VA Form 26-1874 Claim Under Loan Guaranty

OMB Control No. 2900-0021
Respondent Burden: 1 Hour
Expiration Date: XX-XX-XXXX

CLAIM UNDER LOAN GUARANTY
(Chapter 37, Title 38, U.S.C.)

NOTE: SEE BELOW FOR DOCUMENTS REQUIRED AND INSTRUCTIONS.
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., to a member of Congress inquiring on your behalf) 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 required to obtain or retain benefits under 38 CFR 36.4321.
Respondent Burden: We need this information to determine the amount payable under the loan guaranty. Title 38, United States Code, allows us to ask for this
information. We estimate that you will need an average of 1 hour 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.
SUPPORTING DOCUMENTS REQUIRED

D. Copies of all deeds transferring title from the original veteranobligor through the owner holding title at liquidation. Put the Social
Security number or taxpayer identification number of each obligor
not listed in Items 2A through 2D on the corresponding deed.

A. A Certified Statement of Account. This should be a copy of the ledger
history or equivalent from the inception of the loan or at minimum from
the date of default or the date of the first advance that is claimed in Item
12, if it is earlier than the date of default. A key for reading the ledger
must also be included.

E. Copy of foreclosure document showing amount bid at sale when
property is not conveyed to VA (e.g. Trustee, Sheriff, or Foreclosure
Deed).

B. Copy of paid receipts/invoices for items claimed in Items 12 and 13.
C. Bankruptcy docket report or equivalent (if applicable).

PURSUANT TO THE REGULATIONS ISSUED UNDER TITLE 38, U.S.C., THE UNDERSIGNED
SUBMITS A CLAIM FOR PAYMENT OF THE GUARANTY, AS SET FORTH BELOW
1. NAME AND ADDRESS OF CLAIMANT

2A. NAME(S) AND ADDRESS(ES) OF ORIGINAL VETERAN-OBLIGOR AND CO-OBLIGOR

2B. SOCIAL SECURITY OR TAXPAYER
IDENTIFICATION NUMBER(S) OF ORIGINAL
VETERAN-OBLIGOR AND CO-OBLIGOR

2C. NAME(S) AND ADDRESS(ES) OF LAST TITLE HOLDER(S)

2D. SOCIAL SECURITY OR TAXPAYER
IDENTIFICATION NUMBER(S) OF LAST TITLE
HOLDER(S)

3A. VA LOAN NO.

4. DATE OF LOAN TERMINATION

3B. HOLDER'S LOAN NO.
A. SALE DATE

B. VOLUNTARY CONVEYANCE DATE: DATE DEED
RECORDED OR DATE DEED SENT FOR RECORDING

5. PAYMENTS
A. AMOUNT OF EACH PAYMENT (P&I)

$
A. AMOUNT

B. TOTAL PAYMENTS RECEIVED

C. AMOUNT APPLIED TO INTEREST

D. AMOUNT APPLIED TO PRINCIPAL

$

$

$

6. PREPAYMENT(S) TO PRINCIPAL (Include no-bid avoidance writeoffs)
B. DATE
A. AMOUNT

$

$

$

$

$

$
$

$
7. ORIGINAL LOAN AMOUNT

$
VA FORM
XXXX

B. DATE

8. PERCENT OF GUARANTY

9. DATE INTEREST COLLECTED TO

10. DATE OF FIRST UNCURED
DEFAULT

%

26-1874

(Continued on Reverse)

11. STATUS OF LOAN ACCOUNT
A. PRINCIPAL BALANCE OF DATE INTEREST WAS LAST PAID BY THE OBLIGOR
B. ADVANCES PRIOR TO DATE IN ITEM 4 (Itemize in Item 12)

+$

C. BALANCE IN T & I ACCOUNT ON DATE IN ITEM 4 (If negative, enter "0")
D. SUBTOTAL

-$
$

E. ADVANCES PAID AFTER DATE IN ITEM 4 (Itemize in Item 12)

+$

F. LIQUIDATION EXPENSES (Itemize in Item 13)
G. MISCELLANEOUS CREDITS (Rents, Insurance refund, any remaining subsidy buydown funds,
etc.) (Attach an itemized listing of all miscellaneous credits)
H. TOTAL AMOUNT CLAIMED (VA will increase amount claimed by amount of interestdue from
date interest is collected from borrower to interest cutoff date, sale date, or confirmation of sale)
(See instructions)
I. PROCEEDS OF LIQUIDATION
OR SPECIFIED AMOUNT
(Whichever is greater) (Check applicable box and give amount)
12. ITEMIZED ADVANCES
(Submit copies of paid receipts; attach separate listing if necessary)
A. DATE

$

B. PURPOSE

C. AMOUNT

+$
-$
$
$

13. ITEMIZED LIQUIDATION EXPENSES
(Submit copies of paid receipts; attach separate listing if necessary)
A. DATE

B. PURPOSE

C. AMOUNT

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

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 therefore has not been received. The undersigned further certifies that it is the owner of the loan identified in Item 3A and that the
Certificate of Guaranty or Endorsement of Guaranty issued by the Secretary of Veterans Affairs in respect to such loan will be surrendered or
cancelled in accordance with 38 CFR 36.4333 upon full payment of this claim. If the undersigned fails or is unable to comply with the requirements
of 38 CFR 36.4333 upon full payment of this claim, it agrees to indemnify the Department of Veterans Affairs to the extent of any loss which may be
sustained by reason of such failure or inability.
14. NAME AND TELEPHONE NUMBER OF OFFICIAL WHOSE SIGNATURE APPEARS BELOW

15. OFFICIAL SIGNATURE AND TITLE

16. DATE

PENALTY: 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.
VA FORM 26-1874, XXXX