Maine Educational Course Affidavit
Maine Mortgage Loan Originator License Application
Applicant’s Affidavit of Completion of 20 hours of Maine-Approved Educational Courses
Name of Applicant ___________________NMLS “Unique Identifier” Number:________________
Now comes the above-named __________________________, and attests to the truth of the following statements:
1) My name is _ _____________ , and my home address is ___________ __________________________________.
2) This Affidavit is submitted to the Maine Bureau of Consumer Credit Protection in support of my application for a Mortgage Loan Originator (MLO) license.
3) I have successfully completed a minimum of 20 total hours of educational courses approved by the Bureau, as follows (use additional pages if necessary):
Title of Course Where or how taken Date of Completion Number of hours
The above statements are true and complete to the best of my knowledge and belief.
______________________ Date: ___________
Signature
_____________________
Name (printed)
Personally appeared before me the above-named _____________________________ and made oath to the statements by him/her subscribed,
Before me,
________________________________
Notary Public/Justice of the Peace/Attorney
