Uniform Borrower Assistance Form

Uniform Borrower Assistance Form
Today's Date
MonthDayYear
Date
Borrower's Information
Borrower's Name
First NameLast Name
Borrower's Phone Number
Borrower's Email
example@example.com
Borrower's Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Occupation
Company Name
Co-Borrower's Information
Co-borrower's Name
First NameLast Name
Co-borrower's Phone Number
Co-borrower's Email
example@example.com
Co-borrower's Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Occupation
Company Name
Property Information
Type of property
ResidentialCommercialIndustrialOther
Address Location
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Property Status
Occupied by the ownerOccupied by the renterVacant
What do you want to do with this property?
KeepSellTransferOther
Financial Information
Select the type of hardship you're currently experiencing
UnemploymentDemotion in the current jobIncrease expensesDisasterMedical conditionsDisabilityGlobal pandemicRecessionDeathDivorce or legal separationOther
Monthly Gross Income ($)
Monthly Gross Household Income Total ($)
What are the current assets of the borrower?
Total ($)
Savings accounts
Checking accounts
Investment Stocks
Other
Does the borrower have other sources of income? If yes, please list them below and explain about it.
Self-employment income, unemployment benefit income etc.
What are the expenses of the borrower?
Total ($)
Monthly Rental
Electricity
Water
Internet Connection
Taxes
Upload any supporting documents here
Cancelof
Agreement, Terms, & Conditions
I confirm that all information in this form is accurate and true.I understand that I need to provide all necessary documents required for the request to be completed.I authorized the loan/mortgage servicer to request an updated credit report of the borrower and the co-borrower.I understand that the loan/mortgage servicer have an option to assist me for any documentation related to the application request.I authorized the disclosure by my loan/mortgage servicer of any personal details captured during the application processI understand that I can be contacted via phone or email regarding assistance for mortgage application.
Date Signed
MonthDayYear
Date
Borrower's Signature
Clear
Date Signed
MonthDayYear
Date
Co-borrower's Signature
Clear
Should be Empty:

	Total ($)
Savings accounts
Checking accounts
Investment Stocks
Other

	Total ($)
Monthly Rental
Electricity
Water
Internet Connection
Taxes