Glen Rock Savings Bank (Loan Department) 250 Lincoln Avenue Hawthorne, New Jersey

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1 Glen Rock Savings Bank (Loan Department) Hawthorne, New Jersey Dear Borrower(s): Thank you for applying to Glen Rock Savings Bank for your Home Equity Loan, and becoming another of our Valued Customers. NOTICE: If you are applying for "JOINT CREDIT" each applicant must sign the disclosure on the top of the application. Included in your Application Package: 1. Home Equity Loan Application 2. Borrower's Blanket Signature Authorization (All borrowers must sign and date form) 3. Appraisal Request Form (Complete Section Two) 4. Privacy Notice Please provide all required information: 1. Loan Amount, Term and Purpose of the loan 2. All sections of the application must be complete 3. Be sure to sign and date the application Origination Fee Information: This fee should be submitted to the bank no later than 10 Business Days along with your "Initial Disclosures." The "Initial Disclosures" will be provided after application review. Origination Fee is: $ or $ We will refund our origination fee provided your loan closes: If you should re-apply with Glen Rock Savings Bank for an additional Equity Loan on the same property within a one year period, your Origination Fee will not be refunded. The Application Package can be dropped off or mailed to the above location. All of the above items must be submitted with the application in order to process your loan. Any items or information that is missing will delay the processing of your loan. If you should require any assistance, or an appointment, please contact our Loan Department and speak with: Dawn T. Dalenberg, Senior Vice President/Lending Manager NMLS#699611, or any of our processors: Janice Ferriola NMLS#699824, Nora Hicswa NMLS# or Lina Guarin NMLS# Cover Ltr Home Equity 01/08/15

2 Glen Rock Savings Bank (Loan Department) Hawthorne, New Jersey Dear Borrower: In order to complete your application the following information will also be required. In order expedite the processing of your application, you can submit the information with your application, otherwise it must be returned with your initial disclosures. YOU MUST PROVIDE COPIES OF THE REQUIRED ITEMS LISTED BELOW; PLEASE CHECK OFF AS YOU SUBMIT + 1. Two current Pay Stubs for each applicant a. Indicate your pay schedule below: Weekly Bi-Weekly Monthly Bi-Monthly 2. Last Two years of your W-2's 3. If Self-Employed LAST TWO YEARS of your signed Income Tax Returns 4. If Retired, copy of Annual Social Security Letter 5. Copy of Pension Letter, if applicable 6. Photo Copy of Drivers Licenses for all applicants 7. Provide a copy of your current DEED to the property (if applicable) 8. If applicable provide a Rental Lease If you should require assistance, or an appointment, please contact: Dawn T. Dalenberg, Senior Vice President/Lending Manager, or any of our processors: Janice Ferriola, Nora Hicswa or Lina Guarin. PLEASE RETURN THIS CHECKLIST WITH YOUR DOCUMENTATION Required Info Request 01/08/15

3 Glen Rock 183 Rock Road 525 Cedar Hill Avenue Cedar Hill Plaza Glen Rock, New Jersey Wyckoff, New Jersey Savings Bank Established in 1922 Hawthorne, New Jersey IMPORTANT: Read these Directions Before Completing this Application. If you are applying for an individual account in your own name AND are relying on your own income or assets, NOT the income or assets of another person, as the basis for repayment of the credit requested, complete this application with only information pertaining to you, the borrower. U If you are applying for a joint account OR an account that you and another person will use, complete this application with information pertaining to you as the Borrower and information applying for a joint applicant or user as the Co-borrower. Please acknowledge by signing below: We intend to aposvforlotritcredit 0 Home Equity Loan Home Equity Line of Credit No. of Months Amount Is This Your Principal Residence? Yes No Interest Rate Is This Property Currently Listed For Sale? Yes 0 No Property Type $ Single Family Dwelling Other Address of Property Property Taxes Annual Hazard Insurance Purchase Price Present Value of Home Loan Purpose Title In Name Of Address of Title Holder Year House Built Name No of Rooms No. of Bedrooms No. of Baths BORROWER Date of Birth School Family Room or Den Yes No Name Finished Attic 0 Finished Basement CO-BORROWER Garage/Carport (Specify Type & No.) Date of Birth Central Air Yes No School Yrs. Yrs. Address Address Present Address No. of Years Own Rent Present Address No. of Years J Own J Rent Street City/State/Zip Former Address - If less than 5 years at present address Street City/State/Zip Street City/State/Zip Former Address - If less than 5 years at present address Street City/State/Zip Years at former address Own Rent Years at former address Own Rent Marital Status U Married U Separated U Unmarried (incl. single, divorced, widowed) U Civil Union Name And Address of Employer DEPENDENTS OTHER THAN LISTED BY CO -BORROWER NO. AGES Years Employed in this line of work or profession? Years Years on the Job Marital Status Married U Separated U Unmarried (incl. single, divorced, widowed) LI Civil Union Name And Address of Employer DEPENDENTS OTHER THAN LISTED BY CO -BORROWER NO. AGES Years Employed in this line of work or profession? Years Years on the Job LI Self-Employed Position/Title Type of Business Position/Title Type of Business Self-Employed Social Security Number Home Phone Business Phone Social Security Number Home Phone Business Phone Item GROSS MONTHLY INCOME Borrower Co-Borrower Empl. Income $ $ Other t (Before completing, see notice under Describe Other Income below). Total $ V B-Borrower Total BANK Checking Yes Savings No 0 Yes No DESCRIBE OTHER INCOME Account No. Notice: t Alimony, Child Support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered as a basis for repaying the loan. Name & Address of Depository Monthly Amount $ IF EMPLOYED IN CURRENT POSITION FOR LESS THAN TWO YEARS, COMPLETE THE FOLLOWING B/C V Previous Employer/School City/State Type of Business Position/Title Dates/From/To Monthly Income

