Name:
(Your Name)
Address: (Your Address)
Mortgage Co: (Mort. Co.)
Loan No: (your Loan Number)
I/We, (Your Name), are requesting that you review my
financial situation to see if I/We qualify for any workout
option.
I/We are having problems making my monthly
payments because of financial difficulties created by (fill
in with your situation):
Unemployment
Reduced Income
Divorce
Separation
Medical Bills
Too Much Debt
Death of my Spouse
Death of a family member
Payment Increase
Business Failure
Job Relocation
Illness
Damage to Property
Military Service
Incarceration
Other (Please Specify)
This difficulty or situation happened on or about this date
(##/##/####).
I/We believe that my/our situation is
(circle one) Temporary / Permanent
.
This is a brief
account of the situation is as follows: (explain your
situation… tell them you feel you can now afford your
payments)
I/We, (your name), state the information provided above to
be true and correct to the best of my/our knowledge.
Borrower’s Signature Date
_______________________________
Co-Borrower’s Signature
Date
_________________________________