Request for Mortgage Assistance

If you are experiencing a financial hardship and need help, you must complete and submit this form along with other required documentation to be considered for

foreclosure prevention. You must provide information about yourself and your intentions to either keep or transition out of your property; a description of the

hardship that prevents you from paying your mortgage(s); information about all of your income, expenses and financial assets; whether you have declared

bankruptcy; and information about the mortgage(s) on your principal residence and other single family real estate that you own. Finally, you will need to return to

your loan Servicer (1) this completed, signed and dated Request for Mortgage Assistance (RMA); and all required income documentation identified in Section 4.

When you sign and date this form, you will make important certifications, representations and agreements, including certifying that

all of the information in this RMA is accurate and truthful. Complete all sections and if not applicable, print N/A.

SECTION 1: BORROWER INFORMATION

BORROWER CO BORROWER

BORROWER'S NAME

SOCIAL SECURITY NUMBER

DATE OF BIRTH (MM/DD/YY)

HOME PHONE NUMBER WITH AREA CODE

CELL OR WORK NUMBER WITH AREA CODE

MAILING ADDRESS

CO-BORROWER'S NAME

SOCIAL SECURITY NUMBER

DATE OF BIRTH (MM/DD/YY)

HOME PHONE NUMBER WITH AREA CODE

CELL OR WORK NUMBER WITH AREA CODE

MAILING ADDRESS (IF SAME AS BORROWER, WRITE "SAME")

EMAIL ADDRESS

Has any borrower filed for bankruptcy?� Chapter 7

Filing Date:� Bankruptcy case number:

Has your bankruptcy been discharged?

Yes No

Chapter 13

Is any borrower a service member? �

Have you recently been deployed away from your principal

residence or recently received a permanent change of station

order?

Yes

Number of people in household _______________________�

SECTION 2: HARDSHIP AFFIDAVIT

I (We) am/are having difficulty making my monthly payment because of financial difficulties created by (check all that apply):

My household income has been reduced. For example: reduced pay or hours,

decline in business or self employment earnings, death, disability or divorce of a

borrower or co-borrower.

My monthly debt payments are excessive and I am overextended with my

creditors. Debt includes credit cards, home equity or other debt.

My expenses have increased. For example: monthly mortgage payment reset,

high medical or health care costs, uninsured losses, increased utilities or

property taxes.

My cash reserves, including all liquid assets, are insufficient to maintain my

current mortgage payment and cover basic living expenses at the same time.

I am unemployed and (a) I am receiving/will receive unemployment benefits or

(b) my unemployment benefits ended less than 6 months ago.

Death of a borrower or death of either the primary or secondary wage

earner in the household

Divorce or legal separation; Separation of Borrowers unrelated by marriage, civil

union or similar domestic partnership under applicable law

Disaster (natural or man-made) adversely impacting the property of

Borrower’s place of employment

Long-term or permanent disability; Serious illness of a borrower/ co-borrower or

dependent family member

Distant employment transfer / Relocation

Other:

Explanation (continue on a separate sheet of paper if necessary):

July 2018

Page 1 of 5

�

SECTION 3: PRINCIPAL RESIDENCE INFORMATION

(This section is required even if you are not seeking mortgage assistance on your principal residence)

I am requesting mortgage assistance with my principal residence Yes No

Keep the property

If "Yes", I want to:

Sell the property

Property Address:�

Other mortgages or liens on the property?�

Do you have condominium or homeowner association (HOA) fees?�

Name and address that fees are paid to:�

Does your mortgage payment include taxes and Insurance?�

Annual Homeowner's Insurance $�

Is the property listed for sale?�

List date?

Loan I.D. Number:�

Are fees paid current?

Yes No Lien Holder / Servicer Name:

Yes NoYes No If "Yes", Monthly Fee $

Yes No If "No", are the taxes and insurance paid current? Yes No

Yes No If "Yes", Listing Agent's Name: Phone Number:

Have you received a purchase offer? Yes No Amount of Offer $ Closing Date:

Complete this section ONLY if you are requesting mortgage assistance with a property that is not your principal residence.

Principal residence Servicer name:�

Is the mortgage on your principal residence paid?

Principal residence Servicer phone number:

if "No", number of months your payment is past due (if known): Yes No

SECTION 4: COMBINED INCOME AND EXPENSE OF BORROWER AND CO BORROWER

Monthly Household Income

Monthly Household Expenses/Debt �

(*Principal Residence Expense Only)

Monthly Gross wages

Auto Insurance

Overtime

Medical or Life Insurance (not

deducted from salary)

Self employment Income

Food/Groceries

Unemployment Income

Telephone/Cell Phone

Untaxed Social Security / SSD

Gas/Electric/Water/Trash

Food Stamps/Welfare $

Gasoline/Parking/Auto

Maintenance/Transportation (not

including auto loans)

Taxable Social Security or

retirement income

Cable/Satellite/Internet

Child Support / Alimony**

Child care (not including child

support payments)

Tips, commissions, bonus

and overtime

Reoccurring Medical Expenses

Miscellaneous Expenses $

Gross Rents Received ***

Child Support/Alimony Payments

Tax Lien Payments $

Other

Housekeeping supplies $

Apparel and Services $

Personal Care Products and Services $

Total (Gross income) $ Total Debt/Expenses $

Please Note: If any expense is $1,500.00 or more please provide a written or verbal explanation verifying the amount is a monthly expense.

