Homeowner Assistance Form (Page 2 of 5) in pdf

Have you filed for bankruptcy?

Yes

If yes:

Chapter 7

Chapter 11

Chapter 12

Chapter 13

Filing date_____________________________

Has your bankruptcy been discharged?

Yes

Bankruptcy case number ___________________

Please note that if you have or will receive a discharge from a chapter 7 bankruptcy case, and the mortgage was not reaffirmed in the bankruptcy

case, we will only exercise our rights against the property and are not attempting any act to collect the discharged debt from you personally.

Additionally, your decision to discuss workout options with us is strictly voluntary. You are not obligated to pursue any workout options

discussed with us. At your request, we will immediately terminate any such discussions should you no longer wish to pursue these options.

Hardship Affidavit (Provide a written explanation with this request describing the specific nature of your hardship.)

I/We am/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 (under 6 months)

Medium-term (6-12 months)

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

I/we am/are having difficulty making my/our monthly payment because of reasons set forth below:

(Please check all that apply and submit required documentation demonstrating your hardship)

If your hardship is:

Then the required hardship documentation is:

Unemployment

No hardship documentation required

No hardship documentation required, as long as you have submitted income

Underemployment

documentation that supports the income described in the required income

documentation section

Income reduction (e.g., elimination of

No hardship documentation required, as long as you have submitted income

overtime, reduction in regular working hours,

documentation that supports the income described in the required income

or a reduction in base pay)

documentation section

Divorce decree signed by the court; OR

Divorce or legal separation; Separation of

Separation agreement signed by the court; OR

Borrowers unrelated by marriage, civil union

Current credit report evidencing divorce, separation, or non-occupying

or similar domestic partnership under

borrower has a different address; OR

applicable law

Recorded quitclaim deed evidencing that the non-occupying Borrower or Co-

borrower has relinquished all rights to the property

Death of borrower or death of either the

Death certificate; OR

primary or secondary wage earner in the

Obituary or newspaper article reporting the death

household

Long-term or permanent disability; Serious

Doctor’s certificate of illness or disability; OR

illness of a borrower/co-borrower or dependent

Medical bills; OR

family member

Proof of monthly insurance benefits or government assistance (if applicable)

Insurance claim; OR

Disaster (natural or man-made) adversely

Federal Emergency Management Agency grant or Small Business

impacting the property or Borrower’s place of

Administration loan; OR

employment

Borrower or Employer property located in a federally declared disaster area

Distant employment transfer

No hardship documentation required

Tax return from the previous year (including all schedules) AND

Proof of business failure supported by one of the following:

• Bankruptcy filing for the business; or

Business failure

• Two months recent bank statements for the business account evidencing

cessation of business activity; or

• Most recent signed and dated quarterly or year-to-date profit and loss

statement

Homeowner Assistance Form (HAMP)

RFDocType 50431

Page 2 of 5

29290MU 11/11

BARCODE

Homeowner Assistance Form Page 2

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