Non-Borrower Occupant Certification Form printable pdf download

Non- Borrower Occupant Certification Form

This form is for any individual committed to residing at your property address who is not on the loan as a

borrower, but whose income you are requesting be considered in the review for loss mitigation options.

Borrower Name (s): ____________________________________________________________________

Mortgage Account Number: _____________________________________________________________

Property Address: ______________________________________________________________________

Information to be completed by the Non-Borrower Occupant(s):

Name:

_____________________________________________________________________________________

First

Middle

Last

Suffix

Date of birth: _________________________

Social Security number: ______- ______- ______

Relationship to the borrower/homeowner: ____________________________________

By signing below, I agree to the following:

•

I reside at the borrower’s principal residence and request that my income be considered in the

review for loss mitigation options.

•

I contribute the following income to the household expenses and mortgage payments each month

and will continue to do so for the foreseeable future (Check 1 option below):

_______ 100% of my income

________ other amount $____________

•

I direct ServiSolutions, a Department of Alabama Housing Finance Authority, to obtain copies of

my credit report to verify my occupancy at the borrower’s principal residence.

•

I understand my consent for a credit bureau report shall expire upon completion of any loss

mitigation program that the borrower completes.

•

Has the mortgage on any other property that you own had a final Home Affordable Modification?

___ Yes

___ No If yes, how many? _____

•

Information and documents submitted are subject to examination and verification. Any potential

misrepresentation will be referred to the appropriate law enforcement authority for investigation

and prosecution.

Signature of Non-Borrower Occupant:

____________________________________

____________________________

Signature

Date

Non-Borrower Occupant Certification Form