Mac Form 710 - Uniform Borrower Assistance Form Page 12
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17INSURANCE
Monthly Auto Insurance
Monthly Health/Dental Premium
Monthly Life Insurance
Other Monthly Insurance
Please describe other below:
Total Monthly Insurance
DEBT-AUTO
Monthly Auto Payments1
Monthly Auto Payments 2
Total Monthly Auto Payments
DEBT-CREDIT CARD
Monthly Credit Card Payment 1
Monthly Credit Card Payment 2
Monthly Credit Card Payment 3
Monthly Credit Card Payment 4
Total Monthly Credit Card
Payments
TOTAL EXPENSES
NET INCOME
- TOTAL EXPENSES
-
=
=
ASSETS
VALUE
AMOUNT OWED
Property 1
Property 2
401K Accounts
Automobiles
Checking Accounts
Savings Accounts
IRA/Keogh Accounts
Stocks/Bonds
Motor Home/Travel Trailer
Other Recreational Vehicles
Other Real Estate
Other Assets
Please describe other below:
Borrower Signature ________________________ Date_________
Co-Borrower Signature______________________ Date_________
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Parent category: Financial