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BORROWER
COBORROWER
COBORROWERSNAME
SOCIALSECURITYNUMBER DATEOFBIRTH
HOMEPHONENUMBERWITHAREACODE CELLORWORKNUMBERWITHAREACODE
EMAILADDRESS
Isthepropertylistedforsale? Yes No Haveyoucontactedacreditcounselingagencyforhelp? No Ifyes,whatwasthelistingdate? Yes Ifpropertyhasbeenlistedforsale,haveyoureceivedanofferonthe Ifyes,pleasecompletethecounselorcontactinformationbelow: property? CounselorsName: Yes No AmountofOffer:$ Dateofoffer: AgencysName: AgentsName: CounselorsPhoneNumber: AgentsPhoneNumber: CounselorsEmailAddress: ForSalebyOwner? Yes No Doyouhavecondominiumorhomeownerassociation(HOA)fees? Yes No Totalmonthlyamount:$ Nameandaddressthatfeesarepaidto: Haveyoufiledforbankruptcy? Yes No Chapter7 Chapter11 Chapter12 Chapter13 Ifyes: FilingDate: Hasyourbankruptcybeendischarged? Yes No Bankruptcycasenumber: FannieMae/FreddieMacForm710 Page1of4 August2012
UNIFORMBORROWERASSISTANCEFORM
MonthlyHouseholdIncome
Grosswages Overtime
FirstMortgagePayment
CheckingAccount(s) CheckingAccount(s)
ChildSupport/Alimony*
Nontaxablesocialsecurity/SSDI
$ $
$
CreditCards/InstallmentLoan(s)(total $ minimumpaymentpermonth)
$ $
Savings/MoneyMarket CDs
Stocks/Bonds
$ $ $
$ $
Alimony,childsupportpayments
OtherCashonHand
Total(Grossincome)
$ $ $
$ $
OtherRealEstate(estimatedvalue) Other
TotalAssets
$ $ $
$ $
Anyotherliens(mortgageliens,mechanicsliens,taxliens,etc.) LienHoldersName
BalanceandInterestRate
LoanNumber
LienHoldersPhoneNumber
RequiredIncomeDocumentation
Doyouearnasalaryorhourlywage? Foreachborrowerwhoisasalariedemployeeor paidbythehour,includepaystub(s)reflectingthe mostrecent30daysearningsanddocumentation reflectingyeartodateearnings,ifnotreported onthepaystubs(e.g.signedletterorprintout fromemployer). Areyouselfemployed? Foreachborrowerwhoreceivesselfemployedincome,includeacomplete,signed individualfederalincometaxreturnand,asapplicable,thebusinesstaxreturn;AND eitherthemostrecentsignedanddatedquarterlyoryeartodateprofit/lossstatement thatreflectsactivityforthemostrecentthreemonths;ORcopiesofbankstatementsfor thebusinessaccountforthelasttwomonthsevidencingcontinuationofbusiness activity.
Doyouhaveanyadditionalsourcesofincome?Provideforeachborrowerasapplicable: OtherEarnedIncomesuchasbonuses,commissions,housingallowance,tips,orovertime: Reliablethirdpartydocumentationdescribingtheamountandnatureoftheincome(e.g.,paystub,employmentcontractorprintouts documentingtipincome). SocialSecurity,disabilityordeathbenefits,pension,publicassistance,oradoptionassistance: Documentationshowingtheamountandfrequencyofthebenefits,suchasletters,exhibits,disabilitypolicyorbenefitsstatementfromthe provider,and Documentationshowingthereceiptofpayment,suchascopiesofthetwomostrecentbankstatementsshowingdepositamounts. Rentalincome: Copyofthemostrecentfiledfederaltaxreturnwithallschedules,includingScheduleESupplementIncomeandLoss.Rentalincomefor qualifyingpurposeswillbe75%ofthegrossrentyoureportedreducedbythemonthlydebtserviceontheproperty,ifapplicable;or IfrentalincomeisnotreportedonScheduleESupplementalIncomeandLoss,provideacopyofthecurrentleaseagreementwitheither bankstatementsorcancelledrentchecksdemonstratingreceiptofrent. Investmentincome: Copiesofthetwomostrecentinvestmentstatementsorbankstatementssupportingreceiptofthisincome. Alimony,childsupport,orseparationmaintenancepaymentsasqualifyingincome:* Copyofdivorcedecree,separationagreement,orotherwrittenlegalagreementfiledwithacourt,orcourtdecreethatstatestheamount ofthealimony,childsupport,orseparationmaintenancepaymentsandtheperiodoftimeoverwhichthepaymentswillbereceived,and Copiesofyourtwomostrecentbankstatementsorotherthirdpartydocumentsshowingreceiptofpayment. *Notice:Alimony,childsupport,orseparatemaintenanceincomeneednotberevealedifyoudonotchoosetohaveitconsideredforrepaying thisloan.
