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Notification of
Loan Officer Employment or Termination |
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Use this form to notify OFIR when you employ or terminate a Loan Officer, prior to registration as required under Michigan Law. After a Loan Officer is registered in Michigan, use form MU-4 to report termination.
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Type of notification: (must choose one)
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Loan Officer Personal Information (bold items are required)
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Last Name:
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First Name:
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Middle Name:
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Suffix:
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Social Security Number (last 4 digits only)
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Date of Birth:
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Termination Date:
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Sponsoring Employer Information
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Company or entity is (must choose one)
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Name of company or entity:
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Describe company or entity type:
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Michigan mortgage license or registration number:
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Full name of authorized person filing this form:
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Authorized person email address:
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Authorized person daytime telephone with area code:
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By digitally signing below, I certify that I am familiar with the requirements of the Michigan Mortgage Brokers, Lenders, and Servicers Licensing Act, Act 173 of 1987, as amended. I further certify that I have completed the criminal records check of the applicant, and the criminal records check results disclose that the applicant is eligible to be registered under Section 2a(5).
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Digital Signature of authorized person
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