Form VA Form 29-0543 VA Form 29-0543 Veterans Mortgage Life Insurance Inquiry

OMB Approved No. 2900-0501
Respondent Burden: 5 minutes
Expiration Date: XX/XX/XXXX

VETERANS MORTGAGE LIFE INSURANCE INQUIRY
CLAIM NUMBER
C-

PRIVACY ACT INFORMATION: The 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 5, Code of Federal Regulations 1.526 for routine uses identified in the VA system of records, 36VA29,
Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance Records - VA, published in the Federal Register. Your
obligation to respond is voluntary, but your failure to provide us the information could impede processing.
RESPONDENT BURDEN: We need this information to verify your eligibility for VA Insurance benefits (38 U.S.C. 5902). 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.
ADDRESS OF MORTGAGED PROPERTY AS SHOWN IN VA RECORDS:

NAME OF MORTGAGE HOLDER AS SHOWN IN VA RECORDS

MORTGAGE LOAN ACCOUNT NUMBER AS SHOWN IN VA
RECORDS

NOTE: IF THE NAME OF THE MORTGAGE HOLDER OR THE ACCOUNT NUMBER SHOWN IS INCORRECT, PLEASE ENTER
THE CORRECT INFORMATION IN THE SPACE BELOW.
1A. NAME OF CURRENT MORTGAGE HOLDER

1B. CURRENT ACCOUNT NUMBER

NOTE: PLEASE ANSWER THE FOLLOWING QUESTIONS AND, IF YOUR ANSWER IS "YES" TO ANY QUESTIONS IN ITEMS 2
THROUGH 6 SHOW THE DATE OF THAT ACTION IN THE SPACE PROVIDED.

ITEM

YES

NO

DATE

2. HAVE YOU MOVED FROM THE MORTGAGED PROPERTY?
3. HAVE YOU SOLD THE MORTGAGED PROPERTY?
4. HAVE YOU PAID OFF YOUR MORTGAGE?
5. HAVE YOU REFINANCED YOUR MORTGAGE?
6. HAVE YOU ADDED A SECOND MORTGAGE?
7A. IS THE TITLE TO THE MORTGAGED PROPERTY SHARED WITH ANY ONE
OTHER THAN YOUR SPOUSE? (If "Yes," show with whom title is shared in Item 7B)
7B. NAME OF PERSON WITH WHOM TITLE IS SHARED

8. PLEASE ENTER YOUR CURRENT ADDRESS IF IT IS DIFFERENT THAN THE ADDRESS TO WHICH THIS LETTER WAS SENT

The fastest and most secure way for insureds and beneficiaries to
send the application to VA Insurance is to use the document
upload service at https://insurance.va.gov/home/IDU.
9. SIGNATURE OF MORTGAGE HOLDER (Sign in ink)
VA FORM
XXX XXXX

29-0543

OR MAIL THE COMPLETED FORM TO:
VAROIC
P.O. BOX 7208 (VMLI)
PHILDELPHIA, PA 19101

10. DAYTIME TELEPHONE NUMBER

SUPERSEDES VA FORM 29-0543, AUG 2018,
WHICH WILL NOT BE USED.

11. DATE SIGNED