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North Carolina Mortgage Licensing & Compliance Forms and Fees

NOTE: The downloadable forms listed below are in Adobe Acrobat "PDF" format unless otherwise indicated. You may "fill in fields and save your data" in the following electronic forms using Adobe Reader 7 or higher. Download the free Adobe Reader.


Please visit the NMLS website to complete, amend, and submit filings (such as MU1, MU2, MU3, and MU4). Please note that to access these filings, you will first need to establish a user I.D. and password, which can be created directly on the NMLS website.

Mortgage Licensing & Compliance Forms

The forms below are North Carolina specific and are not available in NMLS.

Form Name Form # Fees Applies To Purpose
Authority For Release of Information Form MLA01 $0 Owners, Directors, etc. To give authorization to perform a fingerprint search of the State and Federal criminal history record.
Exclusive Mortgage Broker (EMB) Surety Bond Exclusive Mortgage Broker (EMB) Surety Bond
NA Exclusive Mortgage Brokers Establish and maintain financial responsibility as a Licensee.
Claim of Exemption to the NC SAFE Act MLA04 $0 Mortgage Lenders exempt from licensure (primarily banks and credit unions) Satisfy claim for exemption from licensure.  Please submit via email specified on the Contact Us page.
Note: Individuals employed as Mortgage Loan Originators of exempt entities are not required to be licensed nor to file to claim their exempt status.
Notice of Amortization Information & Examples MLA09 NA Mortgage Lenders Mortgage Brokers Required notice for NC home loans per NCGS 24.
North Carolina SAFE Act Annual Report Questionnaire Form Click the "NCCOB Online Login" link in the navigation menu to the left and enter your login information to get access to the Annual Report Questionnaire form. NA Mortgage Lenders Mortgage Brokers To fulfill annual reporting requirements, due annually by March 31.
Employer Certification MLA15 N/A Mortgage Loan Originators Applies to Mortgage Loan Originators that are licensed with conditions.
Affidavit regarding Net Branching for Qualifying Individual MLA16 $0 Qualifying Individual To confirm the Qualifying Individual’s understanding of prohibited branch arrangements.
Verification of Deposit Account MLA17 NA Mortgage Lenders Mortgage Brokers To fulfill annual reporting requirements.
Model Mortgage Broker Disclosure Form MLA18 NA Mortgage Brokers Model Form that can be used to comply with requirements of N.C.G.S. § 53-244.109(5)
Branch Manager Attestation Form MLA19 NA Mortgage Lenders Mortgage Brokers Form used to attest branch manager responsibilities
NDE Authorization Form MLA20 NA Complainants, Mortgage Loan Originators, Brokers, Lenders, Servicers, Exclusive Mortgage Brokers, and Transitional Mortgage Loan Originators Authorization for third parties to receive information related to a complaint, company, or individual license.
Mortgage Origination Support Registrant (MOSR) Attestation Form MLA21 NA Contract Mortgage Loan Processors and Underwriters Form used to attest MOSR responsibilities
Reverse Mortgage Loan Application RM56 Reverse Mortgage Loan Application $500 Mortgage Lenders Form used to apply for authorization to make reverse mortgage loans in North Carolina.
Reverse Mortgage Lender Surety Bond Reverse Mortgage Lender Surety Bond $100,000 NA Mortgage Lenders Establish and maintain financial responsibility as a Licensee.
Additional Information
NC SAFE Act Fee Schedule Fee Schedule NA All Overview of fees.