third party processing company affiliated business ... company is licensed as required by applicable...

NEWPENNFINANCIAL, LLC 4000 CHEMICAL ROAD, SUITE 200 PLYMOUTH MEETING, PA 19462 www.gonewpenn.com Third Party Processing Company Affiliated Business Attestation Form Borrower Last Name(s):____________________________________Loan Number:______________ Property Address:___________________________________________________________________ Broker Name:______________________________________________________________________ 3 rd Party Processing Company Name:___________________________________________________ New Penn Financial, LLC (“New Penn”) allows the use of unaffiliated 3 rd party processing companies. Broker (listed above) certifies and attests that it has no affiliation, as that term (“affiliate”) is defined in Regulation Z (12 CFR 1026.32(b)(5)), with 3 rd Party Processing Company (listed above) being used on this transaction. Furthermore, Broker attests that the 3 rd party processor working on this transaction is not an employee of Broker. The above named 3 rd party processing company will provide an invoice for their services on their letterhead specific to this transaction to Broker, and Broker will deliver a copy to New Penn. Broker understands and represents such 3 rd party processing company is licensed as required by applicable law and is listed accordingly in NMLS. Broker acknowledges that it is Broker’s responsibility to ensure the 3 rd party processing company complies with all applicable federal, state and local laws, rules and regulations, including but not limited to the Gramm-Leach-Bliley Act (GLBA). By signing below I represent that I have the authority to sign on behalf of the named broker listed above. I understand and represent that the above is true and correct. ___________________________ ________________________ ______________________ Broker Representative Signature Title Date ____________________________ ___________________________ Printed Name Phone #

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Page 1: Third Party Processing Company Affiliated Business ... company is licensed as required by applicable law andis listed accordingly in NMLS. Broker acknowledges that it is Broker’s

NEWPENNFINANCIAL,LLC4000CHEMICALROAD,SUITE200PLYMOUTHMEETING,PA19462www.gonewpenn.com

ThirdPartyProcessingCompanyAffiliatedBusinessAttestationFormBorrowerLastName(s):____________________________________LoanNumber:______________PropertyAddress:___________________________________________________________________BrokerName:______________________________________________________________________3rdPartyProcessingCompanyName:___________________________________________________NewPennFinancial,LLC(“NewPenn”)allowstheuseofunaffiliated3rdpartyprocessingcompanies.Broker(listedabove)certifiesandatteststhatithasnoaffiliation,asthatterm(“affiliate”)isdefinedinRegulationZ(12CFR1026.32(b)(5)),with3rdPartyProcessingCompany(listedabove)beingusedonthistransaction.Furthermore,Brokeratteststhatthe3rdpartyprocessorworkingonthistransactionisnotanemployeeofBroker.Theabovenamed3rdpartyprocessingcompanywillprovideaninvoicefortheirservicesontheirletterheadspecifictothistransactiontoBroker,andBrokerwilldeliveracopytoNewPenn.Brokerunderstandsandrepresentssuch3rdpartyprocessingcompanyislicensedasrequiredbyapplicablelawandislistedaccordinglyinNMLS.BrokeracknowledgesthatitisBroker’sresponsibilitytoensurethe3rdpartyprocessingcompanycomplieswithallapplicablefederal,stateandlocallaws,rulesandregulations,includingbutnotlimitedtotheGramm-Leach-BlileyAct(GLBA).BysigningbelowIrepresentthatIhavetheauthoritytosignonbehalfofthenamedbrokerlistedabove.Iunderstandandrepresentthattheaboveistrueandcorrect._________________________________________________________________________BrokerRepresentativeSignature Title Date_______________________________________________________PrintedName Phone#

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