Servicer Name Sen icer's Loan Number

Financial Information Form

Homeowner lnformation Name:
Property Address

Co-Homeowner Information Name:

Property Address (If different from Homeomer)

Mailing Address
Home Nmber Sell Number

Mailing Address (lfdrfferenr liom Homeouner)

Home Nmber Cell NLmber EmDlover: Employer's Number:
:

Fmnlover Emoloyer's Number: No. of Peoole in Household

Have you filed Yes

Bankruptcy?

lf

Yes: Ch 7

Filing Date

No

ch

13

Attomey's Name: Attomey's Phone

Other Mortgage Information

Name of Other Morlcage Companr Other Mortgage Position Monmv Pavmenl:
.

Phone Numbtr to

rach vour Lender:

Pnncrpal Balmce; Are you cunently workrng wlth you lender on payment armqements or workoul oDtions?: f yes, foreclosue date?:

lf delinquent, how mmy months:

ls there a scheduled toreclosure qle dale

Monthlv Income Homeowner

Wases/Take Home Overtime
Commissions,/Bonrrs

Monthlv Income Co-Homeowner

Wases/Take Home Overtime Commissions/Bonus Unemployment lncome Child Srrnnnr,/Alimanv Orher (Please ExDlain
I

Unemployment Income

Child Suooon/Alimonv
Social Securiw,/Disabilitv Other (Please ExDlain)

Total

Total

Monthly Expenses

Retirment. 40lK's etc Insumce(auto, health, life)

Please remember to:

Cu
Expenses (gas, maint, etc) 1, Sign and date this form. 2. Include a copy ofyour most recent pay stubs (2 months), or Bank statements or a copy ofyour last year's Federal Tax Retum with all attachments if self-employed. 3. Include a hardship letter ofwhy you fell bhind and what you would like to do to get caught up.

Automobile Loms List All

Doctor Bills / Medical Bills / RX

Comments:

(please list) examples:

L4Ve cerdry that the financial infomation stated above is true, md is an a@uBte statement of my/our finmcial condition L^Ve undeGtand acknowledge that ay action taken by tle lender ofmy/our mortgage loan on my/our behalfwill be made in strict reliance on the finmcial infomation provided My/Our signature(s) below grmts the holder of my/our mongage the authority to obtain a credit report to veriry the infomation in this financial to be accurare.

md

Home Owner Signature

CrHome Owner Sisnature