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Appraiser Roster Application

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* Personal Information *

First Name:
Middle Initial:
Last Name:
Suffix:
Date of Birth:
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Social Security Number:
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Gender:
Ethnicity:
Race(s): 
American Indian: Asian: Black:
Native Hawaiian: White:

* Contact Information *

Home Address:
Street Address:
City:
State: Zip Code:

Is mailing address the same as home address? 

Mailing Address:
Business Name:
Street Address:
City:
State: Zip Code:

Contact Information:
Phone Number:
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Fax Number:  ()   -
E-mail Address:
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* License Information *

  Type: State: License Number: Expiration Date:  
 
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* Appraiser Certification *

All new applicants and license renewal applicants must read, understand and agree to the following Agreement and Certifications prior to submitting an application or renewal request.
To avoid the possibility of any conflict on interest and to ensure compliance with HUD appraisal standards, the following certifications are to be completed by personnel qualified to receive assignments from HUD or HUD approved lending institutions for HUD/FHA mortgage insurance applications. The term "interest" refers to direct interest as well as any "interest" held by relatives, business associates, or other controlled persons.
Note:   Any of the following items that have been struck out and initialed are exempted from this certificate and are to be explained truthfully in an attached letter.
  (a) I certify that I do not own more than 10% interest in any lender doing business with HUD in local HUD office jurisdiction.
  (b) I certify that I do not actively engage in the management or operation of a lending institution doing business with HUD.
  (c) I certify that I will not accept any assignments for fee work in a transaction in which I have an interest.
  (d) I certify that I am not currently suspended, debarred, or in any way disqualified from participating in HUD programs.
  (e) I certify that I have read and fully understand and will comply with HUD handbook 4150.2 , "Valuation analysis for Home Mortgage Insurance for Single family One-to-Four Unit Dwellings" (with particular emphasis on Appendix D, "Valuation Protocol"), any updates to the Handbook, Mortgagee Letters, and all other instructions and standards, in performing all appraisals on properties that will be security for HUD/FHA insured mortgages.
  (f) HUD or its authorized agent(s) may inspect my work files at my place of business during normal business hours after providing me reasonable notice of such inspection.
I understand and agree that:
  1. The approval of this application or license renewal does not constitute my appointment as an agent or employee of HUD/FHA.
  2. In performing fee work my status is that of an independent contractor.
  3. My sole interest in all transactions shall be to perform fee assignments as required by HUD standards and criteria.
  4. An appraisal is a substantial and material element in the determination of the eligibility of an application for FHA mortgage insurance, and HUD/FHA will rely upon the accuracy and truthfulness of an appraisal completed by me in approving any insurance.
I hereby certify that to the best of my knowledge all the information stated on my application or request for license renewal, as well as any information provided in the accompaniment herewith, is true, accurate, and complete. I further certify that I have read the Warnings set forth below.
Any person who knowingly presents materially false, fictitious, or fraudulent statements in a matter within the jurisdiction of HUD is subject to penalties, sanctions, or other regulatory actions, including but not limited to:
  1. Fines and imprisonment under 18 USC 287, 1001, 1010, 1012, which provides for fines of a maximum of $25,000 for individual and $500,000 for organizations of imprisonment for up to 5 years, or both; or
  2. Civil penalties and damages under 31 USC 3729, of not less than $5000 and not more than $10,000, plus 3 times the amount of damages which the government sustains; and
  3. Administrative sanctions, claims, and penalties by HUD pursuant to 24 CFR Part 24, 28, and 30.
  I agree and certify to these terms

 

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