Borrower Assistance Form


Borrower Assistance Form Instructions:
Enclosed you will find BSI’s Borrower Assistance Form. In order for our office to properly
review your current financial situation, we need to have the enclosed Assistance Form (financial
worksheet) filled out in its entirety and returned to BSI with the supporting documentation listed
below. Your Borrower Assistance Form and the information you provide us must be
complete and accurate.
Required Documentation for Loss Mitigation Options
1. Hardship letter
1. Completed and signed Borrower Assistance Form/financial worksheet
2. 3
party authorization (if necessary)
3. Two (2) months of complete checking and savings account statements (latest not more
than 30 days old), with transaction history
4. Copy of two (2) most recent paycheck stubs from every source of income
5. Copy of homeowner’s declaration page or hazard insurance policy, if NOT escrowed
6. Copy of property tax bill or receipt, if NOT escrowed
7. If self-employed, a copy of your most recent quarterly or year to date profit and loss
8. Bankruptcy discharge orders signed by the court, if applicable
9. Two (2) years of Tax returns or IRS Form 4506-T, must be signed by the borrower(s)
10. 401k, brokerage account, other investment account statements
11. Copy of current utility bill
12. If income is from social security, disability or death benefits, pension, public assistance,
or unemployment, a copy of the most recent benefit letter or benefit statement
13. If income is from alimony or child support, a copy of the court order or judgment and
proof of regular and timely payments
14. If you are applying for assistance without a co-borrower identified on the Note, please
include relevant documentation, such as a copy of the divorce decree and property deed.
Please note: Not all loss mitigations options (e.g. a loan modification) will satisfy certain
terms required by a divorce decree.
Please return your completed Borrower Assistance Form and documentation via overnight mail
or first class mail to BSI Financial Services, PO Box 517, Titusville, PA 16354, or via fax to
814-217-1366. Once we receive your documentation, we will acknowledge receipt and inform
you if any additional information is missing or needed.
Should you have any questions, please contact us toll-free at 800-327-7861 from 8:00 a.m. - 8:00
p.m. (ET) Monday through Friday, and 8:00 a.m. - 12:00 p.m. (ET) Saturday.


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