Form 710 - Uniform Borrower Assitance Form
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4UNIFORM BORROWER ASSISTANCE FORM
If you are experiencing a temporary or long‐term hardship and need help, you must complete and submit this form along with
other required documentation to be considered for available solutions. On this page, you must disclose information about (1)
you and your intentions to either keep or transition out of your home; (2) the property’s status; (3) bankruptcy; and (4) your
credit counseling agency.
On Page 2, you must disclose information about all of your income, expenses and assets. Page 2 also lists the required income
documentation that you must submit in support of your request for assistance. Then on Page 3, you must complete the
Hardship Affidavit in which you disclose the nature of your hardship. The Hardship Affidavit informs you of the required
documentation that you must submit in support of your hardship claim.
NOTICE: In addition, when you sign and date this form, you will make important certifications, representations and
agreements, including certifying that all of the information in this Borrower Assistance Form is accurate and truthful
and any identified hardship has contributed to your submission of this request for mortgage relief.
REMINDER: The Borrower Response Package you need to return consists of: (1) this completed, signed and dated Borrower
Assistance Form; (2) completed and signed IRS Form 4506T‐EZ (4506T for self‐employed borrowers or borrowers with rental
income); (3) required income documentation; and (4) required hardship documentation.
Loan Number
(usually
your monthly mortgage statement)
Servicer’s Name
I want to:
Keep the Property
Vacate the Property
Sell the Property
Undecided
The property is currently:
My Primary Residence
A Second Home
An Investment Property
The property is currently:
Owner Occupied
Renter Occupied
Vacant
BORROWER
CO‐BORROWER
BORROWER’S NAME
CO‐BORROWER’S NAME
SOCIAL SECURITY NUMBER
DATE OF BIRTH
SOCIAL SECURITY NUMBER
DATE OF BIRTH
HOME PHONE NUMBER WITH AREA CODE
HOME PHONE NUMBER WITH AREA CODE
CELL OR WORK NUMBER WITH AREA CODE
CELL OR WORK NUMBER WITH AREA CODE
MAILING ADDRESS
PROPERTY ADDRESS (IF SAME AS MAILING ADDRESS, JUST WRITE SAME)
EMAIL ADDRESS
Is the property listed for sale?
Yes
No
Have you contacted a credit‐counseling agency for help?
If yes, what was the listing date?
Yes
No
If property has been listed for sale, have you received an offer on the
If yes, please complete the counselor contact information below:
property?
Yes
No
Counselor’s Name:
Date of offer:
Amount of Offer: $
Agency’s Name:
Agent’s Name:
Counselor’s Phone Number:
Agent’s Phone Number:
Counselor’s Email Address:
For Sale by Owner?
Yes
No
Do you have condominium or homeowner association (HOA) fees?
Yes
No
Total monthly amount: $
Name and address that fees are paid to:
Have you filed for bankruptcy?
Yes
No
If yes:
Chapter 7
Chapter 11
Chapter 12
Chapter 13
Filing Date:
Has your bankruptcy been discharged?
Yes
No
Bankruptcy case number:
Fannie Mae/Freddie Mac Form 710
Page 1 of 4
August 2012
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