Form 710 - Uniform Borrower Assitance Form Page 3
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4UNIFORM BORROWER ASSISTANCE FORM
HARDSHIP AFFIDAVIT
I am requesting review of my current financial situation to determine whether I qualify for temporary or permanent mortgage loan relief
options.
Date Hardship Began is:
I believe that my situation is:
Short‐term (under 6 months)
Medium‐term (6 – 12 months)
Long‐term or Permanent Hardship (greater than 12 months)
I am having difficulty making my monthly payment because of reason set forth below:
(Please check the primary reason and submit required documentation demonstrating your primary hardship)
If Your Hardship is:
Then the Required Hardship Documentation is:
Unemployment
No hardship documentation required
Reduction in Income: a hardship that
No hardship documentation required
has caused a decrease in your income
due to circumstances outside your
control (e.g., elimination of overtime,
reduction in regular working hours, a
reduction in base pay)
Increase in Housing Expenses: a
No hardship documentation required
hardship that has caused an increase in
your housing expenses due to
circumstances outside your control
Divorce or legal separation; Separation
Divorce decree signed by the court; OR
Separation agreement signed by the court; OR
of Borrowers unrelated by marriage,
Current credit report evidencing divorce, separation, or non‐occupying
civil union or similar domestic
partnership under applicable law
borrower has a different address; OR
Recorded quitclaim deed evidencing that the non‐occupying Borrower or co‐
Borrower has relinquished all rights to the property
Death of a borrower or death of either
Death certificate; OR
Obituary or newspaper article reporting the death
the primary or secondary wage earner
in the household
Long‐term or permanent disability;
Doctor’s certificate of illness or disability; OR
Medical bills; OR
Serious illness of a borrower/co‐
Proof of monthly insurance benefits or government assistance (if applicable)
borrower or dependent family member
Disaster (natural or man‐made)
Insurance claim; OR
Federal Emergency Management Agency grant or Small Business Administration
adversely impacting the property or
Borrower’s place of employment
loan; OR
Borrower or Employer property located in a federally declared disaster area
Distant employment transfer / Relocation For active‐duty service members: Notice of Permanent Change of Station (PCS) or
actual PCS orders.
For employment transfers/new employment:
Copy of signed offer letter or notice from employer showing transfer to a new
employment location; OR
Pay stub from new employer; OR
If none of these apply, provide written explanation
In addition to the above, documentation that reflects the amount of any relocation
assistance provided, if applicable (not required for those with PCS orders).
Business Failure
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
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
Other: a hardship that is not covered
Written explanation describing the details of the hardship and relevant
above
documentation
Fannie Mae/Freddie Mac Form 710
Page 3 of 4
August 2012
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