Authorization For Use With For Profit And Non Profit Loan Assistance Consultants Form (Page 2 of 2) in pdf

Authorization

[FOR USE WITH FOR PROFIT AND NON PROFIT LOAN ASSISTANCE CONSULTANTS]

DESIGNATED AGENT ACKNOWLEDGEMENT

The undersigned officer, member or partner of the Designated Agent hereby acknowledges that any material

misrepresentation, misstatement or omission of fact made to BAC, or any lender, investor or insurer in connection with any

modification or other workout arrangement under the Treasury Department’s Making Homes Affordable Program (“MHA”) :

(a) may violate the anti-fraud provisions of MHA, (b) may be prosecuted pursuant to Section 18 U.S.C §1001 et. Seq. of the

Federal Code of Crimes and Criminal Procedures and be punishable by up to 30 years in federal prison or $1,000,000 fine, or

both, and/or (c) may be prosecuted under the Civil False Claims Act (31 U.S.C.

§§ 3729-3733).

In addition, the undersigned hereby represents on behalf of the Designated Agent that: (i) it has made all disclosures to the

Borrower and Co-Borrower required to be made in accordance with any applicable federal or state rule or regulation and if the

Designated Agent is a for profit provider of mortgage relief services subject to the terms of FTC Rule No. [

] (the ‘FTC

Rule”), it further represents that it has complied with all disclosures required to be made under the FTC Rule , (ii) it is in

compliance with all applicable federal and state laws, rules, and regulations, governing the registration, licensing,

certification, business practices or conduct of loan counselors or consultants providing mortgage relief services to consumers,

(iii) any payment arrangement for services rendered to the Borrower or Co-Borrower is structured in a manner consistent

with any applicable federal or state rule or regulation, and if the Designated Agent is a for profit provider of mortgage relief

services subject to the terms of

the FTC Rule, it further represents that any fee arrangement with the Borrower and Co-

Borrower complies with the terms of the FTC Rule: and (iv) the contact and licensing information provided below is true and

correct.

Name of Designated Agent: ______________________________________________________

Mailing Address: ____________________________________________

E-mail Address: ____________________________________________________

Business Phone Number: _______________________________________________

State license/Registration No., TIN, NMLS, or EIN: __________________________________

Name of State Licensing Entity (if applicable): _____________________________________

Type of License: __________________________________________________

Designated Agent Signature

Name: _________________________________

Title: _________________________________

Date: _________________________________

Authorization For Use With For Profit And Non Profit Loan Assistance Consultants Form Page 2