Borrower Assistance Form Page 2
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4BORROWER ASSISTANCE FORM
Borrower Name:
Loan number:
BORROWER INFORMATION
BSI offers options for resolving your home loan issues. Please answer the questions below as completely and accurately as possible.
This information will only be used to aid in the evaluation of homeownership preservation options, not for any other purpose.
Borrower
Co-Borrower
Borrower Name
)
Co-Borrower Name
(Include Jr. on Sr. if applicable.
(Include Jr. on Sr. if applicable.)
Borrower Social Security Number
Borrower Home Phone
Co-Borrower Social Security
Co-Borrower Home Phone
(Best Time)
Number
(Best Time)
Borrower Work Phone
Borrower Other Phone
Co-Borrower Work Phone
Co-Borrower Other Phone
(Best Time)
(Best Time)
(Best Time)
(Best Time)
Borrower E-mail Address
Borrower Marital Status
Co-Borrower Marital Status
Co-Borrower E-mail Address
(Married, Unmarried, Separated,
(Married, Unmarried, Separated,
Divorced)
Permission To Contact Via E-mail
Divorced)
Permission To Contact Via E-mail
PROPERTY INFORMATION
Property Address
Mailing Address
(Street, city, state & zip code.)
(If different than Property Address.)
Reside at
Want to Retain
# Units at
Property
# People in
# Dependents
Is the Property for
Property?
Property?
Property
Condition?
Household
sale?
Borrower
(Good, Fair, Poor)
Co-Borrower
Listing Amount
Realtor Name
Realtor Address
Realtor Phone
LOAN INFORMATION
Loan Account Number
Months Past Due
Second Loan Account Number
Second Loan
Balance
Months Past
Mortgage Co.
Due
Are you currently working with BSI on a foreclosure prevention
Which foreclosure resolution is in process?
resolution?
(Refinance, Repayment Plan, Short Sale, Modification, Deferment, Deed-in Lieu)
BSI Associate Name
BSI Associate Phone
Date Process Began
BANKRUPTCY STATUS
If you are in an active bankruptcy, we will need to work with your attorney on a possible resolution.
Are you in an Active Bankruptcy?
Bankruptcy Chapter Type
Bankruptcy Case Number
Date of Bankruptcy Filing
Bankruptcy Attorney Name
Bankruptcy Attorney Address
Bankruptcy Attorney Phone
EMPLOYMENT INFORMATION
Borrower
Co-Borrower
Borrower Employer
Co-Borrower Employer
Borrower Employer Address
Co-Borrower Employer Address
Borrower Employer Phone
How long
Self-Employed?
Co-Borrower Employer
How long
Self-Employed?
employed?
Phone
employed?
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