Chase D19693 Rma 0913 Form – Fill Out and Use This PDF

CUSTOMER

Customer’s name

ADDITIONAL CUSTOMER

Customer’s name

Step 2: Help us understand your unique situation

HARDSHIP AFFIDAVIT

DESCRIBE YOUR HARDSHIP: __________________________________________________________________________________________

__________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

If your mortgage loan is insured or guaranteed by the Federal Housing Administration (FHA) or the Rural Housing Service (RHS), you are considered to be facing imminent default if your loan is up to date or less than 30 days past due and you have a hardship that will keep you from making your next mortgage loan paymentin the month it’s due.

Date situation began:

_______/_______/_______

I believe my situation is:

nTemporary n Long term

Check all boxes that explain your situation:

nUnemployment

n*For FHA ONLY: Unemployed customer not currently receiving benefits

Unemployment start date: _______________________

nExcessive obligations

nIncome reduction/underemployment

nPayment increase

nDivorce or legal separation; separation of customers unrelated by marriage, civil union or similar domestic partnership under applicable law

nDeath of a customer, or death of either the primary or

additional wage earner in the household or a dependent family member

nLong-term or permanent disability; serious illness of a customer, additional customer or a dependent family member

nDisaster (natural or man-made) adversely affecting the property or customer's place of employment

nDistant employment transfer

nBusiness failure

Please send us the documents that apply:

A copy of your benefits statement or letter detailing the amount, frequency and duration of your unemployment benefits.

For FHA, we need:

• An explanation of why the obligations are excessive, and

• Documents that support excessive obligation—including but not limited to monthly billing statements and home repair invoices

No hardship documentation is required as long as you have submitted documents that show your income. If you have an FHA loan, you may need to send more documents.

•Divorce decree or separation agreement signed by the court; or

•Current credit report showing divorce, separation or different address of non-occupying customer; or

•Recorded quitclaim deed showing that the non-occupying customer or additional customer has relinquished all rights to the property

•Death certificate; or

•Obituary or newspaper article reporting the death

Do not send medical records or any details of your illness or disability. Instead, please

send:

•Written statement from you or other documentation verifying disability or illness; or

•Proof of monthly insurance benefits or government assistance (with expiration date, if applicable)

•Insurance claim; or

•Proof of a FEMA grant or Small Business Administration loan; or

•Evidence that customer or employer property is in a federally-declared disaster area

•For active duty Servicemembers: Permanent Change of Station (PCS) orders or letter showing transfer

•For employment transfers/new employment:

•Copy of your signed offer letter, notice from your employer showing transfer to a new location (if applicable), or written explanation from your employer; and

•Documentation that reflects the amount of any relocation assistance provided

•Tax return from the previous year (including all schedules), and

•Proof of business failure supported by one of the following:

•Bankruptcy filing for the business; or

•Two months of recent bank statements for the business account showing that business activity has stopped; or

•Most recent signed and dated quarterly or year-to-date profit and loss statement

Customer

Co-Customer

Contributor

$

$

$

Do you have any existing asset accounts as listed below?

Yes

No

If Yes, please complete this section excluding Retirement

Funds.

TOTAL ASSETS

$

REQUEST FOR MORTGAGE ASSISTANCE FORM

Step 4: Property Information

Loan Number: _____________________________

Number of people in household: ________________

REQUEST FOR MORTGAGE ASSISTANCE FORM

Step 5: Please read carefully and sign

Loan Number: _____________________________

In making this request for consideration, I certify under penalty of

perjury that I understand and agree that:

1.The servicer of my mortgage loan may pull a current credit report for all customers obligated on the Note for the loan.

2.If my liability for the mortgage debt was discharged in a Chapter 7 bankruptcy proceeding after I signed the mortgage documents, or if I am entitled to the protections of any automatic stay in bankruptcy, the servicer is providing information about the mortgage assistance program at my request and for informational purposes, and not as an attempt to impose personal liability for the mortgage debt.

3.If I am eligible for a Trial Period Plan, Repayment Plan or Forbearance Plan, and I accept and agree to all the terms of such a plan, I also agree that the terms of this Acknowledgment and Agreement are incorporated into that plan.

4.If I'm eligible for an assistance option that requires an escrow account to pay taxes and/or insurance and my mortgage loan doesn’t have one, the servicer may establish one. If my loan previously had an escrow account and the servicer agreed to remove this requirement, this agreement has been revoked.

5.All the information in this document is true, and the hardships listed in Step 2 explain why I’m requesting mortgage assistance.

6.The servicer, owner, or guarantor of my mortgage or their agents may investigate the accuracy of my statements and I may need to provide additional documentation.

7.The servicer may directly obtain copies of account statements, including, but not limited to, checking and savings accounts, certificates of deposit (even if held for an extended period of time), mutual funds, money market funds, stocks or bonds, on accounts that are held by the servicer, its subsidiaries and affiliates for the review of my request for mortgage assistance.

8.If I have intentionally defaulted on my existing mortgage or engaged in fraud, or if any of the information I’ve provided is false, I may be ineligible for assistance under applicable investor/insurer programs or guidelines. This includes ineligibility now and for any future benefits and incentives that would otherwise have been available. I also understand that the servicer may recover any benefits or incentives I’ve previously received.

9.The property securing the mortgage I’m requesting assistance for can be lived in and hasn’t been or isn’t at risk of being condemned.

10.The servicer will use the information I provide to determine my eligibility for mortgage assistance, but isn’t obligated to offer me assistance based solely on the statements in this or any other document I send as part of this request.

11.The servicer will collect and record personal information, including my name, address, phone number, Social Security number, credit score, income, payment history and information about account balances and activity. I understand and consent to the disclosure of my personal information and the terms of any mortgage assistance option I receive by the servicer to (a) any investor, insurer, guarantor or servicer of my mortgage loan(s);(b) companies that perform support services in conjunction with any other mortgage relief program; and (c) any HUD-certified housing counselor.

12. The Servicer, Lender, and Other Loan Participants can obtain, use and share tax return information for purposes of (i) providing an offer; (ii) originating, maintaining, managing, monitoring, servicing, selling, insuring, and securitizing a loan; (iii) marketing; or (iv) as otherwise permitted by applicable laws, including state and federal privacy and data security laws. References to “Servicer” and “Lender” in the first sentence shall be deemed to include both parties’ vendors, affiliates, agents, service providers, and any of the aforementioned parties’ successors and assigns. The reference to “Other Loan Participants” in the first sentence shall also include any actual or potential owners of the loan, or acquirers of any beneficial or other interest in the loan, any mortgage insurer, guarantor, any servicers or service providers for these parties and any of the aforementioned parties’ successors and assigns.

13. If I, or someone on my behalf, have submitted a Fair Debt Collection Practices Act cease and desist notice to my Servicer, I withdraw that notice and understand that the servicer must contact me throughout the mortgage assistance process.

14. I consent to being contacted about this request for mortgage assistance at any email address I have provided.

If you have questions about this document or the assistance process, please call Chase. If you have questions about government programs that we cannot answer or you need further counseling, call the Homeowner’s HOPE™ Hotline at 1-888-995-HOPE (4673). The hotline can answer questions about the program and offers free HUD-certified counseling services in English and Spanish.

For a list of HUD-approved counseling agencies that can provide foreclosure prevention information, contact the U.S. Department of Housing and Urban Development (HUD) at 1-800-569-4287 or hud.gov/counseling.