Seterus Borrower Assistance Form – Fill Out and Use This PDF

Loan number: __________________

Borrower Assistance Form

If you are having mortgage payment challenges because of a temporary or long-term hardship, please complete and submit this form, along with the required documentation, to Seterus via mail: PO Box 1077, Hartford, CT 06143-1077, fax: 866.578.5277, or online: www.seterus.com/uploadmydocs. We will follow up and let you know if you’re missing any required information or documents within five business days of receipt.

The requested information is extremely important because it helps us understand your situation, identify the solutions you may be eligible to receive, and consult with you to determine what option may best meet your needs.

If you need help while completing this form, please contact Seterus at 866.570.5277 for assistance.

Borrower Information

Borrower’s name: ___________________________________		Co-Borrower’s name: __________________________________
Social Security Number (last 4 digits): ___________________		Social Security Number (last 4 digits): _____________________
	 Cell		 Cell
Primary phone number: _________________________	 Home	Primary phone number: ___________________________	 Home
	 Work		 Work
	 Cell		 Cell
Alternate phone number: ________________________	 Home	Alternate phone number: __________________________	 Home
	 Work		 Work
E-mail address: _____________________________________		E-mail address: _______________________________________

Is either borrower an active duty service member or the surviving spouse of a service member who was on active duty at the time of death?  Yes  No

Property Information

Property address: _____________________________________________________________________________________________

Mailing address (if different from property address): _________________________________________________________________

The property is currently:	 A primary residence	 A second home	 An investment property
The property is:	 Owner occupied	 Renter occupied	 Vacant
Borrower’s preference:	 Keep the property	 Not keep the property	 Undecided

Is the property listed for sale?  Yes  No; if yes, provide the following: 1) Listing date: ____________________ 2) Listing agent’s

name and phone number—or indicate “for sale by owner” if applicable: _________________________________________________

Is the property subject to condominium or homeowners association (HOA) fees?  Yes  No; if yes, indicate monthly dues $__________

Household Income

	MONTHLY INCOME TYPE AND AMOUNT			REQUIRED DOCUMENTATION
Gross wages, salaries and overtime pay,		$	 Most recent pay stub(s) reflecting 30 consecutive days' or four weeks’
commissions, tips, and bonuses				earnings AND documentation of year-to-date earnings if not on pay stub
Self-employment income		$	 The most recent signed and dated quarterly or year-to-date profit/loss
				statement
Social Security, pension, disability, or		$	 Documentation from the provider showing the amount and frequency of
	death benefits			benefits OR two most recent bank statements showing deposit amounts
Rental income (Rents received, less		$	 Provide a copy of the current lease agreement with either bank
expenses other than mortgage expense)				statements or cancelled rent checks demonstrating receipt of rent
Unemployment income		$	 No documentation required at this time

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					Loan number: __________________
		MONTHLY INCOME TYPE AND AMOUNT			REQUIRED DOCUMENTATION
	Adoption assistance, housing allowance,		$	 No documentation required at this time
	and other public assistance
	Other (e.g. income from alimony*, child		$	 No documentation required at this time
	support*, investments, or insurance)
	_________________________________
	_________________________________
	_________________________________
	Total gross monthly household income		$
	*Not required if you choose not to have it considered for repaying this loan
	Household Assets – excluding retirement funds such as a 401(k) or Individual Retirement Account (IRA) funds
	Checking account(s) and cash on hand					$
	Savings, money market funds, and Certificates of Deposit (CDs)					$
	Stocks and bonds					$
	Other (please describe):					$
	Total assets					$

Hardship Information

The hardship causing mortgage payment challenges began on ____________________________ and is believed to be:

 Short-term (up to 6 months)  Long-term or permanent (greater than 6 months)  Resolved as of: _______________________

	TYPE OF HARDSHIP (CHECK ALL THAT APPLY)			REQUIRED DOCUMENTATION
 Divorce or legal separation			 Final divorce decree or final separation agreement
 Separation of borrowers unrelated by marriage,			 Recorded quitclaim deed or other legally binding agreement evidencing
	civil union, or similar domestic partnership			that the non-occupying borrower or co-borrower has relinquished all
	under applicable law			rights to the property
 Death of borrower or death of either the			 Death certificate
	primary or secondary wage earner
 Distant employment transfer / relocation			 For active duty service members: PCS orders or letter showing transfer.
			 For employment transfers/new employment: Copy of signed offer
				letter or notice from employer showing transfer to a new location OR
			 A written explanation if employer documentation not applicable AND
				documentation that reflects the amount of any relocation assistance
				provided (not required for those with PCS orders)
 Unemployment			 No documentation required at this time
 Reduction in income			 No documentation required at this time
 Increase in housing-related expenses			 No documentation required at this time
 Long-term or permanent disability, serious			 No documentation required at this time
	illness of a borrower/co-borrower or
	dependent family member
 Disaster (natural or man-made) impacting the			 No documentation required at this time
	property or borrower's place of employment
 Other: _______________________________			 Written explanation describing the details of the hardship and relevant
_______________________________________				documentation
_______________________________________
_______________________________________

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Loan number: __________________

Borrower Certification

I certify, acknowledge, and agree to the following:

1.All of the information in this Borrower Assistance Form is truthful, and the hardship I identified contributed to my need for mortgage relief. Knowingly submitting false information may violate Federal and other applicable law.

2.I may be required to provide additional supporting documentation. I will provide all requested documents and will respond in a timely manner to all servicer or authorized third party** communications.

3.My mortgage servicer is not obligated to offer me assistance based solely on the representations in this document or other documentation submitted in connection with my request.

4.The servicer or authorized third party** may obtain a current credit report for the borrower and co-borrower.

5.I consent to the servicer, authorized third party**, or any investor/guarantor, disclosing of personal information collected during the mortgage assistance process, as well as information about any relief I receive, to Fannie Mae, Freddie Mac, or any investor, insurer, guarantor, or servicer of my first lien or subordinate lien (if applicable) mortgage loan(s) or any companies that provide support services to them. Personal information may include, but is not limited to: (a) my name, address, telephone number, (b) my Social Security number, (c) my credit score, (d) my income, and (e) my payment history and information about my account balances and activity.

6.I consent to being contacted concerning this request for mortgage assistance at any telephone number or email address I have provided to the lender/servicer or authorized third party**.

7.If I am eligible for and enter in to a Trial Period Plan for a modification, I agree that payments due will contain escrow amounts. If I was not previously required to pay escrow amounts, and my Trial Period Plan contains escrow amounts, I agree to the establishment of an escrow account and agree that any prior waiver is revoked. Payments due under a repayment plan or forbearance plan may or may not contain escrow amounts. If I was not previously required to pay escrow amounts and my repayment plan or forbearance plan contains escrow amounts, I agree to the establishment of an escrow account and agree that any prior escrow waiver is revoked.

Borrower signature: _____________________________________________	Date: _________________________
Co-Borrower signature: __________________________________________	Date: _________________________

**An authorized third party may include, but is not limited to, a counseling agency, Housing Finance Agency (HFA), or other similar entity that is helping me obtain mortgage assistance.

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