Financial Worksheet for Loan Modification

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									This is a template for a worksheet that can be used by an individual or entity to prove
financial hardship in order to obtain debt relief or loan modification. This template
includes a financial statement of assets and liabilities, household expenses,
authorization for a first and second mortgage, and includes a loan modification
agreement. This document is ideal for individuals or entities that want to prove they are
undergoing financial hardship in order to obtain debt relief or loan modification from a
lender.
                                      Financial Worksheet for Loan Modification
Borrower Name                                                                Social Security #

Co-Borrower Name                                                             Social Security #

Property Address                                                          City                               Sate        Zip

MailingAddress                                                            City                                Sate       Zip

Home Phone                              Work Phone                          Cell                            Fax

Best time to Call                                 Email

Borrower Employer                                                    Full-Time          Part-Time Unemployed Self-Employed Retired

Occupant Employer                                                    Full-Time         Part-Time Unemployed Self-Employed Retired

Borrower Income Frequency                        Weekly      Bi-Weekly       Semi Monthly         Monthly         Quarterly    Yearly

Additional Occupants Income Frequency            Weekly      Bi-Weekly       Semi Monthly         Monthly         Quarterly    Yearly
                                 st                                                    nd
Mortgage Company Name: 1                                                           2
                            st                                                         nd
Loan Number                 1                                                      2



     Income         Borrower Income              Occupant Income                                 Assets / Liabilities
                    Gross      Net               Gross      Net                    Description            Value       Owe               Net
Income                                                                  Auto
Disability                                                              Checking/Saving
Rental                                                                  IRA
Unemployment                                                            401K
Child Support                                                           Stocks/Bond/CDs
Other                                                                   Other
Total                                                                   Total
                                                     Household Liabilities and Expenses
          Expenses                    Payments       Balance Due                   Expenses                  Payments          Balance Due
Alimony Child Support                                                    Clothing
Auto Expense(gas repairs)                                                Dry Cleaning
Child Care/Elder Care                                                    Monthly Parking
Other Mortgages                                                          Club or Union Dues
Education                                                                School or Work Lunch Cost
Medical                                                                  HOA Dues
Pets                                                                     Other
Spending Money                                                           Debts
Other Expenses                                                           Auto Loan
Auto Insurance                                                           Credit Cards
Health Insurance                                                         Installment Loans
Life Insurance                                                           Mortgage Payment
                                                                          nd
Hospital                                                                 2 Loan Payment
Prescriptions                                                            Property Tax & Insurance
Cable                                                                    Personal Loans
Electricity                                                              Other Secured Debts
Gas                                                                      Other Unsecured Debts
Phone/Cell/Internet                                                      Other
Water/Sewage                                                             Total Expense / Debts
            Authorization Form: 1st Mortgage
This form will serve to acknowledge that the captioned mortgagor has authorized our firm,
, to act in their behalf to resolve their mortgage problems. This is in accordance with Title 24 of the CFR
203.500 (HUD).


                                    Mortgagor / Borrower(s)
Borrower Name:

Co-Borrower Name:

Property Street Address:

City, State, Zip:

Borrower Social Security #:

Co-Borrower Social Security #:

                                       Mortgagee / Lender
Lender:

Loan Number:

Current Balance:

Months Behind:

Street Address:

City, State, Zip:

                                     Mortgagor’s Signatures
Borrower Signature:                                               Date:


Co-Borrower Signature:                                            Date:
           Authorization Form: 2nd Mortgage
This form will serve to acknowledge that the captioned mortgagor has authorized our firm,
, to act in their behalf to resolve their mortgage problems. This is in accordance with Title 24 of the CFR
203.500 (HUD).

                                    Mortgagor / Borrower(s)
Borrower Name:

Co-Borrower Name:

Property Street Address:

City, State, Zip:

Borrower Social Security #:

Co-Borrower Social Security #:

                                       Mortgagee / Lender
Lender:

Loan Number:

Current Balance:

Months Behind:

Street Address:

City, State, Zip:

                                     Mortgagor’s Signatures
Borrower Signature:                                               Date:


Co-Borrower Signature:                                            Date:
                        LOAN MODIFICATION PROGRAM AGREEMENT AND
                               LIMITIED POWER OF ATTORNEY


Below are the general terms of the Loan Modification Program.

This is an agreement between you and _________, You are requesting ________ to provide you with loan
modification to your current mortgage including first mortgages and second mortgages. These
arrangements will be made directly with your current mortgage holder.

Loan Modifications will reestablish interest rates, monthly payments, and adjust mortgage balances. Each of
these will be determined by your current lender. You will still be the personal guarantor for this modification
for financing and agree not to apply for any other related funding during this process. You certify that you are
the applicant and all information you have provided is true and accurate. You agree to hold ___________,
harmless from any misrepresentation.

You authorize __________ to act upon your behalf with Limited Power of Attorney in this application
process and verification process, either electronically, verbally, written or otherwise.

Once a term of modification is presented by your lender, it is still your final approval of this new rate, terms
and balances before any program takes effect. There will be no changes to the current status of your loan
without your full written approval to these arrangements.

Loan Modification Fee: this is a onetime fee for the sole purpose for loan modification to the current
lender/lender’s, we guarantee that a loan modification program will be provided for the client, upon
acceptance of these terms you will provide a cashier's check, made payable to __________, in the amount
of $XX.

ACKNOWLEDGEMENT: You understand and agree to all terms of this agreement as well as the Fee
Agreement. This agreement and the interpretation of all its terms shall be governed by and
constructed in accordance with the laws of the State of _________, without regard to its conflicts of
laws and rules. The parties irrevocably submit and consent to the exclusive jurisdiction and venue of
____________ State Courts. The parties waive all rights to a trial by jury and in any action or
proceeding instituted in connection with this agreement. It is understood all information is mutually
proprietary and confidential and will not be disclosed to any other parties.



Signature                                                   Date

Print Name                                                  Social Number

Signature                                                   Date

Print Name                                                  Social Number

								
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