Request Mortgage Assistance Form – Fill Out and Use This PDF

The Request Mortgage Assistance Form is an online request form that anyone can complete with their information in order to apply for a mortgage.

The best place to get access to and use this form is here. Our straightforward PDF editor can help you have your PDF in no time. Virtually any system you prefer, whether it's a PC, laptop, smartphone, or tablet, works extremely well.

Request Mortgage Assistance Form PDF Details

Mortgage assistance is available to homeowners who are struggling to make their monthly mortgage payments. The Request Mortgage Assistance Form can be used to request help from your mortgage lender. The form can be submitted online or by mail. By completing and submitting the form, you will be able to receive information about various programs that may be available to you. You may also be eligible for a loan modification or other assistance program.

Below, you'll discover some information about request mortgage assistance form PDF. You might want to go through it before typing in the gaps.

Question	Answer
Form Name	Request Mortgage Assistance Form
Form Length	5 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 15 sec
Other names	rma form template, sps rma form, online rma, rma pdf form

Form Preview Example

REQUEST FOR MORTGAGE ASSISTANCE FORM

Completing this form will help us understand your current situation.
We’ll work with you to find a solution as quickly as possible.			Loan Number: _____________________________
Step 1: Tell us about you		For the purposes of this form, a Customer is someone who is obligated on the Note for the loan or
		interested in assuming responsibility for the Note. If another person not on the Note has community
		property or similar rights per applicable state law, please provide their name: ______________________________
CUSTOMER			ADDITIONAL CUSTOMER
Customer’s			Customer’s
name			name
Last four digits of Social	Date		Last four digits of Social	Date
Security number	of birth		Security number	of birth
Mobile or daytime number with area	Preferred contact method		Mobile or daytime number with area	Preferred contact method
code1		Text	code1	Text
		Voice		Voice
		Email		Email

Email address			Email address

1By providing your mobile phone number(s), you are giving Chase and companies working on its behalf permission to contact you at this number about all your Chase or J.P. Morgan accounts. Your consent permits the use of text messaging, artificial or prerecorded voice messages and automatic dialing technology for informational or account servicing purposes, but not for telemarketing or sales. Message and data rates may apply. You may contact us anytime to change these preferences.

Step 2: Help us understand your unique situation

HARDSHIP AFFIDAVIT

	DESCRIBE YOUR HARDSHIP: _____________________________________________________________________	Date situation began:
	_______________________________________________________________________________________________	_______/_______/_______
	_______________________________________________________________________________________________	I believe my situation is:
	If your mortgage loan is insured or guaranteed by the Federal Housing Administration (FHA) or the Rural Housing	Temporary
	Service (RHS), you are considered to be facing imminent default if your loan is up to date or less than 30 days past	Temporary
		Long term
	due and you have a hardship that will keep you from making your next mortgage loan payment in the month it’s due.	Long term

Check all boxes that explain your situation:	Please send us the documents that apply:
Unemployment	A copy of your benefits statement or letter detailing the amount, frequency and duration
Unemployment	of your unemployment benefits.
	of your unemployment benefits.
*For FHA ONLY: Unemployed customer not currently	Are you seeking new employment?	Yes	No
receiving benefits	Are you available for employment?	Yes	No
Unemployment start date:_______________________	Are you available for employment?	Yes	No
Unemployment start date:_______________________

	For FHA, we need:
Excessive obligations	• An explanation of why the obligations are excessive, and
Excessive obligations	• Documents that support excessive obligation - including but not

	limited to monthly billing statements and home repair invoices
Income reduction/underemployment	No hardship documentation is required as long as you have submitted documents that
Payment increase	show your income. If you have an FHA loan, you may need to send more documents.
Divorce or legal separation; separation of customers	• Divorce decree or separation agreement signed by the court; or
unrelated by marriage, civil union or similar domestic	• Current credit report showing divorce, separation or different address of
partnership under applicable law	non-occupying customer; or

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

Death of a customer, or death of either the primary or	• Death certificate; or
additional wage earner in the household or a dependent family member	• Obituary or newspaper article reporting the death
Long-term or permanent disability; serious illness of a	Do not send medical records or any details of your illness or disability. Instead,
Long-term or permanent disability; serious illness of a	please send:
customer, additional customer or a dependent family	• Written statement from you or other documentation verifying disability or illness; or
member	• Proof of monthly insurance benefits or government assistance (with expiration date, if
	applicable)
Disaster (natural or man-made) adversely affecting	• Insurance claim; or
the property or customer's place of employment	• 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
Distant employment 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
Business failure	• 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

Other (please explain) _______________________________________________________________________________________________

RMA

8/2021

Page 1

REQUEST FOR MORTGAGE ASSISTANCE FORM

Step 3: Help us determine your options

Loan Number: _____________________________

I'm interested in:	All assistance options
	Only options that involve moving out of the property

	ADDITIONAL CONTRIBUTOR INFORMATION (Optional)
Does anyone not listed on the loan live in and contribute financially to the household?			Yes	No
Monthly amount they contribute to the household (including amount contributed to the mortgage): $ ___________________________
First and Last Name(s): ____________________________________		Please indicate any living expenses for this person(s) in
Last four digits of SSN: ____________________________________		the Contributor column of the Monthly Living Expenses
		section of this form (see next page).

