UNIFORM BORROWER ASSISTANCE FORM BORROWER CO

UNIFORM BORROWER ASSISTANCE FORM If you are experiencing a temporary or long‐term hardship and need help, you must complete and submit this form along with other required documentation to be considered for available solutions. On this page, you must disclose information about (1) you and your intentions to either keep or transition out of your home; (2) the property’s status; (3) real estate taxes; (4) homeowner’s insurance premiums; (5) bankruptcy; (6) your credit counseling agency, and (7) other liens, if any, on your property. On Page 2, you must disclose information about all of your income, expenses and assets. Page 2 also lists the required income documentation that you must submit in support of your request for assistance. Then on Page 3, you must complete the Hardship Affidavit in which you disclose the nature of your hardship. The Hardship Affidavit informs you of the required documentation that you must submit in support of your hardship claim. NOTICE: In addition, when you sign and date this form, you will make important certifications, representations and agreements, including certifying that all of the information in this Borrower Assistance Form is accurate and truthful and any identified hardship has contributed to your submission of this request for mortgage relief. REMINDER: The Borrower Response Package you need to return consists of: (1) this completed, signed and dated Borrower Assistance Form; (2) completed and signed IRS Form 4506T‐EZ; (3) required income documentation, and (4) required hardship documentation. Loan I.D. Number (usually found on your monthly mortgage statement) I want to: Keep the Property Sell the Property The property is currently: My Primary Residence A Second Home
An Investment Property The property is currently: Owner Occupied Renter occupied Vacant
BORROWER BORROWER’S NAME SOCIAL SECURITY NUMBER CO‐BORROWER CO‐BORROWER’S NAME DATE OF BIRTH SOCIAL SECURITY NUMBER HOME PHONE NUMBER WITH AREA CODE HOME PHONE NUMBER WITH AREA CODE CELL OR WORK NUMBER WITH AREA CODE CELL OR WORK NUMBER WITH AREA CODE MAILING ADDRESS PROPERTY ADDRESS (IF SAME AS MAILING ADDRESS, JUST WRITE SAME)
DATE OF BIRTH EMAIL ADDRESS
Have you contacted a credit‐counseling agency for help? Yes Is the property listed for sale? Yes No If yes, what was the listing date? If yes, please complete the counselor contact information below: If property has been listed for sale, have you received an offer on the Counselor’s Name: property? Yes No Agency’s Name: Date of offer: Amount of Offer: $ Counselor’s Phone Number: Agent’s Name: Counselor’s Email Address: Agent’s Phone Number: For Sale by Owner? Yes No Do you have condominium or homeowner association (HOA) fees? Yes No Total monthly amount: $ Name and address that fees are paid to: Have you filed for bankruptcy? Yes No If yes: Chapter 7 Chapter 13 Filing Date: Has your bankruptcy been discharged? Yes No Bankruptcy case number: Fannie Mae/Freddie Mac Form 710 Page 1 of 4 No 06/11 UNIFORM BORROWER ASSISTANCE FORM Monthly Household Income Monthly Gross wages $ Overtime Child Support / Alimony*
$ $ Non‐taxable social security/SSDI $ Taxable SS benefits or other monthly income from annuities or retirement plans
$ self‐employed income
Unemployment Income
Food Stamps/Welfare
Other $ _____________________
$ First Mortgage Payment
$
Second Mortgage Payment
$
Homeowner’s Insurance
$
Property Taxes
Credit Cards / Installment Household Assets (associated with the property and/or borrower(s) Checking Account(s)
$
Checking Account(s)
$
Savings / Money Market
$
$ CDs $ $ Stocks / Bonds $ Other Cash on Hand
$ Other Real Estate $ $ Monthly Household Expenses/Debt Loan(s) (total minimum $ Tips, commissions, bonus and Rents Received
$ payment per month)
Alimony, child support payments
Car Lease Payments
(estimated value)
HOA/Condo Fees/Property Maintenance
$ $ Other _____________________
Mortgage Payments on $ $ $ $ $ $ other properties
Other _____________________
Total (Gross income)
$ Total Debt/Expenses $
Total Assets
$
*Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repaying this loan.