** Alimony, child support or separate maintenance income need not be disclosed if you do not choose to have it considered for repaying your mortgage debt.

*** Include rental income received from all properties you own EXCEPT a property for which you are seeking mortgage assistance in Section 6.

Include mortgage payments on all properties you own EXCEPT your principal residence and the property for which you are seeking mortgage assistance in Section 6.

July 2018

Page 2 of 5

Required Income Documentation

(Your Servicer may request additional documentation to complete your evaluation)

All Borrowers

Do you earn a wage?

Borrower Hire Date (MM/DD/YY)

Co-borrower Hire Date (MM/DD/YY)

For each borrower who is a salaried employee or hourly wage earner, provide the most recent pay stub(s) that reflects

at least 30 days of year-to-date income.

USDA Only: If Borrower has a USDA loan W2 is required in addition to paystub

Are you self-employed? Most recent complete individual income tax return (and business tax return as applicable) AND Most recent signed and

dated quarterly or YTD profit and loss statement, (that reflect activity for the most recent 3 months)

Do you receive tips, commissions, bonuses,

housing allowance or overtime?

Describe the type of income ______________________________________________________

Frequency of income ___________________________________________________________

Do you receive social security, disability, death

benefits, pension, public assistance or adoption

assistance?

Provide documentation showing the amount and frequency of the benefits, such as letters, exhibits, disability policy or

benefits statement from the provider and receipt of payment (such as two most recent bank statements or deposit

advices).

Do you receive alimony, child support, or separation

maintenance payments?

Copies of your two most recent bank statements or deposit advices showing you have received payment.

Provide a copy of the divorce decree, separation agreement, or other written legal agreement filed with the court that

states the amount of the payments and the period of time that you are entitled to receive them.

Notice: Alimony, child support or separate maintenance income need not be disclosed if you do not choose to have

it considered for repaying your mortgage debt.

Do you have income from rental properties that are not

your principal residence?

Provide your most recent Federal Tax return with all schedules, including Schedule E.

If rental income is not reported on Schedule E, provide a copy of the current lease agreement with two most recent

bank statements showing deposit of rent checks.

SECTION 5: OTHER PROPERTIES OWNED

(You must provide information about all properties that you or the co-borrower own, other than your principal residence and any property described in Section 6

below. Use additional sheets if necessary.)

Other Property #1

Property Address:

Loan I.D. Number:

Servicer Name:�

Mortgage Balance $ Current Value $

Property is:

Vacant Second or seasonal home Rented Gross Monthly Rent $ Monthly mortgage payment* $

Do you have condominium or homeowner association (HOA) fees?�

Yes No

If "Yes", Monthly Fee $ Are HOA fees paid current?

Name and address that fees are paid to:

Does your mortgage payment include taxes and insurance?�

Yes No

If "No", are the taxes and insurance paid current? Yes

Annual Homeowner's Insurance $ Annual Property Taxes $

Yes

Other Property #2

Property Address:

Loan I.D. Number:

Servicer Name:�

Mortgage Balance $ Current Value $

Property is:

Vacant Second or seasonal home Rented Gross Monthly Rent $ Monthly mortgage payment* $

Do you have condominium or homeowner association (HOA) fees?�

Yes No

If "Yes", Monthly Fee $ Are HOA fees paid current?

Name and address that fees are paid to:

Does your mortgage payment include taxes and insurance?�

Yes No

If "No", are the taxes and insurance paid current? Yes

Annual Homeowner's Insurance $ Annual Property Taxes $

Yes

Other Property #3

Property Address:

Loan I.D. Number:

Servicer Name:�

Mortgage Balance $ Current Value $

Property is:

Vacant Second or seasonal home Rented Gross Monthly Rent $ Monthly mortgage payment* $

Do you have condominium or homeowner association (HOA) fees?�

Yes No

If "Yes", Monthly Fee $ Are HOA fees paid current?

Name and address that fees are paid to:

Does your mortgage payment include taxes and insurance?�

Yes No

If "No", are the taxes and insurance paid current? Yes

Annual Homeowner's Insurance $ Annual Property Taxes $

Yes

* The amount of the monthly payment made to your lender – including, if applicable, monthly principal, interest, real property taxes and insurance premiums.

July 2018

Page 3 of 5

SECTION 6: OTHER PROPERTY FOR WHICH ASSISTANCE IS REQUESTED

(Complete this section ONLY if you are requesting mortgage assistance with a property that is not your principal residence.)

Yes No

I am requesting mortgage assistance with a second or seasonal home.