4 Debts: List all fixed obligations and installment accounts. (If more space is needed list on attached Indicate by (1 these liabilities which will be satisfied with the proceeds of this loan. LIABILITIES Creditor's Name, Address and Account Number sheets). Monthly Payments Unpaid Balance Real Estate Loans Automobile Loans/Leases Charge Accounts/Credit Cards ianncdlucdoeubrtalnukd,gfeinmaennctes.caottmapcahnaydcdriteido intaci asrdhe, esttofrneecheasrgsaeryar fdnpoenrs e osntatl edenbtosn, eanl.so alimony, support payments, TOTAL LIABILITIES LIST ALL ASSETS Include all cash and other items readily convertible into cash as well as all other assets. Attach additional sheet if necessary. VALUE GOVERNMENT MONITORING INFORMATION INSTRUCTIONS FOR COMPLETION Complete requested Government Monitoring Information ONLY if home equity loan proceeds will be used to purchase or improve a residential dwelling OR proceeds will be used to pay off an existing loan that is dwelling secured, regardless of loan purpose. (DO NOT COMPLETE FOR LINES OF CREDIT) APPLICANT: I do not wish to furnish this information Ethnicity: U Hispanic or Latino U Not Hispanic or Latino Race: U American Indian, Alaskan Native U Native Hawaiian or Other Pacific Islander U Asian U White Black or African American Sex Female U Male CO-APPLICANT: I do not wish to furnish this information Ethnicity: Hispanic or Latino U Not Hispanic or Latino Race: U American Indian, Alaskan Native U Native Hawaiian or Other Pacific Islander U Asian U White Black or African American Sex U Female U Male AGREEMENT: The undersigned applies for the loan indicated in this application to be secured by a mortgage or deed of trust on the property described herein, and represents that the property will not be used for any illegal or restricted purpose, and that all statements made in This application are true and made for the purpose of obtaining the loan. Verification may be obtained from any source named in this application. The original or a copy of this application will be retained by the Lender, even if the loan is not granted. A consumer report may be requested in connection with this credit application. Without notice, future reports may be requested to update, renew or extend credit. If reports are requested, the names and addresses of the consumer reporting agencies that furnished them are available from the Lender. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding for terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your drivers license or other identifying documents. Borrower's Signature Date Co-Borrower's Signature Date To Be Completed by Interviewer This application was taken by: face to face interview by mail by telephone U by fax by internet Interviewer Name and MLO# Date Application Received Cr EQUAL HOUSING LENDER Rev 2-12

5 BORROWER'S BLANKET SIGNATURE AUTHORIZATION Glen Rock Savings Bank Hawthorne, NJ I Hereby authorize Glen Rock Savings Bank 1. ("Lender") it's agents or assigns, to verify my past and present employment earnings records, bank accounts, stock holdings and any other assets needed to process my loan application. 2. It is understood a photocopy of this form will also serve as authorization. The information the lender obtains is to be used in the processing of my Mortgage Loan Application. This information may also be obtained in conjunction with a quality control review of the file after the loan has closed. Borrower: Date: Social Security Number Co-Borrower: Date: Social Security Number BORROWER BLANKET SIGNATURE AUTHORIZATION

