Form 710

UNIFORMBORROWERASSISTANCEFORM
Ifyouareexperiencingatemporaryorlongtermhardshipandneedhelp,youmustcompleteandsubmitthisformalongwith
otherrequireddocumentationtobeconsideredforavailablesolutions.Onthispage,youmustdiscloseinformationabout(1)
youandyourintentionstoeitherkeeportransitionoutofyourhome;(2)theproper
ty’sstatus;(3)realestatetaxes;(4)
homeowner’sinsurancepremiums;(5)bankruptcy;(6)yourcreditcounselingagency,and(7)otherliens,Ifany,onyour
property.
OnPage2youmustdiscloseinformationaboutall
ofyourincome,expensesandassets.Page2alsoliststherequiredincome
documentationthatyoumustsubmitinsupportofyourrequestforassistance.ThenonPage3,youmustcompletethe
HardshipAffidavitinwhichyoudisclosethenatureofyourhardship.TheHardship Affidavitinformsyouoftherequired
documentationthatyoumustsubmitinsupportofyourhardshipclaim.
NOTICE:Inaddition,whenyousignanddatethisform,youwillmakeimportantcertifications,representationsand
agreements,includingcertifying thatalloftheinformationinthisBorrowerAssistanceFormisaccurateandtruthful
andanyidentifiedhardshiphascontributedtoyoursubmissionofthisrequestformortgagerelief.
REMINDER:TheBorrowerResponsePackageyouneedtoreturnconsistsof:(1)thiscompleted,signedanddatedBorrower
AssistanceForm;(2)completedandsignedIRSForm4506TEZ;(3)requiredincomedocumentation,and(4)requiredhardship
documentation.
LoanI.D.Number_________________________(usuallyfoundonyourmonthlymortgagestatement)
Iwantto: KeeptheProperty SelltheProperty
Thepropertyiscurrently: MyPrimaryResidence ASecondHome AnInvestmentProperty
Thepropertyiscurrently: OwnerOccupied Renteroccupied Vacant
BORROWER COBORROWER
BORROWER’SNAME
COBORROWER’SNAME
SOCIALSECURITYNUMBER
DATEOFBIRTH SOCIALSECURITYNUMBER DATEOFBIRTH
HOMEPHONENUMBERWITHAREACODE
HOMEPHONENUMBERWITHAREACODE
CELLORWORKNUMBERWITHAREACODE CELLORWORKNUMBERWITHAREACODE
MAILINGADDRESS
PROPERTYADDRESS(IFSAMEASMAILINGADDRESS,JUSTWRITESAME) EMAILADDRESS
Isthepropertylistedforsale?YesNo
Ifyes,whatwasthelistingdate?___________________
Ifpropertyhasbeenlistedforsale,haveyoureceivedanofferonthe
property?YesNo
Dateofoffer:______________AmountofOffer:$______________
Agent’sName:____________________________________________
Agent’sPhoneNumber:__
__________________________________
ForSalebyOwner?YesNo
Haveyoucontactedacreditcounselingagencyforhelp?YesNo
Ifyes,pleasecompletethecounselorcontactinformationbelow:
Counselor’sName:_____________________________________________
Agency’sName:_______________________________________________
Counselor’sPhoneNumber:_____________________________________
Counselor’sEmailAddress:
_____________________________________________
Doyouhavecondominiumorhomeownerassociation(HOA)fees?YesNo
Totalmonthlyamount:$________________
Nameandaddressthatfeesarepaidto:________________________________________________________________________________________
Haveyoufiledforbankruptcy?YesNo
Ifyes:Chapter7Chapter13FilingDate:_________________________________
Hasyourbankruptcybeendischarged?YesNoBankruptcycasenumber:_____________________
FannieMae/FreddieMacForm710 Page1of4 June2011
Form 710
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