Affiliated Business Arrangement Disclosure Statement

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This is to give you notice that Mutual of Omaha Insurance Company has a business relationship with Mutual of Omaha Bank doing business as Mutual of Omaha Mortgage (the "Bank"). Mutual of Omaha Insurance Company owns 100% of the Bank. Because of this relationship, this referral may provide Mutual of Omaha Insurance Company a financial or other benefit.

The estimated charge or range of charges for the origination or refinance of your mortgage loan by the Bank are set forth below. You are NOT required to use the Bank as a condition for purchase or refinance of your property. THERE ARE FREQUENTLY OTHER SETTLEMENT SERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU ARE RECEIVING THE BEST SERVICES AND THE BEST RATE FOR THESE SERVICES.

Origination Charge: 0-1% of Loan Amount Underwriting Fee: $0-$995
Tax Service Fee: $45-$107 Closing Fee: $0-$595
Processing Fee: $0-$1,200

I/we have read this disclosure form, and understand that Mutual of Omaha Insurance Company is referring me/us to purchase the above-described settlement service(s) and may receive a financial or other benefit as the result of this referral.

Please print or download this disclosure for your records.