VA Form 26-8497a Request for Verification of Deposit

OMB Control No. 2900-0521
Respondent Burden: 5 Minutes
Expiration Date: XX/XX/XXXX

REQUEST FOR VERIFICATION OF DEPOSIT
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 (i.e., information may be disclosed to depository institutions to enable them to provide information on assets for
purposes of credit underwriting) 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
voluntary, but failure to provide requested information could impede processing.
Respondent Burden: We need this information to help determine a veteran's qualifications for a VA-guaranteed loan. Title 38, United States Code, allows us to ask for
this information. We estimate that you will need an average of 5 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.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to
get information on where to send comments or suggestions about this form.
INSTRUCTIONS
LENDER OR LOCAL PROCESSING AGENCY: Complete Items 1 through 8. Have applicant(s) complete Item 9. Forward directly to the Depository named in
Item 1. DEPOSITORY: Please complete Items 10 through 15 and return DIRECTLY to Lender or Local Processing Agency named in Item 2.
PART I - REQUEST
2. FROM (Name and Address of Lender or Local Processing Agency)

1. TO (Name and Address of Depository)

I CERTIFY THAT this verification has been sent directly to the bank or depository and has not passed through the hands of the applicant or any other party.
3. SIGNATURE OF LENDER OR OFFICIAL OF LOCAL
PROCESSING AGENCY

4. TITLE

6. LENDER'S NUMBER (Optional)

5. DATE

7. INFORMATION TO BE VERIFIED:
TYPE OF ACCOUNT AND/OR LOAN

ACCOUNT / LOAN IN NAME OF

ACCOUNT/LOAN NUMBER

BALANCE

$
$
$
$
TO DEPOSITORY: I have applied for mortgage insurance or guaranty or for a rehabilitation loan and stated that the balance on deposit and/or outstanding loans with
you are as shown above. You are authorized to verify this information and to supply the lender or the local processing agency identified above with the information
requested in Items 10 through 12. Your response is solely a matter of courtesy for which no responsibility is attached to your institution or any of your offices.
8. NAME AND ADDRESS OF APPLICANT(S)

9. SIGNATURE OF APPLICANT(S)

TO BE COMPLETED BY DEPOSITORY
PART II - VERIFICATION OF DEPOSITORY

10. DEPOSIT ACCOUNTS OF APPLICANT(S)
TYPE OF ACCOUNT

ACCOUNT NUMBER

CURRENT BALANCE
$
$
$
$

AVERAGE BALANCE FOR
PREVIOUS TWO MONTHS
$
$
$
$

11. LOANS OUTSTANDING TO APPLICANT(S)
LOAN
NUMBER

DATE OF
LOAN

CURRENT
BALANCE

ORIGINAL AMOUNT

DATE OPENED

INSTALLMENTS

(Monthly/Quarterly)

SECURED BY

NUMBER OF LATE
PAYMENTS WITHIN
LAST 12 MONTHS

per
per
per
12. ADDITIONAL INFORMATION WHICH MAY BE OF ASSISTANCE IN DETERMINATION OF CREDITWORTHINESS: (Please include information on loans paid-in-full as
in Item 11 above)
$
$
$

13. SIGNATURE OF DEPOSITORY OFFICIAL

$
$
$

$
$
$

14. TITLE

15. DATE

The confidentiality of the information you have furnished will be preserved except where disclosure of this information is required by applicable law. The completed
form is to be transmitted directly to the lender or local processing agency and is not to be transmitted through the applicant or any other party.
VA FORM
XXX XXXX

26-8497a

SUPERSEDES VA FORM 26-8497a, DEC 2007,
WHICH WILL NOT BE USED.