I am requesting mortgage assistance with a rental property.

Yes No

If "Yes" to either, I want to:

Keep the property Sell the property

Property Address:� Loan I.D. Number:�

Do you have a second mortgage on the property�

If "Yes", Servicer Name:

Loan I.D. Number:�

Do you have condominium or homeowner association (HOA) fees?�

Yes

If "Yes", Monthly Fee $

Are HOA fees paid current? Yes No

Name and address that fees are paid to:�

Does your mortgage payment include taxes and insurance?�

Yes

If "No", are the taxes and insurance paid current?

Yes No

Annual Homeowner's Insurance $�

Yes

Annual Property Taxes $

If requesting assistance with a rental property, property is currently:

Vacant and available for rent.�

Occupied without rent by your legal dependent, parent or grandparent as their principal residence.�

Occupied by a tenant as their principal residence.�

Other

If rental property is occupied by tenant: Term of lease /occupancy� Gross Monthly Rent $

MM / DD / YYYY MM / DD / YYYY

If rental property is vacant, describe efforts to rent property:

If applicable, describe relationship of and duration of non-rent paying occupant of rental property:

Is the property for sale?

Yes Phone Number: No

If "Yes", Listing Agent's Name:

List date? Have you received a purchase offer?

Yes No Amount of Offer $ Closing Date:

July 2018

Page 4 of 5

■

-SECTION 7: BORROWER AND CO BORROWER ACKNOWLEDGEMENT AND AGREEMENT

I certify, acknowledge, and agree to the following:

1. All of the information in this Request for Mortgage Assistance Form is truthful and the hardship that I have identified contributed to my need for mortgage relief.

2. The accuracy of my statements may be reviewed by the Servicer, owner or guarantor of my mortgage, their agent(s), or an authorized third party*, and I may

be required to provide additional supporting documents. I will provide all requested documents and will respond timely to all Servicer, or authorized third party*,

communications.

3. Knowingly submitting false information may violate Federal and other applicable law.

4. 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. 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.

6. I may be eligible for a trial period plan, repayment plan, or forbearance plan. If I am eligible for one of these plans, I agree that:

a) Agreement are incorporated into such plan by reference as if set forth in such plan in full.

b) My first timely payment under the plan will serve as acceptance of the terms set forth in the notice of the plan sent by the Servicer.

c) The Servicer's acceptance of any payments under the plan will not be a waiver of any acceleration of my loan or foreclosure action that has occurred and

will not cure my default unless such payments are sufficient to completely cure my entire default under my loan.

d) Payments due under a trial period plan for a modification will contain escrow amounts. If I was not previously required to pay escrow amounts, and my trial

period plan contains escrow amounts, I agree to the establishment of an escrow account and agree that any prior waiver is revoked. Payments due under a

repayment plan or forbearance plan may or may not contain escrow amounts. If I was not previously required to pay escrow amounts and my repayment plan

or forbearance plan contains escrow amounts, I agree to the establishment of an escrow account and agree that any prior escrow waiver is revoked.

7. A condemnation notice has not been issued for the property.

8. The Servicer or authorized third party* will obtain a current credit report on all borrowers obligated on the Note.

9. The Servicer or authorized third party* will collect and record personal information that I submit in this Request for Mortgage Assistance and during the

evaluation process. This personal information may include, but is not limited to: (a) my name, address, telephone number, (b) my social security number, (c) my

credit score, (d) my income, and (e) my payment history and information about my account balances and activity. I understand and consent to the Servicer or

authorized third party*, as well as any investor or guarantor, disclosing my personal information and the terms of any relief or foreclosure alternative that I

receive to the following:�

a) Any investor, insurer, guarantor, or servicer that owns, insures, guarantees, or services my first lien or subordinate lien (if applicable) mortgage loan(s) or

any companies that perform support services to them; and

b) The U.S. Department of Treasury, or any companies that perform support services to them.

10. I consent to being contacted concerning this request for mortgage assistance at any telephone number, including mobile telephone number, or email

address I have provided to the Lender/Servicer/ or authorized third party*. By checking this box, I also consent to being contacted by text messaging.

11. I understand that in order for any non-borrower income to be considered in conjunction on with this request, the non-borrower(s) must provide their social

security number and they are required to sign and date this consent agreeing to the terms and conditions outlined in this Acknowledgment and Agreement.

12. If a non-borrower** income is to be considered, we will pull a credit report to verify occupancy. By signing below and providing your social security number,

as a non-borrower you are giving permission for the Servicer to pull a copy of your credit report.

Borrower Signature

Social Security Number Date

Co-Borrower Signature

Social Security Number Date

*An authorized third party may include, but is not limited to, a counseling agency, Housing Finance Agency (HFA) or other similar entity that is assisting me in

obtaining a foreclosure prevention alternative.

**If additional lines are necessary for additional borrowers, please provide on separate piece of paper with signature, social security number, and date.

July 2018

Page 5 of 5