Va Form 29-0543 - Veterans Mortgage Life Insurance Inquiry Page 2
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2OMB Approved No. 2900-0501
Respondent Burden: 5 minutes
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, 36VA00,
Veterans and Armed Forces Personnel 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 If desired, you can call 1-800-827-1000 to get information on where to send
comments or suggestions about this form.
NAME OF MORTGAGE HOLDER AS SHOWN IN VA
ADDRESS OF MORTGAGED PROPERTY AS SHOWN IN VA RECORDS:
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?
7.
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
9. SIGNATURE OF MORTGAGE HOLDER
10. DAYTIME TELEPHONE NUMBER
11. DATE SIGNED
VA FORM
29-0543
MAR 2005
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