Financial Hardship Affidavit printable pdf download

Financial Hardship Affidavit

__________________________________________________________

Borrower Name(s):

__________________________________________________________

Property Street Address:

__________________________________________________________

Property City, State, Zip:

__________________________________________________________

Lender:

__________________________________________________________

Loan Number:

In order to qualify for _____________________________’s offer of a conditional Loan

Workout and Modification Agreement, I am submitting this form to the Lender and

indicating by my checkmarks (“”) the one or more events that contributed to my

inability to remain current on my mortgage loan.

Borrower Co-Borrower

My income has been reduced or lost. For example: unemployment,

reduced job hours, reduced pay, decline in business earnings. Explain

below.

My household financial circumstances have changed. For example:

permanent or short-term disability, death in the family, divorce or separation,

increased family responsibilities (birth or adoption of a child, taking care of

elderly relatives or other family members). Explain below.

My expenses have increased. For example: my monthly mortgage

payment will rise or has risen, high medical and health-care costs,

uninsured losses (such as those due to fires or natural disasters),

unexpectedly high utility bills. Explain below.

Other. Explain below.

Explanation:

______________________________________________________________________

Financial Hardship Affidavit