For each additional contributor on the property, please complete an Authorization to Obtain Consumer Credit Report form, which you’ll find in the Forms Center at chase.com/MortgageAssistance. Please also provide proof of the contributor's income.

MONTHLY HOUSEHOLD INCOME

Customer

Co-Customer

Contributor

WAGE:
Employer 1 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you		$	$	$
paid:________		$	$	$
paid:________

WAGE:
Employer 2 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you		$	$	$
paid:________

Self-employment income:
(Includes 1099 income)		$	$	$
Percentage of business ownership: _______%

Benefits Income:
Social Security benefits, investments, pensions or other retirement benefits		$	$	$
Please specify: ________________________________________		$	$	$
Please specify: ________________________________________

Voluntary Income:
Child support/alimony/separation maintenance		$	$	$
You aren’t required to disclose child support, alimony or separation maintenance income		$	$	$

unless you want us to consider it as qualifying income.

Gross rents/boarder rents received (Primary recipient)		$	$	$

Unemployment Income	Start Date _______ End Date_________	$	$	$

Food stamps/welfare (Primary recipient)		$	$	$

Tips, commissions, bonuses		$	$	$

Other (please specify)____________________________________		$	$	$

TOTAL MONTHLY INCOME

$0.00

RMA

8/2021

Page 2

REQUEST FOR MORTGAGE ASSISTANCE FORM

Loan Number: _____________________________

ADDITIONAL REQUIRED INFORMATION

MONTHLY LIVING EXPENSES

Expense	Customer(s)			Contributor(s)

Food (required field)	$		$

Utilities (required field)	$		$

Automobile (required field)	$		$
(insurance, maintenance, gas)	$		$
No automobile

Life insurance premium	$		$

Clothing	$		$

Cable, internet, phone	$		$

Medical	$		$

Tuition/school	$		$

Child care (daycare, babysitting)	$		$

Child support/alimony	$		$

Total monthly living expenses	$	0.00	$	0.00

HOUSEHOLD ASSETS

Please provide the most recent statement for each account listed

Do you have any existing asset accounts as listed below?	Yes If Yes, please complete this
	Yes If Yes, please complete this
	No		section excluding Retirement
			section excluding Retirement
			Funds.

Checking account #1		$
Bank name: ________________________________________________________		$


Checking account #2
Checking account #2		$
Bank name: ________________________________________________________		$


Savings/money market #1		$
Bank name: ________________________________________________________		$

Savings/money market #2

Bank name: ________________________________________________________

CDs

Stocks/bonds

Other cash on hand

Other (please specify) _______________________________________________________

Total assets

$0.00

RMA

8/2021

Page 3

REQUEST FOR MORTGAGE ASSISTANCE FORM

Loan Number: _____________________________

Step 4: Property Information

Property address: ____________________________________________________________________________________

Number of people in household: ________________			Number of vehicles: _______________
The property is my:	Primary Residence	Second Home	Investment
The property is:	Owner Occupied	Renter Occupied	Vacant

If any customer or occupant of the property is a military Servicemember who is currently on Active Duty or has been on Active Duty within the last 12 months, or is a dependent of a Servicemember, please call Chase Military Services at 1-877-469-0110.

LIENS, MORTGAGES OR JUDGMENTS (if applicable)

Please list any other mortgages or liens associated with this property. If you have more than one loan with us, we'll need you to complete a Request for Mortgage Assistance form for each account you’d like us to review for assistance.


Servicer: ______________________________________________________________			Account #: _____________________________________
Servicer: ______________________________________________________________			Account #: _____________________________________
Servicer: ______________________________________________________________			Account #: _____________________________________

Condominium or HOA fees? Yes	No	If yes, how much each month? $___________ Are payments up to date?		Yes	No

If you own other properties, please fill out the following section.

OTHER PROPERTIES OWNED

Customers with more than two additional properties, please download the Schedule of Real Estate Owned form from the

Forms Center at chase.com/MortgageAssistance. Please include the completed form with this application.

Property address:____________________________________________________________________ Monthly rents received: $______________

1st mortgage servicer name: _______________________________________________________________________________________________

Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________

2nd mortgage servicer name:_______________________________________________________________________________________________

Loan #: __________________________________________________________		Monthly principal and interest payment: $__________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:	Vacant	Second/seasonal home	Owner-occupied	Rented

Monthly condominium or HOA fees: $_________________ Comments:_____________________________________________________________

________________________________________________________________________________________________________________________________________________________________

Property address:____________________________________________________________________ Monthly rents received: $______________

1st mortgage servicer name: _______________________________________________________________________________________________

Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________

2nd mortgage servicer name:_______________________________________________________________________________________________

Loan #: __________________________________________________________		Monthly principal and interest payment: $__________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:	Vacant	Second/seasonal home	Owner-occupied	Rented

Monthly condominium or HOA fees: $_________________ Comments:_____________________________________________________________

________________________________________________________________________________________________________________________________________________________________

Third-Party Authorization:

If you want, you can authorize someone to work with us on your behalf. This is optional.

