Fillable Form 240a - Reaffirmation Agreement ( (Page 3 of 9) in pdf

Form 240a - Reaffirmation Agreement ( Page 3

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Form 240A - Reaffirmation Agreement (Cont.)

the amount of each balance and the rate applicable to it are:

$ _________@ _________%;

$_________ @ _________%;

$_________ @ _________%.

c. If the underlying debt transaction was disclosed as a variable rate transaction on the

most recent disclosure given under the Truth in Lending Act:

The interest rate on your loan may be a variable interest rate which changes from

time to time, so that the annual percentage rate disclosed here may be higher or

lower.

d. If the reaffirmed debt is secured by a security interest or lien, which has not been

waived or determined to be void by a final order of the court, the following items or types of

items of the debtor’s goods or property remain subject to such security interest or lien in

connection with the debt or debts being reaffirmed in the reaffirmation agreement described in

Part B.

Item or Type of Item

Original Purchase Price or Original Amount of Loan

Optional---At the election of the creditor, a repayment schedule using one or a combination of

the following may be provided:

Repayment Schedule:

Your first payment in the amount of $___________ is due on _________(date), but the future

payment amount may be different. Consult your reaffirmation agreement or credit agreement, as

applicable.

— Or —

Your payment schedule will be: _________(number) payments in the amount of $___________

each, payable (monthly, annually, weekly, etc.) on the __________ (day) of each ____________

( week, month, etc.), unless altered later by mutual agreement in writing.

— Or —

A reasonably specific description of the debtor’s repayment obligations to the extent known by

the creditor or creditor’s representative.

Form 240a - Reaffirmation Agreement ( Page 3

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