Maine Mortgage Loan Originator License Application

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: ___________



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

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