICATION FOR LOAN
8.
THIS IS TO CERTIFY THAT THE ABOVE-NAMED SERVICEMAN MEETS THE ELIGIBILITY REQUIREMENTS SET FORTH IN SECTION
222, NATIONAL HOUSING ACT, AS AMENDED (12 U.S.C. 1715M)
THIS CERTIFICATE IS VALID UNTIL (Date)
9. DATE
10. TYPED NAME, TITLE, ORGANIZATION AND
11. SIGNATURE OF CERTIFYING OFFICER
ADDRESS OF CERTIFYING OFFICER
PART III - TO BE COMPLETED BY MORTGAGEE
12. PROPERTY ADDRESS AND LOCATION
13. NAME AND ADDRESS OF MORTGAGEE OR SERVICER
PART IV - NOTIFICATION OF FHA ACTION
(To be completed by FHA)
14. FHA CASE NO.
15. FHA ACTION AND DATE
16. AMOUNT OF MORTGAGE,
17. SIGNATURE OF AUTHORIZED AGENT
TERM, AND INTEREST
INDORSED
RATE
(Date)
TRANSFERRED TO SECTION
222 EFFECTIVE
(Date)
OFFICE:
18. RETURN TO (Return address of military service)
COMMANDANT (G-WPW-1)
U.S. COAST GUARD
2100 2ND STREET, S.W.
WASHINGTON, DC 20593-0001
PRIVACY ACT STATEMENT: Solicitation of the above information is authorized by 12 U.S.C. 1215m and E.O. 9397 to determine eligibility for
FHA 222 mortgage insurance. Disclosure of this information is voluntary, however, non-disclosure may result in suspension of premium payments.
(This form replaces DD-802)
Reset
U.S. DEPARTM ENT O F
REQUEST FOR AND CERTIFICATE OF ELIGIBILITY
HOMELAND SECURITY
U.S. COAST GUARD
(See Privacy Act Statement Attached)
CG -5501 (6-04)
PART I - REQUEST FOR CERTIFICATE OF ELIGIBILITY
(To be completed by serviceman)
1. NAME OF SERVICEMAN (Last, First, Middle Initial)
2. GRADE
3. SOCIAL SECURITY NO.
4. ORGANIZATI ON AND ADDRESS TO WHICH ASSIGNE D
4. ORGANIZATION AND ADDRESS TO WHICH ASSIGNED
5. MILITARY SERVICE
6. HAVE YOU PREVIOUSLY BEEN ISSUED OR TRANSFERRED A CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE
FOR SERVICEMEN?
YES
NO
(If answer is yes indicate status of prior certificates, i.e., surrendered, transferred, lost, or destroyed and the date of disposition.)
7.
I hereby agree that in the event I am issued a certificate of Eligibility and subsequently obtain financing pursuant to the provisions of Section
222, National Housing Act, as amended, I will immediately notify my commanding officer in writing when I sell or otherwise dispose of the
property so financed. In the event I fail to notify my commanding officer, I further agree that any liability incurred by the Military Service, of
which I am a member, on mortgage insurance premiums paid subsequent to the date of such sale or disposal, will be reimbursed by me. Also,
I understand that in the event I dispose of property, I should seek a release of personal liability from the holder of the note; otherwise, I may
subsequently be required to make payments on the loan or possibly be subjected to legal action for a deficiency judgement.
I CERTIFY THAT I AM CURRENTLY ON ACTIVE
DATE
SIGNATURE OF SERVICEMAN
DUTY, HAVE COMPLETED OVER TWO YEARS (2) OF
ACTIVE SERVICE, AND I REQUIRE HOUSING OR
HAVE ASSUMED A MORTGAGE INDEBTEDNESS.
PART II - CERTIFICATE OF ELIGIBILITY FOR MORTGAGE INSURANCE FOR SERVICEMAN
(To be completed by Military Service)
THIS CERTIFICATE MUST ACCOMPANY THE SERVICEMAN'S APPLICATION FOR LOAN
8.
THIS IS TO CERTIFY THAT THE ABOVE-NAMED SERVICEMAN MEETS THE ELIGIBILITY REQUIREMENTS SET FORTH IN SECTION
222, NATIONAL HOUSING ACT, AS AMENDED (12 U.S.C. 1715M)
THIS CERTIFICATE IS VALID UNTIL (Date)
9. DATE
10. TYPED NAME, TITLE, ORGANIZATION AND
11. SIGNATURE OF CERTIFYING OFFICER
ADDRESS OF CERTIFYING OFFICER
PART III - TO BE COMPLETED BY MORTGAGEE
12. PROPERTY ADDRESS AND LOCATION
13. NAME AND ADDRESS OF MORTGAGEE OR SERVICER
PART IV - NOTIFICATION OF FHA ACTION
(To be completed by FHA)
14. FHA CASE NO.
15. FHA ACTION AND DATE
16. AMOUNT OF MORTGAGE,
17. SIGNATURE OF AUTHORIZED AGENT
TERM, AND INTEREST
INDORSED
RATE
(Date)
TRANSFERRED TO SECTION
222 EFFECTIVE
(Date)
OFFICE:
18. RETURN TO (Return address of military service)
COMMANDANT (G-WPW-1)
U.S. COAST GUARD
2100 2ND STREET, S.W.
WASHINGTON, DC 20593-0001
PRIVACY ACT STATEMENT: Solicitation of the above information is authorized by 12 U.S.C. 1215m and E.O. 9397 to determine eligibility for
FHA 222 mortgage insurance. Disclosure of this information is voluntary, however, non-disclosure may result in suspension of premium payments.
(This form replaces DD-802)
Reset

Download DHS Form CG-5501 Request for and Certificate of Eligibility

983 times
Rate
4.7(4.7 / 5) 59 votes
ADVERTISEMENT