1 Loan number: _____. Mortgage Assistance Application If you are having Mortgage payment challenges, please complete and submit this Application , along with the required documentation, to [servicer name] via mail: [address], fax: [fax #], or online: [website/email address]. We will contact you within five business days to acknowledge receipt and let you know if you need to send additional information or documents. We will use the information you provide to help us identify the Assistance you may be eligible to receive. If you need help completing this Application , please contact [servicer name] at [phone #]. For a list of HUD-approved housing counseling agencies that can provide foreclosure prevention information, contact one of the following federal government agencies: The Department of Housing and Urban Development (HUD) at (800) 569-4287 or The Consumer Financial Protection Bureau (CFPB) at (855) 411-2372 or If you need Assistance with translation or other language Assistance , HUD-approved housing counseling agencies may be able to assist you.
2 These services are provided without charge. Borrower Information Borrower’s name: _____. Social Security Number (last 4 digits): _____. E-mail address: _____ _____. Primary phone number: _____ Cell Home Work Other Alternate phone number: _____ Cell Home Work Other Co-borrower’s name: _____. Social Security Number (last 4 digits): _____. E-mail address: _____ _____. Primary phone number: _____ Cell Home Work Other Alternate phone number: _____ Cell Home Work Other Preferred contact method (choose all that apply): Cell phone Home phone Work phone Email Text checking this box indicates your consent for text messaging Is either borrower on active duty with the military (including the National Guard and Reserves), the dependent of a borrower on active duty, or the surviving spouse of a member of the military who was on active duty at the time of death?
3 Yes No Property Information Property Address: _____. Mailing address (if different from property address): _____. The property is currently: A primary residence A second home An investment property The property is (select all that apply): Owner occupied Renter occupied Vacant I want to: Keep the property Sell the property Transfer ownership of the property to my servicer Undecided Is the property listed for sale? Yes No If yes, provide the listing agent’s name and phone number or indicate for sale by owner if applicable: _____. Is the property subject to condominium or homeowners’ association (HOA) fees? Yes No If yes, indicate monthly dues: $_____. Fannie Mae/Freddie Mac Form 710 Page 1 of 4 August 2017.
4 Hardship Information The hardship causing Mortgage payment challenges began on approximately (date) _____ and is believed to be: Short-term (up to 6 months). Long-term or permanent (greater than 6 months). Resolved as of (date) _____. TYPE OF HARDSHIP (CHECK ALL THAT APPLY) REQUIRED HARDSHIP DOCUMENTATION. Unemployment Not required Reduction in income: a hardship that has caused a Not required decrease in your income due to circumstances outside your control ( , elimination of overtime, reduction in regular working hours, a reduction in base pay). Increase in housing-related expenses: a hardship that Not required has caused an increase in your housing expenses due to circumstances outside your control ( , uninsured losses, increased property taxes, HOA special assessment).
5 Disaster (natural or man-made) impacting the Not required property or borrower’s place of employment Long-term or permanent disability, or serious illness Written statement from the borrower, or other of a borrower/co-borrower or dependent family documentation verifying disability or illness member Note: Detailed medical information is not required, and information from a medical provider is not required Divorce or legal separation Final divorce decree or final separation agreement OR. Recorded quitclaim deed Separation of borrowers unrelated by marriage, civil Recorded quitclaim deed OR. union, or similar domestic partnership under Legally binding agreement evidencing that the non- applicable law occupying borrower or co-borrower has relinquished all rights to the property Death of borrower or death of either the primary or Death certificate OR.
6 Secondary wage earner Obituary or newspaper article reporting the death Distant employment transfer/relocation For active duty service members: Permanent Change of Station (PCS) orders or letter showing transfer. For employment transfers/new employment: Copy of signed offer letter or notice from employer showing transfer to a new location or written explanation if employer documentation not applicable, AND. Documentation that reflects the amount of any relocation Assistance provided (not required for those with PCS. orders). Other hardship that is not covered above: Written explanation describing the details of the hardship _____ and any relevant documentation _____.
7 _____. _____. _____. Fannie Mae/Freddie Mac Form 710 Page 2 of 4 August 2017. Borrower Income Please enter all borrower income amounts in middle column. MONTHLY TOTAL BORROWER INCOME TYPE & AMOUNT REQUIRED INCOME DOCUMENTATION. Gross (pre-tax) wages, salaries and $ Most recent pay stub and documentation of year-to- overtime pay, commissions, tips, and date earnings if not on pay stub OR. bonuses Two most recent bank statements showing income deposit amounts Self-employment income $ Two most recent bank statements showing self- employed income deposit amounts OR. Most recent signed and dated quarterly or year-to-date profit/loss statement OR. Most recent complete and signed business tax return OR.
8 Most recent complete and signed individual federal income tax return Unemployment benefit income $ No documentation required Taxable Social Security, pension, $ Two most recent bank statements showing deposit disability, death benefits, adoption amounts OR. Assistance , housing allowance, and Award letters or other documentation showing the other public Assistance amount and frequency of the benefits Non-taxable Social Security or disability $ Two most recent bank statements showing deposit income amounts OR. Award letters or other documentation showing the amount and frequency of the benefits Rental income (rents received, less $ Two most recent bank statements demonstrating expenses other than Mortgage receipt of rent OR.)
9 Expense) Two most recent deposited rent checks Investment or insurance income $ Two most recent investment statements OR. Two most recent bank statements supporting receipt of the income Other sources of income not listed $ Two most recent bank statements showing receipt of above (Note: Only include alimony, income OR. child support, or separate maintenance Other documentation showing the amount and income if you choose to have it frequency of the income considered for repaying this loan). Current Borrower Assets Exclude retirement funds such as a 401(k) or Individual Retirement Account (IRA), and college savings accounts such as a 529 plan. Checking account(s) and cash on hand $.
10 Savings, money market funds, and Certificates of Deposit (CDs) $. Stocks and bonds (non-retirement accounts) $. Other: $. Fannie Mae/Freddie Mac Form 710 Page 3 of 4 August 2017. Borrower Certification and Agreement 1. I certify and acknowledge that all of the information in this Mortgage Assistance Application is truthful, and the hardship I. identified contributed to my need for Mortgage relief. Knowingly submitting false information may violate Federal and other applicable law. 2. I agree to provide my servicer with all required documents, including any additional supporting documentation as requested, and will respond in a timely manner to all servicer or authorized third party* communications.