To:
From:
Property:
Date:
This
is to give you notice that [referring party] has a business relationship
with [settlement services providers(s)]. [Describe the nature of
the relationship between the referring party and the providers(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 NOTrequired 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 24 CFR 3500.15(b)(1)
of Regulation X.] These INSTRUCTIONS TO PREPARERS should not appear
on the statement.
[61
FR 58477, Nov 15, 1996]
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