6 GLEN ROCK SAVINGS BANK Hawthorne, New Jersey (973) APPRAISAL REQUEST SECTION ONE - BANK USE ONLY Date of order: APPRAISER: FAX NUMBER: (2055) (1004) (1025) (1073) CIRCLE ONE: RIDEBY URAR 2-4 Family Condo Include Photos PROCESSOR: JANICE ( ) NORA ( LINA ( ) BORROWER: PROPERTY ADDRESS: RESIDENCE PHONE NUMBER: WORK PHONE NUMBER: SECTION TWO - TO BE COMPLETED BY THE CUSTOMER Type of Dwelling: CHECK ONE: SFD PUD CONDO 2 4 UNITS FULL BATHRO OMS: %BATH RM: KITCHEN: DISHWASHER: BUILT IN MICROWAVE: DINING ROOM: LIVING ROOM: BEDROOMS: FAMILY RM: CENTRAL AIR: IN GROUND POOL: DECK: PATIO: PORCH: GARAGE: ( ) ( ) ( ) ( ) # OF BAYS TYPE OF HEAT: Hot Water Baseboard Electric Oil Heat Radiators Forced Hot Air BASEMENT: ( ) FINISHED ( ) UN-FINISHED BATHROOM IN BASEMENT: YES NO ATTIC: FULL: ( ) WALK-UP: ( ) FINISHED: ( ) UNFINISHED: ( ) HEATED ATTIC ( TOTAL ROOM COUNT: PLEASE DO NOT COUNT ANY ROOMS IN YOUR BASEMENT IN THE TOTAL ROOM COUNT STYLE OF YOUR HOME: CUSTOMER'S SIGNATURE: DATE:

7 Glen Rock Savings Bank Rev 9/12 Privacy Policy FACTS WHAT DOES GLEN ROCK SAVINGS BANK DO WITH YOUR PERSONAL INFORMATION? Why? Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share and protect your personal information. Please read this notice carefully to understand what we do. The types of personal information we collect and share depend on the product or service you have with us. This information can include: What? How? Social Security Number and Account Balances Transaction History and Checking Account Information Credit History and Payment History When you are no longer our customer, we continue to share your information as described in this notice All financial companies need to share customers' personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers' personal information; the reasons Glen Rock Savings Bank chooses to share; and whether you can limit this sharing. 4:Reasons we can share your information Does Glen Rock Savings Bank share? " Can'You limit this sharing? For our everyday business purposessuch as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus Yes NO For our marketing purposesto offer our products and services to you Yes No For joint marketing with other financial companies No We Don't Share For our affiliates' everyday business purposes information about your transactions and experiences No We Don't Share For our affiliates' everyday business purposes - information about your creditworthiness No We Don't Share For nonaffiliates to market to you No We Don't Share Call or go to

8 Page 2 Who we are Who is providing this notice? Glen Rock Savings Bank What we do How does Glen Rock Savings Bank protect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We collect your personal information, for example, when you Open an account Apply for a loan How does Glen Rock Savings Bank collect my Make deposits to or withdrawals from your personal information? account Provide employment information Give us your contact information We also collect your personal information from others, such as credit bureaus, or other companies. Federal law gives you the right to limit only Why can't I limit all sharing? Sharing for affiliates' everyday business purposes information about your creditworthiness Affiliates from using your information to market to you Sharing for non affiliates to market to you State laws and individual companies may give you additional rights to limit sharing. imfiiiitto f*, 21_Apkr: Affiliates Companies related by common ownership or control. They can be financial and non financial companies. Glen Rock Savings Bank has no affiliates Nonaffiliates Joint Marketing Companies not related by common ownership or control. They can be financial and nonfinancial companies. Glen Rock Savings Bank does not share with nonaffilates so that they can market to you A formal agreement between nonaffiliated financial companies that together market financial products or services to you. Glen Rock Savings Bank doesn't jointly market. Other Important Information You can contact Glen Rock Savings Bank at , or

GLEN ROCK SAVINGS BANK (Loan Department) 250 Lincoln Avenue Hawthorne, NJ 07506 973-636-5888

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