FannieMae/FreddieMacForm710
Page2of4
August2012
UNIFORMBORROWERASSISTANCEFORM
HARDSHIPAFFIDAVIT
IamrequestingreviewofmycurrentfinancialsituationtodeterminewhetherIqualifyfortemporaryorpermanentmortgageloanrelief options. DateHardshipBeganis: Ibelievethatmysituationis: Shortterm(under6months) Mediumterm(612months) LongtermorPermanentHardship(greaterthan12months)
Iamhavingdifficultymakingmymonthlypaymentbecauseofreasonsetforthbelow:
(Pleasechecktheprimaryreasonandsubmitrequireddocumentationdemonstratingyourprimaryhardship)
IfYourHardshipis:
Unemployment ReductioninIncome:ahardshipthat hascausedadecreaseinyourincome duetocircumstancesoutsideyour control(e.g.,eliminationofovertime, reductioninregularworkinghours,a reductioninbasepay) IncreaseinHousingExpenses:a hardshipthathascausedanincreasein yourhousingexpensesdueto circumstancesoutsideyourcontrol Divorceorlegalseparation;Separation ofBorrowersunrelatedbymarriage, civilunionorsimilardomestic partnershipunderapplicablelaw
ThentheRequiredHardshipDocumentationis:
Nohardshipdocumentationrequired Nohardshipdocumentationrequired
Nohardshipdocumentationrequired
Doctorscertificateofillnessordisability;OR Medicalbills;OR Proofofmonthlyinsurancebenefitsorgovernmentassistance(ifapplicable) Insuranceclaim;OR FederalEmergencyManagementAgencygrantorSmallBusinessAdministration loan;OR BorrowerorEmployerpropertylocatedinafederallydeclareddisasterarea Distantemploymenttransfer/Relocation Foractivedutyservicemembers:NoticeofPermanentChangeofStation(PCS)or actualPCSorders. Foremploymenttransfers/newemployment: Copyofsignedofferletterornoticefromemployershowingtransfertoanew employmentlocation;OR Paystubfromnewemployer;OR Ifnoneoftheseapply,providewrittenexplanation Inadditiontotheabove,documentationthatreflectstheamountofanyrelocation assistanceprovided,ifapplicable(notrequiredforthosewithPCSorders). BusinessFailure Taxreturnfromthepreviousyear(includingallschedules)AND Proofofbusinessfailuresupportedbyoneofthefollowing: Bankruptcyfilingforthebusiness;OR Twomonthsrecentbankstatementsforthebusinessaccountevidencing cessationofbusinessactivity;OR Mostrecentsignedanddatedquarterlyoryeartodateprofitandloss statement Other:ahardshipthatisnotcovered Writtenexplanationdescribingthedetailsofthehardshipandrelevant above documentation
FannieMae/FreddieMacForm710
Page3of4
August2012
UNIFORMBORROWERASSISTANCEFORM
Borrower/CoBorrowerAcknowledgementandAgreement Icertify,acknowledge,andagreetothefollowing: 1. AlloftheinformationinthisBorrowerAssistanceFormistruthfulandthehardshipthatIhaveidentified contributedtomyneedformortgagerelief. 2. TheaccuracyofmystatementsmaybereviewedbytheServicer,ownerorguarantorofmymortgage,their agent(s),oranauthorizedthirdparty*,andImayberequiredtoprovideadditionalsupportingdocumentation. IwillprovideallrequesteddocumentsandwillrespondtimelytoallServicer,orauthorizedthirdparty*, communications. 3. KnowinglysubmittingfalseinformationmayviolateFederalandotherapplicablelaw. 