Loss Mitigation Application Form

Loss Mitigation Application and Agreement

Borrower Name:   Co-Borrower Name:

Loan Account Number:   Servicer Name:

Property Address:

WHEREAS

WHEREAS, Borrower holds a mortgage, deed of trust, or other security instrument (the "Loan") securing the Property and identified by Loan Account Number above; and

WHEREAS, Borrower asserts hardship that materially affects Borrower’s ability to make payments as scheduled and seeks loss mitigation assistance; and

WHEREAS, Servicer has authority to evaluate applications for loss mitigation and may, in its discretion and subject to compliance and verification, offer temporary or permanent alternatives to foreclosure on terms described herein.

SCOPE OF APPLICATION

The Borrower submits this Loss Mitigation Application requesting evaluation of available loss mitigation options. Borrower certifies the information provided is complete and authorizes Servicer to verify employment, income, assets, debts and any other facts relevant to loss mitigation evaluation. The specific services requested and any interim obligations are described below.

REQUESTED LOSS MITIGATION OPTIONS

Please indicate all options you are requesting for consideration:

Loan modification    Repayment plan    Forbearance    Short sale    Deed-in-lieu of foreclosure    Partial claim

HARDSHIP DESCRIPTION

INCOME, ASSETS, AND EMPLOYMENT

MONTHLY EXPENSES

DOCUMENTATION CHECKLIST

Provide or indicate the documents attached to support this application:

Most recent pay stubs    Federal tax returns (2 years)    Bank statements (2 months)    Hardship letter    Recent mortgage statement

PAYMENT TERMS (PROPOSED)

Proposed monthly payment amount:   Payment schedule:

Proposed payment start date:   Proposed late fee or penalty:

Servicer review and acceptance of any proposed payment terms shall be evidenced by a written modification agreement executed by both parties. Until such written modification is executed, Borrower remains obligated under the original loan documents and Servicer retains all rights to pursue foreclosure in accordance with applicable law.

TERM AND TERMINATION

Proposed term start date:   Proposed term end date:

Notice period for termination by either party: days.

This application and any interim offers may be terminated by Servicer upon Borrower’s material misrepresentation, failure to provide documentation, failure to make required interim payments, or upon Servicer’s determination that Borrower is ineligible. Termination does not waive Servicer’s rights under the loan documents.

CONFIDENTIALITY

Borrower information submitted in connection with this application will be used to evaluate loss mitigation options. Servicer will handle personal data in accordance with applicable privacy laws. Notwithstanding the foregoing, Servicer may share information with third parties (including investors, insurers, attorneys, and vendors) to effectuate review and processing of this application. Borrower expressly consents to such disclosures for the purpose of loss mitigation review.

GOVERNING LAW

This Application and any accepted modification executed by the parties shall be governed by and construed in accordance with the laws of the state in which the Property is located, without regard to conflicts of law principles.

ENTIRE AGREEMENT

This Application, together with any written modification agreement executed by Borrower and Servicer, constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior discussions and agreements with respect to loss mitigation for the Loan.

BORROWER CERTIFICATIONS AND AUTHORIZATIONS

By signing below, Borrower certifies under penalty of perjury that the information contained in this Application (including all attachments) is true, accurate and complete to the best of Borrower’s knowledge. Borrower authorizes Servicer to obtain, verify and disclose information concerning Borrower’s employment, income, assets, liabilities and credit history as necessary to evaluate this Application. Borrower understands that making a materially false statement may be a criminal offense and may result in denial of relief or legal action.

Borrower further acknowledges that submission of this Application does not obligate Servicer to offer any loss mitigation option and that any offer of relief will be effective only if memorialized in a separate, signed agreement.

ADDITIONAL ACKNOWLEDGMENTS

Borrower acknowledges receiving and reviewing the required documentation checklist and understands that failure to provide requested documentation within the timeframes specified by Servicer may result in denial or withdrawal of loss mitigation consideration.

Borrower authorizes Servicer and its agents to communicate with Borrower and any designated third parties regarding the status of this Application and any required documentation.

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