FAX: (203) 330-0073 - No Cover Sheet Required

Certificate of Title and Request for Policy

To: Old Republic National Title Insurance Company
From:
Property:
Present Owner:
Date Policy Needed: Closing Date:
Pending Transaction: Purchase    Refinance    Construction Mortgage    Residential    Commercial

Policies To Be Issued

Owners Amount:
Owners Policy # (if applicable)
Proposed Insured:  *
Loan Amount:
Loan Policy # (if applicable)
Proposed Insured: *
* Please give name of Insured exactly as it should appear on the final policy

Schedule "A"

1. Title to be vested in
2. Mortgage to:
3. Assigned to:
4. Legal description to be insured (Attach legal description to be placed on Schedule C)

Schedule "B"

1. Standard Exceptions
Exception

Loan Policy

Owner's Policy
Unified Mechanics Liens Except  Omit Except  Omit
Tenants in Possession Except  Omit Except  Omit
Survey (Do not omit survey from Owner's Policy unless an A-2 survey certified to ORT will be provided) Except  Omit Except  Omit
Riparian Rights Except  Omit Except  Omit
2. Taxes Taxes on the List of October 1, Except  Omit
Status:
3. Special Exceptions - Schedule B - Attached
(All present encumbrances are listed thereon - released or to be released items are marked "omit" and should not appear on the final policy.)

Page 2

Certificate of Title and Request for Policy

Endorsements

Provide the Following Coverages to the Policies
Affirmative Language (Secondary Mortgage Market)
Condominium (ALTA 4.1)
Variable Rate (ALTA 6.0)
Environmental (ALTA 8.1)
Residential Mortgage (CTA 001.1)
FNMA Balloon Mortgage
Variable Rate Convertible Mortgage
Water Rights
Construction Mortgage
NOTE: Only Condominium and Water Rights Endorsements apply to Owner's Policy.
Other Endorsement(s)

Other Comments/Instructions

Certificate of Title and Request for Policy

The undersigned hereby certifies to Old Republic National Title Insurance Company that in accordance with the local standards of practice and the Company's instructions, I (we) have examined all public records affecting title to the premises described in Schedule C attached hereto and am (are) of the opinion that as of the date and time of this Certificate, Marketable and insurance tile is vested in the present owner set forth herein subject only to the matters set forth on Schedule B Attached hereto.

 

Please forward the completed policy(ies) to the undersigned. I (we) acknowledge that the policy(ies) were prepared based upon my (our) instructions and the foregoing information, and that is my (our) responsibility to determine insurability as required by RESPA.

 

I (we) further agree that my(our) countersigning and release of the policy(ies) to the insured(s) constitutes certificate to Old Republic that as of the dates thereof, the interests of the insured(s) in the premises described in said policy(ies) is (are) vested as set forth therein, subject only to those matters set forth on Schedule B, that the consideration for the transaction has been properly disbursed to or for the account of the grantor(s) and/or mortgagor(s) and that the identities of the parties and the authority of those acting have been established to my(our) satisfaction.

Signed:____________________________________________ Dated: _____________________________
Please be sure to forward full copies of the policies as issued, with dates filled in, together with a copy of the executed Comprehensive Title Affidavit.