4. IfIhaveintentionallydefaultedonmyexistingmortgage,engagedinfraudormisrepresentedanyfact(s)in connectionwiththisrequestformortgagerelieforifIdonotprovideallrequireddocumentation,theServicer maycancelanymortgagereliefgrantedandmaypursueforeclosureonmyhomeand/orpursueanyavailable legalremedies. 5. TheServicerisnotobligatedtooffermeassistancebasedsolelyontherepresentationsinthisdocumentor otherdocumentationsubmittedinconnectionwithmyrequest. 6. Imaybeeligibleforatrialperiodplan,repaymentplan,orforbearanceplan.IfIameligibleforoneofthese plans,Iagreethat: a. AllthetermsofthisAcknowledgmentandAgreementareincorporatedintosuchplanbyreferenceas ifsetforthinsuchplaninfull. b. Myfirsttimelypaymentundertheplanwillserveasacceptanceofthetermssetforthinthenoticeof theplansentbytheServicer. c. TheServicersacceptanceofanypaymentsundertheplanwillnotbeawaiverofanyaccelerationof myloanorforeclosureactionthathasoccurredandwillnotcuremydefaultunlesssuchpaymentsare sufficienttocompletelycuremyentiredefaultundermyloan. d. Paymentsdueunderatrialperiodplanforamodificationwillcontainescrowamounts.IfIwasnot previouslyrequiredtopayescrowamounts,andmytrialperiodplancontainsescrowamounts,Iagree totheestablishmentofanescrowaccountandagreethatanypriorwaiverisrevoked.Paymentsdue underarepaymentplanorforbearanceplanmayormaynotcontainescrowamounts.IfIwasnot previouslyrequiredtopayescrowamountsandmyrepaymentplanorforbearanceplancontains escrowamounts,Iagreetotheestablishmentofanescrowaccountandagreethatanypriorescrow waiverisrevoked. 7. Acondemnationnoticehasnotbeenissuedfortheproperty. 8. TheServicerorauthorizedthirdparty*willobtainacurrentcreditreportonallborrowersobligatedonthe Note. 9. TheServicerorauthorizedthirdparty*willcollectandrecordpersonalinformationthatIsubmitinthis BorrowerResponsePackageandduringtheevaluationprocess.Thispersonalinformationmayinclude,butis notlimitedto:(a)myname,address,telephonenumber,(b)mysocialsecuritynumber,(c)mycreditscore,(d) myincome,and(e)mypaymenthistoryandinformationaboutmyaccountbalancesandactivity.Iunderstand andconsenttotheServicerorauthorizedthirdparty*,aswellasanyinvestororguarantor(suchasFannie MaeorFreddieMac),disclosingmypersonalinformationandthetermsofanyrelieforforeclosurealternative thatIreceivetothefollowing: a. Anyinvestor,insurer,guarantor,orservicerthatowns,insures,guarantees,orservicesmyfirstlienor subordinatelien(ifapplicable)mortgageloan(s)oranycompaniesthatperformsupportservicesto them;and b. TheU.S.DepartmentofTreasury,FannieMaeandFreddieMac,inconjunctionwiththeir responsibilitiesundertheMakingHomeAffordableprogram,oranycompaniesthatperformsupport servicestothem. 10. Iconsenttobeingcontactedconcerningthisrequestformortgageassistanceatanytelephonenumber, includingmobiletelephonenumber,oremailaddressIhaveprovidedtotheLender/Servicer/orauthorized thirdparty*.Bycheckingthisbox,Ialsoconsenttobeingcontactedby textmessaging. ________________________________________________________________________________ BorrowerSignature Date CoBorrowerSignature Date *Anauthorizedthirdpartymayinclude,butisnotlimitedto,acounselingagency,HousingFinanceAgency(HFA)or othersimilarentitythatisassistingmeinobtainingaforeclosurepreventionalternative.
FannieMae/FreddieMacForm710 Page4of4 August2012