Lien Holder’s Name Balance / Interest Rate Loan Number Required Income Documentation Do you earn a wage? For each borrower who is a salaried employee or hourly wage earner, include the most recent pay stub that reflects at least 30 days of year‐to‐date earnings for each borrower. Are you self‐employed? For each borrower who receives self‐employed income, include a complete, signed individual federal income tax return and, as applicable, the business tax return; AND either the most recent signed and dated quarterly or year‐to‐date profit/loss statement that reflects activity for the most recent three months; OR copies of bank statements for the business account for the last two months evidencing continuation of business activity. Do you have any additional sources of income? Provide for each borrower as applicable: “Other Earned Income” such as bonuses, commissions, housing allowance, tips, or overtime: Reliable third‐party documentation describing the amount and nature of the income (e.g., employment contract or printouts documenting tip income). Social Security, disability or death benefits, pension, public assistance, or adoption assistance: Documentation showing the amount and frequency of the benefits, such as letters, exhibits, disability policy or benefits statement from the provider, and Documentation showing the receipt of payment, such as copies of the two most recent bank statements showing deposit amounts. Rental income: Copy of the most recent filed federal tax return with all schedules, including Schedule E—Supplement Income and Loss. Rental income for qualifying purposes will be 75% of the gross rent reduced by the monthly debt service on the property, if applicable; or If rental income is not reported on Schedule E – Supplemental Income and Loss, provide a copy of the current lease agreement with either bank statements or cancelled rent checks demonstrating receipt of rent. Investment income: Copies of the two most recent investment statements or bank statements supporting receipt of this income. Alimony, child support, or separation maintenance payments as qualifying income:* Copy of divorce decree, separation agreement, or other written legal agreement filed with a court, or court decree that states the amount of the alimony, child support, or separation maintenance payments and the period of time over which the payments will be received, and Copies of your two most recent bank statements or other third‐party documents showing receipt of payment. *Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repaying this loan. Fannie Mae/Freddie Mac Form 710 Page 2 of 4 06/11 UNIFORM BORROWER ASSISTANCE FORM HARDSHIP AFFIDAVIT (provide a written explanation with this request describing the specific nature of your hardship) I am requesting review of my current financial situation to determine whether I qualify for temporary or permanent mortgage relief options. Date Hardship Began is: I believe that my situation is: Short‐term (under 6 months) Medium‐term (6 – 12 months) Long‐term or Permanent Hardship (greater than 12 months) I am having difficulty making my monthly payment because of reasons set forth below: (Please check all that apply and submit required documentation demonstrating your hardship) If Your Hardship is: Unemployment Then the Required Hardship Documentation is: No hardship documentation required Underemployment No hardship documentation required, as long as you have submitted the income documentation that supports the income described in the Required Income Documentation section above No hardship documentation required, as long as you have submitted the income documentation that supports the income described in the Required Income Documentation section above Divorce decree signed by the court; OR
Separation agreement signed by the court; OR Current credit report evidencing divorce, separation, or non‐occupying borrower has a different address; OR Recorded quitclaim deed evidencing that the non‐occupying Borrower or co‐
Borrower has relinquished all rights to the property Income reduction (e.g., elimination of overtime, reduction in regular working hours, or a reduction in base pay) Divorce or legal separation; Separation of Borrowers unrelated by marriage, civil union or similar domestic partnership under applicable law Death of a borrower or death of either the primary or secondary wage earner in the household Death certificate; OR
Obituary or newspaper article reporting the death Long‐term or permanent disability; Serious illness of a borrower/co‐
borrower or dependent family member Doctor’s certificate of illness or disability; OR Medical bills; OR Proof of monthly insurance benefits or government assistance (if applicable) Disaster (natural or man‐made) adversely impacting the property or Borrower’s place of employment Insurance claim; OR
Federal Emergency Management Agency grant or Small Business Administration loan; OR Borrower or Employer property located in a federally declared disaster area Distant employment transfer No hardship documentation required
