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Hardship Affidavit Form

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Hardship Affidavit Form

Name: ______________________

Address: ________________________________

Loan Number: _________________

Use this form to tell us why it’s difficult for you to make your current mortgage payments.

In addition please provide a written explanation with this request describing the specific nature

of your hardship.

I am/We are requesting review of my/our current financial situation to determine whether I/we

qualify for temporary or permanent mortgage relief options.

Date hardship began is: _________________

I believe that my/our situation is:

Short-term (less than 6 months)

Medium-term (6-12 months)

Long-term or Permanent Hardship (greater than 12 months)

I am / We are requesting review under the Making Home Affordable Program. I am/We are

having difficulty making my/our monthly payment because of financial difficulties created by

(check all that apply):

My/Our household income has been reduced. For example: reduced pay or

hours, decline in business earnings, death, disability or divorce of a borrower or

co-borrower.

My/Our monthly debt payments are excessive and I am/We are overextended

with my/our creditors. Debt includes credit cards, home equity or other debt.

My/Our expenses have increased. For example: monthly mortgage payment

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

property taxes.

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

my/our current mortgage payment and cover basic living expenses at the same

time.

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

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

Other

Hardship Affidavit Form

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Hardship Affidavit Form

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