Fannie Mae Form 1021 - Home Affordable Modification Program Hardship Affidavit Page 3
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48. I/we understand that the Servicer will use this information to evaluate my/our eligibility for a
loan modification or other workout, but the Servicer is not obligated to offer me/us
assistance based solely on the representations in this affidavit.
9. I/we accept and agree to all terms of the Home Affordable Modification Trial Period (“Trial
Period”) Plan which is incorporated herein by reference as if set forth in full.
10. I/we agree that when the Servicer accepts and posts a payment during the Trial Period it will
be without prejudice to, and will not be deemed a waiver of, the acceleration of my loan or
foreclosure action and related activities and shall not constitute a cure of my default under
my loan unless such payments are sufficient to completely cure my entire default under my
loan.
11. I/we agree that any prior waiver as to payment of escrow Items in connection with my loan
has been revoked.
12. I/we agree to the establishment of an escrow account and the payment of escrow items if an
escrow account never existed on my loan.
13. I/we understand that Servicer will collect and record personal information, including, but not
limited to, my name, address, telephone number, social security number, credit score,
income, payment history, government monitoring information, and information about account
balances and activity. I understand and consent to the disclosure of my personal
information and the terms of the Trial Period Plan and Modification Agreement by Servicer to
(a) the U.S. Department of the Treasury, (b) Fannie Mae and Freddie Mac in connection
with their responsibilities under the Homeowner Affordability and Stability Plan; (c) any
investor, insurer, guarantor or servicer that owns, insures, guarantees or services my first
lien or subordinate lien (if applicable) mortgage loan(s); (d) companies that perform support
services for the Home Affordable Modification Program and the Second Lien Modification
Program; and (e) any HUD certified housing counselor.
_________________________ ___________
_________________________ ____________
Borrower Signature
Date
Co-Borrower Signature
Date
E-mail Address: _______________________
E-mail Address: ________________________
Cell Phone # _________________________
Cell Phone # __________________________
Home Phone # _________________________
Home Phone #__________________________
Work Phone # _________________________
Work Phone # __________________________
Social Security # ____ ___ ____
Social Security #
____ ___ ________
Explanation:
Fannie Mae Form 1021
Page 3 of 4
August 2009
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