I/We hereby authorize JPMorgan Chase Bank, N.A., to release, furnish and provide information related to my/our account to:

Name of third party ____________________________________________________ Phone number (________)___________________________

Address of third party____________________________________________________________________________________________________

RMA

8/2021

Page 4

REQUEST FOR MORTGAGE ASSISTANCE FORM

Step 5: Please read carefully and sign

Loan Number: _____________________________

ACKNOWLEDGMENT AND AGREEMENT

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 Forbear- ance 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 require- ment, 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.

By signing this document, I/we certify that all the information is truthful.

I/We understand that knowingly submitting false information may constitute fraud.

Customer Signature______________________________________________________ Date ______/_____/________

mm dd yyyy

Additional Customer Signature_____________________________________________ Date ______/_____/________

mm dd yyyy

Step 6: Here’s how to send your documents

When we receive this form and all required documents, we’ll assign a team of dedicated specialists to your loan who will call you within five business days to talk about your next steps.

Here’s how you can send your information. After you have submitted your documentation, please call us at 1-877-496-3138 to let us know.

Overnight Mail:	Regular Mail:	Fax:
Chase	Chase	1-866-282-5682
720 S. Colorado Blvd., STE 210	PO Box 469030	Online: chase.com
Glendale, CO 80246-1904	Glendale, CO 80246-9030	Online: chase.com

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.

For additional forms, please visit chase.com/MortgageAssistance

	-HOPE
-995			TM
888		TM	Hotline
Homeowner’s		HOPE
Homeowner’s

Si tiene alguna pregunta sobre asistencia hipotecaria, por favor llame al 1-877-496-3138.

RMA

8/2021

Page 5

How to Edit Request Mortgage Assistance Form Online for Free

Our PDF editor will make filling in files effortless. It is rather straightforward to update the [FORMNAME] document. Check out these particular actions in order to achieve this:

Step 1: Select the orange "Get Form Now" button on the web page.

Step 2: The form editing page is right now available. You can include text or change current details.

Prepare the rma pdf form PDF and type in the information for every single part:

Note the data in Check all boxes that explain your, Unemployment, For FHA ONLY Unemployed customer, Unemployment start date, Excessive obligations, Income reductionunderemployment, Divorce or legal separation, Please send us the documents that, Are you seeking new employment Are, Yes Yes, No No, For FHA we need, An explanation of why the, No hardship documentation is, and Divorce decree or separation.

rma form Check all boxes that explain your, Unemployment, For FHA ONLY Unemployed customer, Unemployment start date, Excessive obligations, Income reductionunderemployment, Divorce or legal separation, Please send us the documents that, Are you seeking new employment Are, Yes Yes, No No, For FHA we need, An explanation of why the, No hardship documentation is, and Divorce decree or separation blanks to insert

Note the main details in Business failure, Tax return from the previous year, Bankruptcy filing for the, showing that business activity has, Most recent signed and dated, loss statement, Other please explain, and RMA Page section.

Inside the section REQUEST FOR MORTGAGE ASSISTANCE, Im interested in, All assistance options, Loan Number, Only options that involve moving, ADDITIONAL CONTRIBUTOR INFORMATION, Does anyone not listed on the loan, Yes, Monthly amount they contribute to, First and Last Names, Last four digits of SSN, Please indicate any living, For each additional contributor on, MONTHLY HOUSEHOLD INCOME, and Customer, include the rights and obligations of the parties.

Finish by checking these fields and writing the proper particulars: WAGE Employer name Start date, Selfemployment income Includes, Benefits Income Social Security, Voluntary Income Child, You arent required to disclose, Gross rentsboarder rents received, Unemployment Income, Start Date End Date, Food stampswelfare Primary, Tips commissions bonuses, Other please specify, and TOTAL MONTHLY INCOME.

Step 3: If you are done, choose the "Done" button to upload the PDF form.

Step 4: Be sure to keep away from future complications by creating no less than two duplicates of the form.

Request Mortgage Assistance Form – Fill Out and Use This PDF

Request Mortgage Assistance Form PDF Details

Form Preview Example

How to Edit Request Mortgage Assistance Form Online for Free

Watch Request Mortgage Assistance Form Video Instruction

Request Mortgage Assistance Form isn’t the one you’re looking for?

Please rate Request Mortgage Assistance Form

Request Mortgage Assistance Form – Fill Out and Use This PDF

Request Mortgage Assistance Form PDF Details

Form Preview Example

How to Edit Request Mortgage Assistance Form Online for Free

Watch Request Mortgage Assistance Form Video Instruction

Request Mortgage Assistance Form isn’t the one you’re looking for?

Related Documents

Please rate Request Mortgage Assistance Form

Related Resources