Loan Modification-Questionnaire:
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1 Loan Modification-Questionnaire: Personal Information: Name Date of Birth: Address: County State: Zip Code Telephone: Fax: Mobile: Preferred method of contact: Spouse s Name Date of Birth: Address: County State: Zip Code Telephone: Fax: Mobile: Preferred method of contact: Property Information: Location: Description: Owner Occupied? Page 1 of 6
2 Lender Information: 1 st Bank/Servicer: Loan # Current Loan Balance: Interest rate Date Loan commenced Term of Loan:. Address of Lender: Contact/ bank representative (if known) Telephone: Fax: (if known): Is this Loan guaranteed by Feddie Mac or Fannie Mae? Are you current on your mortgage payments? YES NO, if NO, Please answer the following questions. 1. When did you stop making payments?. 2. Why did you stop making payment? 3. Have your received a Summons & Complaint YES-NO, if YES, please list Index number (located at the top right hand corner of summons) 4. Have you applied for a modification? YES-NO, If YES, a) Date you applied for a modification b) Outcome of your modification request Page 2 of 6
3 2 ND Bank/Servicer: Loan # Current Loan Balance: Interest rate Date Loan commenced Term of Loan:. Is this a home equity loan? Address of Lender: Contact/ bank representative (if known) Telephone: Fax: (if known): Is this Loan guaranteed by Feddie Mac or Fannie Mae? Are you current on your mortgage payments? YES NO, if NO, Please answer the following questions. 1. When did you stop making payments? 2. Why did you stop making payment? 3. Have your received a Summons & Complaint YES-NO, if YES, please list Index number (located at the top right hand corner of summons) 4. Have you applied for a modification? YES-NO, If YES, a) Date you applied for a modification b) Outcome of your modification request BORROWER- Monthly Income 1. Employment Income: Page 3 of 6
4 Do you receive a W-2 for this income? 2. Self-employment Income Do you have financial statements or tax returns that show this income? 3. Other earned income (e.g., bonus, commission, fee, housing allowance, tips, overtime): Please describe Can you document this income? 4. Benefit Income (e.g., social security, disability, workers compensation death benefits, pension, public assistance, adoption assistance) Please describe 5. Unemployment Benefits: 6. Rental income. Is there a lease? Do you claim this income on your tax return? Do you deposit the rental payments in your bank account?. 7. Child Support/ Alimony CO-BORROWER- Monthly Income: 1. Employment Income: Do you receive a W-2 for this income? 2. Self-employment Income Do you have financial statements or tax returns that show this income? Page 4 of 6
5 3. Other earned income (e.g., bonus, commission, fee, housing allowance, tips, overtime): Please describe Can you document this income? 4. Benefit Income (e.g., social security, disability, workers compensation death benefits, pension, public assistance, adoption assistance) Please describe 5. Unemployment Benefits: 6. Rental income. Is there a lease? Do you claim this income on your tax return? Do you deposit the rental payments in your bank account?. 7. Child Support/ Alimony Monthly Household Expenses/debt: (estimated) 1. First Mortgage: 2. Second Mortgage: 3. Insurance: 4. Property tax: 5. Credit Cards/ Installment Loans(s): 6. Alimony/ Child Support: 7. Net Rental Expense: 8. HOA/Condo Fees/ Maintenance: Page 5 of 6
6 9. Car Payments: 10. Auto Insurance: 11. Auto Expenses: 12. Medical Insurance: 13. Other: Additional Information that you feel is relevant to your situation: Questions/Concerns: Page 6 of 6
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