Form 710 - Uniform Borrower Assitance Form Page 4
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4 UNIFORM BORROWER ASSISTANCE FORM
Borrower/Co‐Borrower Acknowledgement and Agreement
I certify, acknowledge, and agree to the following:
1. All of the information in this Borrower Assistance Form is truthful and the hardship that I have identified
contributed to my need for mortgage relief.
2. The accuracy of my statements may be reviewed by the Servicer, owner or guarantor of my mortgage, their
agent(s), or an authorized third party*, and I may be required to provide additional supporting documentation.
I will provide all requested documents and will respond timely to all Servicer, or authorized third party*,
communications.
3. Knowingly submitting false information may violate Federal and other applicable law.
4. If I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any fact(s) in
connection with this request for mortgage relief or if I do not provide all required documentation, the Servicer
may cancel any mortgage relief granted and may pursue foreclosure on my home and/or pursue any available
legal remedies.
5. The Servicer is not obligated to offer me assistance based solely on the representations in this document or
other documentation submitted in connection with my request.
6. I may be eligible for a trial period plan, repayment plan, or forbearance plan. If I am eligible for one of these
plans, I agree that:
a. All the terms of this Acknowledgment and Agreement are incorporated into such plan by reference as
if set forth in such plan in full.
b. My first timely payment under the plan will serve as acceptance of the terms set forth in the notice of
the plan sent by the Servicer.
c. The Servicer’s acceptance of any payments under the plan will not be a waiver of any acceleration of
my loan or foreclosure action that has occurred and will not cure my default unless such payments are
sufficient to completely cure my entire default under my loan.
d. Payments due under a trial period plan for a modification will contain escrow amounts. If I was not
previously required to pay escrow amounts, and my trial period plan contains escrow amounts, I agree
to the establishment of an escrow account and agree that any prior waiver is revoked. Payments due
under a repayment plan or forbearance plan may or may not contain escrow amounts. If I was not
previously required to pay escrow amounts and my repayment plan or forbearance plan contains
escrow amounts, I agree to the establishment of an escrow account and agree that any prior escrow
waiver is revoked.
7. A condemnation notice has not been issued for the property.
8. The Servicer or authorized third party* will obtain a current credit report on all borrowers obligated on the
Note.
9. The Servicer or authorized third party* will collect and record personal information that I submit in this
Borrower Response Package and during the evaluation process. This personal information may include, but is
not limited to: (a) my name, address, telephone number, (b) my social security number, (c) my credit score, (d)
my income, and (e) my payment history and information about my account balances and activity. I understand
and consent to the Servicer or authorized third party*, as well as any investor or guarantor (such as Fannie
Mae or Freddie Mac), disclosing my personal information and the terms of any relief or foreclosure alternative
that I receive to the following:
a. Any investor, insurer, guarantor, or servicer that owns, insures, guarantees, or services my first lien or
subordinate lien (if applicable) mortgage loan(s) or any companies that perform support services to
them; and
b. The U.S. Department of Treasury, Fannie Mae and Freddie Mac, in conjunction with their
responsibilities under the Making Home Affordable program, or any companies that perform support
services to them.
10. I consent to being contacted concerning this request for mortgage assistance at any telephone number,
including mobile telephone number, or email address I have provided to the Lender/Servicer/ or authorized
third party*. By checking this box, I also consent to being contacted by text messaging.
_________________________________ __________ ___________________________ __________
Borrower Signature
Date
Co‐Borrower Signature
Date
*An authorized third party may include, but is not limited to, a counseling agency, Housing Finance Agency (HFA) or
other similar entity that is assisting me in obtaining a foreclosure prevention alternative.
Fannie Mae/Freddie Mac Form 710
Page 4 of 4
August 2012
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