Form VA Form 26-8084 VA Form 26-8084 Claim for Repurchase of Loan

OMB Approved No. 2900-0377
Respondent Burden: 30 minutes

NOTE - Use this form when requesting VA to repurchase a
loan under 38 CFR 36.4600. Submit in duplicate.
Signatures are required on the ORIGINAL ONLY. See
below for documents required and Instructions.

CLAIM FOR REPURCHASE OF LOAN
(Chapter 37, Title 38, U.S.C., 38 CFR 36.4600)

NOTE - Please read the Privacy Act and Respondent Burden statements on the
SUPPORTING DOCUMENTS REQUIRED
1. Executed instrument of reassignment, and/or reconveyance as
prescribed by VA.
2. Instrument evidencing the debt.
3. Security instrument.
4. Title evidence (if any obtained from VA when loan
was purchased).
5. Insurance policies.
6. Any other instruments customarily transferred to a purchaser
incident to the assignment of a loan.

7. Receipted tax bill for last period paid.
8. If claimant is an assignee or transferee of the original holder
who purchased this loan from VA, a certified copy of the
instrument of transfer.
9. Statement of account, in duplicate, one certified. This in effect
should be a copy of ledger sheets or equivalent showing amounts
of all debits and credits.

INSTRUCTIONS
Item 4

- If available, insert the Social Security and/or taxpayer identification
number(s) of all obligors.
Item 6A - This will include any payments remitted to the holder by VA.
Item 6H - Due date of earliest installment not fully satisfied by proper
application of available credits or deposits.

Item 7
Item 8

- Explain here any advances made to principal since holder purchased
loan from VA and enter total at Item 8G.
- Any payments received by the holder after this claim is filed will be
endorsed as appropriate and forwarded to VA.

PURSUANT TO 38 CFR 36.4600 ISSUED UNDER CHAPTER 37, TITLE 38, U.S. CODE, THE UNDERSIGNED SUBMITS
CLAIM FOR REPURCHASE OF LOAN AS SET FORTH BELOW.
1. NAME AND ADDRESS OF HOLDER

2. NAME AND ADDRESS OF OBLIGOR(S)

3. HOLDER’S LOAN NUMBER

4A. OBLIGOR(S) SOCIAL SECURITY NUMBER(S)

4B. OBLIGOR(S) TAXPAYER IDENTIFICATION NUMBER(S)

5. VA LOAN NUMBER

6. SUMMARY OF LOAN ACCOUNT FOLLOWING PURCHASE FROM VA
A. TOTAL PAYMENTS
RECEIVED

$

B. AMOUNT APPLIED TO
TAX & INSURANCE

$

C. AMOUNT APPLIED
TO INTEREST

$

D. AMOUNT APPLIED ON
PRINCIPAL

$

F. DATE LAST PAYMENT MADE

E. LATE CHARGES COLLECTED

$
J. TAXES

TYPE

PAID THROUGH (Date)

G. AMOUNT OF LAST PAYMENT
TOWN OR CITY
H. DATE OF FIRST UNCURED DEFAULT
COUNTY
I. INTEREST COLLECTED TO: (Date)
OTHER
L. BALANCE IN TAX AND
INSURANCE ACCOUNT

K. INSURANCE PREMIUMS PAID THROUGH (Date)

$

M. PRINCIPAL BALANCE OF LOAN

$
7. ADVANCES

AMOUNT

DATE

PURPOSE

$
$
$
8. COMPUTATION OF CLAIM FOR REPURCHASE OF VENDEE ACCOUNT
ITEM
A. PRINCIPAL BALANCE OF OBLIGOR WHEN LOAN WAS PURCHASED
FROM VA

AMOUNT

$

B. PERCENTAGE OF PAR PAID FOR LOAN
C. AMOUNT PAID FOR LOAN (Not to include any accrued interest. Item 8A X 8B)

$

D. CREDITS TO PRINCIPAL

$

E. CREDIT BALANCE IN TAX AND INSURANCE ACCOUNT (Item 6L)

$

F. SUBTOTAL

$

G. ADVANCES TO PRINCIPAL

$

H. UNPAID ACCRUED INTEREST - 38 CFR 36.4600(e)(1) - APPLICABLE ONLY
TO LOANS SOLD AFTER JULY 15, 1970 - USE 365 DAY YEAR BASIS

$

I. NET AMOUNT CLAIMED UNDER 38 CFR 36.4600(e)

$

CERTIFICATION: The undersigned hereby certifies that the information contained herein is true, accurate and complete, that this is a correct and
valid claim, and that payment therefor has not been received. The undersigned further certifies that it is the owner of the loan identified above.
9A. NAME OF CLAIMANT (Type or print)

9B. OFFICIAL SIGNATURE AND TITLE

9C. DATE

Federal statutes provide severe penalties for any fraud, intentional misrepresentation or criminal connivance or conspiracy in making any claim upon or against the
Government of the United States, or any department or officer thereof, and obtaining or aiding to obtain the payment or approval of such claim.

FOR VA
USE ONLY
VA FORM
JUN 2006

THE PAYEE IS ENTITLED, UNDER 38 CFR 36.4600(e), TO
THE PAYMENT OF

AUTHORIZED SIGNATURE

$

26-8084

EXISTING STOCKS OF VA FORM 26-8084, MAR 2001,
WILL BE USED.

DATE

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been
authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (e.g., to a member of
Congress inquiring on behalf of a veteran) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium
and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant
Records - VA, and published in the Federal Register. Your obligation to respond is mandatory under 38 CFR 36.4600.
RESPONDENT BURDEN: We need this information in order to determine the amount payable under 38 CFR 36.4600. Title 38,
U.S.C. 3710 allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions,
find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB
control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA . If
desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.