Loan Payment Assistance Form

Loan Payment Assistance Form

Please complete this form if you are experiencing a financial hardship and would like one of our staff members to review alternative options to repaying your loan
1315 Kalaniana'ole Avenue, Hilo, HI 96720 PO Box 210, Waimanalo, HI 96795 808-587-7656 www.hawaiicommunitylending.com
Borrower Name*
Co-Borrower Name
Street Address*
Please identify your financial hardship and submit documentation to verify your hardship: Unemployment letter Death certificate of a household memberIncome loss Household expenses Homelessness Health challenges Unemployment (age 60+) Veteran Widower of less than 2 years Business Revenue Decreased Other:*

Unemployment LetterDeath Certificate of a household memberIncome LossHousehold expensesHomelessnessHealth ChallengesUnemployment (age 60+)VeteranWidower of less than 2 yearsBusiness Revenue DecreasedOther
Please explain why you need to modify your loan with Hawaii Community Lending attach additional documentation if need*
Payment Proposal Based on my financial hardship identified above, I am able and willing to make a monthly loan payment of $*
Certification and authorization

By signing below, we certify that all information provided in this loan modification request form is true and complete to the best of our knowledge. We acknowledge that loan modification approval is not guaranteed. We also understand that it is our sole responsibility to repay any past-due or monthly loan payments as outlined in the original Promissory Note. Failure to do so may result in a negative impact on our credit reports unless we take corrective action.
Borrower Signature*

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Co-Borrower Signature

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