Borrower Hardship Loss Mitigation Form

Borrower Hardship Loss Mitigation Form
To provide you with resolution alternatives on your delinquent loan with us, please complete this entire form along with the requested supporting documentation. No package will be processed until ALL items requested are received.

Before you begin to complete this form you should have on hand for each borrower:
- Your latest W-2s
- The last three pay statements from your employer(s)
- If self-employed, the cover page of your last two tax returns and/or last three months of bank statements from your business checking and savings accounts
- Auto Loan balances and monthly payment amount
- Credit Card balances and monthly payment amount
- Student Loan balances and monthly payment amount
- Checking Account Balances
- Savings Account Balances
- Retirement Account Balances
- Life Insurance Cash Values
- A calculator will also be helpful
These documents can be uploaded later in the form or scanned/photographed then emailed to Roz@CreativeNoteSolutions.com. No package will be processed until ALL items requested are received.

If any fields do not apply to you, you may leave them blank.
Borrower 1

First NameLast Name
Email - Borrower 1
example@example.com
Primary Phone - Borrower 1
Please enter a valid phone number.Format: (000) 000-0000.
Borrower 2

First NameLast Name
Email - Borrower 2
example@example.com
Primary Phone - Borrower 2
Please enter a valid phone number.Format: (000) 000-0000.
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Homeowner & Property Questions
Occupancy Status of the Property (Select One)
How many people are living in the property including yourself?
How many occupants are under the age of 18?

Homeowner Fund & Payment Questions
What amount of funds do you have have in the next 10 to 20 days to apply towards your Loan's Past Due Amount?
If your loan can be modified to better fit your current financial situation, what amount of funds will you have towards a modification down payment in the next 30 to 90 days?
What amount of funds do you think you can pay Monthly on the Unpaid Principal Loan Balance?

Third Party Authorization to Release Homeowner's 1st Mortgage/Deed of Trust Account Information
This authorization allows us to coordinate/speak with your primary mortgage company to verify the status of homeowners insurance, property tax status, and other details about your mortgage.
1st Mortgage/Deed of Trust Holder
1st Mortgage/Deed of Trust Loan Account Number
1st Mortgage/Deed of Trust Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Homeowner/Borrower Name (First Borrower)

First NameLast Name
Homeowner/Borrower Name (Second Borrower)

First NameLast Name
Subject Lien's Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I / We hereby authorize you to release to Creative Note Solutions or its agents and assigns, any, and all information or documentation that may be requested about the above-referenced loan/account or the above referenced property. "Agents” shall include, but not be limited to, all real estate agents, attorneys, their assistants, and junior lien holders. A copy of this authorization may be accepted as an original.
Homeowner 1/Borrower 1's Signature
Homeowner 1/Borrower 1's Printed Name
Homeowner 2/Borrower 2's Signature
Homeowner 2/Borrower 2's Printed Name

Homeowner Financial Income Statement
1. Total Monthly Net Income for all borrowers (monthly after taxes and benefits are deducted)
Please upload the most recent W-2 and last three pay stubs for all borrowers. If self-employed, please upload the cover page of your two last tax returns or last three months of primary business checking and savings account bank statements.

Cancelof
2. Total Disability Income
3. Total Rental Income
4. Total Unemployment Income
5. Total Child Support/Alimony Income (you do not need to disclose child support or alimony income if you do not want it to be considered in any solutions we develop)
6. Total Investment or Dividend Income
Add line numbers 1 - 6 to enter your total income below:

Homeowner Financial Expense Statement
1. Monthly Other Mortgage Balance
Are taxes escrowed?
2. If no, what are the monthly property taxes
3. Number of Auto Loans
Total Balance of Auto Loan(s)
Total Monthly Auto Loan Payment(s)
4. Monthly Auto Insurance Allowance
5. Monthly Auto Maintenance Allowance
6. Monthly Auto Fuel Allowance
7. Number of Student Loans
Total Balance of Student Loan(s)
Total of Monthly Student Loan Payment(s)
8. Total Number of Credit Card Accounts
Total Balance of Credit Card Account(s)
Total Monthly Minimum Credit Card Payment(s)
9. Monthly Insurance/Medical Expenses
10. Monthly Child Care Expenses
11. Monthly Child Support/Alimony Expenses (Court Ordered)
12. Total Monthly Utility Payments (Water, Sewage, Gas, Electric, Phones, Cable, Internet)
13. Groceries/Household Supply Expenses
14. Spending Money/Charity
Add monthly payment amounts above to enter your total monthly expenses below:

Financial Assets
What type of personal accounts do you currently have
Upload the last three months of statements for each type of account checked above.

Cancelof

Confirmation
I/We confirm and acknowledge that the information presented herein is true and accurate to my/our knowledge.

I am advised here that submission of this information is not a guarantee that a payment plan of any kind, will be approved. The documentation I provided will be reviewed and verified. This process may take 5-7 business days. It is important that I can be reached during this timeframe to address any questions (if any) which may develop during this review process. I understand that it important to supply this information immediately, as Creative Note Solutions will agree to suspend any further action(s) for the next ten (10) days only, thereby allowing you ample time to respond.
Borrower 1 Signature
Printed Name
Date

MonthDayYear
Date
Borrower 2 Signature
Printed Name
Date

MonthDayYear
Date
THIS IS AN ATTEMPT TO COLLECT FINACIAL INFORMATION FROM THE HOMOWNER(S), IN REFERENCE TO THE MORTGAGE / DEED OF TRUST LIEN, SECURED AGAINST THE PROPERTY. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. In the event you have received a Chapter 7 Bankruptcy Discharge, please be advised that this Loss Mitigation Request solely relates to the Mortgage / Deed of Trust Lien, Secured Against the Property. This Loss Mitigation Package Request shall not in one way be construed as an attempt to collect a personal debt from you or in any way to bind you personally liable for the debt. This Loss Mitigation Package Request shall not be considered a reaffirmation Agreement, as that term is defined by applicable bankruptcy law. This Loss Mitigation Package Request is a required request by the Company, so the Company can put the Homeowner(s) in the best possible payment terms on the Mortgage / Deed of Trust Lien, Secured Against the Property.
Should be Empty:

Borrower Hardship Loss Mitigation Form

Homeowner & Property Questions

Homeowner Fund & Payment Questions

Third Party Authorization to Release Homeowner's 1st Mortgage/Deed of Trust Account Information

Homeowner Hardship Explanation Letter

Homeowner Property Financial Statement

Homeowner Financial Income Statement

Homeowner Financial Expense Statement

Financial Assets

Confirmation