Foreclosure Prevention Counseling Forms (Page 4 of 4) in pdf

Form 3: Qualified Written Request Under RESPA by Borrower

(Name of Borrower(s))

_____________________

_________________________________ (Address of Borrower(s))

_________________________________________

Date: ______________

VIA CERTIFIED MAIL

_____________________ (Name of Servicer)

____________________ (Address of Servicer)

____________________

Attn: Mortgage Loan Accounting Department

Re: Loan # ___________________

Dear Sir or Madam:

You are the servicer of our mortgage loan at the above address. We dispute the amount that is owed

according to the Monthly Billing Statement and request that you send us information about the fees,

costs and escrow accounting on our loan. This is a “qualified written request’’ pursuant to the Real

Estate Settlement and Procedures Act (12 U.S.C. Sec. 2605(e)).

Specifically, we are requesting an itemization of the following:

•

a complete payment history, including but not limited to the dates and amounts of all the

payments we have made on the loan to date;

•

a breakdown of the amount of claimed arrears or delinquencies;

•

an explanation of how the amount due on the Monthly Billing Statement ($_________) was

calculated and a explanation of why this amount was increased to $___________ on

__________________ (date);

•

the payment dates, purpose of payment and recipient of any and all foreclosure fees and costs

that have been charged to our account;

•

the payment dates, purpose of payment and recipient of all escrow items charged to our

account since you took over the servicing;

•

a breakdown of the current escrow charge showing how it is calculated and the reasons for any

increase within the last 24r months; and

•

a copy of any annual escrow statements and notices of a shortage, deficiency or surplus, sent

to us within the last three years.

Thank you for taking the time to acknowledge and answer this request as required by the Real Estate

Settlement and Procedures Act.

Very truly yours,

Foreclosure Prevention Counseling Forms Page 4