Business Failure Fannie Mae/Freddie Mac Form 710 Tax return from the previous year (including all schedules) AND
Proof of business failure supported by one of the following: • Bankruptcy filing for the business; or • Two months recent bank statements for the business account evidencing cessation of business activity; or • Most recent signed and dated quarterly or year‐to‐date profit and loss statement Page 3 of 4 06/11 UNIFORM BORROWER ASSISTANCE FORM Borrower/Co‐Borrower Acknowledgement and Agreement 1. I certify that all of the information in this Borrower Assistance Form is truthful and the hardship(s) identified above has contributed to submission of this request for mortgage relief. 2. I understand and acknowledge that the Servicer, owner or guarantor of my mortgage, or their agent(s) may investigate the accuracy of my statements, may require me to provide additional supporting documentation, and that knowingly submitting false information may violate Federal and other applicable law. 3. I understand the Servicer will obtain a current credit report on all borrowers obligated on the Note. 4. I understand that if I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any fact(s) in connection with this request for mortgage relief or if I do not provide all required documentation, the Servicer may cancel any mortgage relief granted and may pursue foreclosure on my home and/or pursue any available legal remedies. 5. I certify that my property has not received a condemnation notice. 6. I certify that I am willing to provide all requested documents and to respond to all Servicer communications in a timely manner. I understand that time is of the essence. 7. I understand that the Servicer will use this information to evaluate my eligibility for available relief options and foreclosure alternatives, but the Servicer is not obligated to offer me assistance based solely on the representations in this document or other documentation submitted in connection with my request. 8. If I am eligible for a trial period plan, repayment plan, or forbearance plan, and I accept and agree to all terms of such plan, I also agree that the terms of this Acknowledgment and Agreement are incorporated into such plan by reference as if set forth in such plan in full. My first timely payment following my Servicer’s determination and notification of my eligibility or prequalification for a trial period plan, repayment plan, or forbearance plan (when applicable) will serve as acceptance of the terms set forth in the notice sent to me that sets forth the terms and conditions of the trial period plan, repayment plan, or forbearance plan. 9. I agree that when the Servicer accepts and posts a payment during the term of any repayment plan, trial period plan, or forbearance plan it will be without prejudice to, and will not be deemed a waiver of, the acceleration of my loan or foreclosure action and related activities and shall not constitute a cure of my default under my loan unless such payments are sufficient to completely cure my entire default under my loan. 10. I agree that any prior waiver as to my payment of escrow items to the Servicer in connection with my loan has been revoked. 11. If I qualify for and enter into a repayment plan, forbearance plan, and trial period plan, I agree to the establishment of an escrow account and the payment of escrow items if an escrow account never existed on my loan. 12. I understand that the Servicer will collect and record personal information that I submit in this Borrower Response Package and during the evaluation process, including, but not limited to, my name, address, telephone number, social security number, credit score, income, payment history, and information about my account balances and activity. I understand and consent to the Servicer’s disclosure of my personal information and the terms of any relief or foreclosure alternative that I receive to any investor, insurer, guarantor, or servicer that owns, insures, guarantees, or services my first lien or subordinate lien (if applicable) mortgage loan(s) or to any HUD‐certified housing counselor. 13. If I am eligible for foreclosure prevention relief under the federal Making Home Affordable Program, I understand and consent to the disclosure of my personal information and the terms of any Making Home Affordable Agreement by the Servicer to (a) the U.S. Department of the Treasury, (b) Fannie Mae and Freddie Mac in connection with their responsibilities under the Homeowner Affordability and Stability Plan, and (c) companies that perform support services in conjunction with Making Home Affordable. 14. I consent to being contacted concerning this request for mortgage assistance at any cellular or mobile telephone number I have provided to the Lender. This includes text messages and telephone calls to my cellular or mobile telephone. ______________________ __________ __________ ___________________________ __________ Borrower Signature
Date
Co-Borrower Signature
Date
Fannie Mae/Freddie Mac Form 710 Page 4 of 4 06/11