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Form 1090 Uniform Loan Modification Application
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In order for your loan modification to begin, you will need to provide us with all of the following information requested below. It is EXTREMELY important to submit
a complete package because MISSING INFORMATION WILL DELAY THE PROCESSING OF YOUR REQUEST. Check off each item as you complete it and/or
gather it for your package. This information must be to your representative by the established deadline. It is your responsibility to furnish the information needed to
successfully complete your loan modification package and obtain the best results!
Section I. Checklist
A. Listed below are required sections included in this B. Listed below are required supporting docu ments that must be provided by both the
modification application that must be completed and returned borrower and co-borrower. If you do not have a certain document, provide what you can.
by you.
1. Explanation of Financial Hardship Letter……... Completed 1. Most recent paystubs for all applicants (1 month for each applicant)….. Completed
2. Letter of Explanation (LOE) of All Income…... Completed 2. 2 yr W-2s for all applicants……………………………………………... Completed
3. Borrower, Co-Borrower Info Worksheet …….. Completed 3. Self Employed (S/E) – 2 yr tax returns for all S/E applicants (all pages) Completed
4. Financial Worksheet …...................................... Completed 4. Personal Bank Statements most recent 3 months (all pages) *if S/E
5. Loan Modification Information Worksheet…… Completed Business Bank Statements Most recent 6 months (all pages)…...……… Completed
5. If S/E Profit and Loss statements most recent 6 months……………….. Completed
6. All other income sources must fully be documented (fixed income such
as Social Security/Disability/Unemployment provide most recent award
letters)……………………………………………………………. Completed
7. Signed and dated rental agreement(s) on all properties owned…………. Completed
8. Mortgage statement(s) (1st & 2nd if applicable) on all properties owned.. Completed
9. Copy of Note (all pages) – if you do not have, provide old mortgage
statement (complete prior to last interest adjustment date)…………….. Completed
10. Homeowner Insurance Policies on all properties owned – Declaration
page with premium amount……………………………………………... Completed
11. Property Tax Bills on all properties owned…………………………….. Completed
12. Homeowners Association statement(s) on all properties owned………. Completed
13. Copy of all bills paid monthly (most current) ie..credit cards, loans, Completed
medical, utilities, auto, insurance etc…
Section II. Explanation of Financial Hardship Letter
This form allows you to explain in detail the reason behind your financial situation. In addition to filling out this form you will need to provide any and all proof of
your hardship claim if there are special circumstances beyond your loan recasting (interest rate increasing), such as medical bills, death certificate, unemployment
stubs, divorce decree, etc. If you need additional space to write your hardship, attach an additional page of your continued explanation.
Borrower’s Name (include Jr. or Sr. if applicable): Co-Borrower’s Name (include Jr. or Sr. if applicable):
What event(s) have caused your financial hardship?
What is the term of your hardship (when did it begin and has it ended)?
What is the financial impact of your hardship (estimated expense of hardship, income lost during hardship, etc)?
How long have you been with your current employer? Are there any foreseeable changes in your employment?
How long have you lived at the property? Why do you want to keep the property?
What actions have you taken thus far to resolve your situation? (e.g. obtained additional employment, reduced optional monthly expense such as cable, internet
service, etc.)
ULMA Form 1090 0 Page 1 of 5 Form 1090-V4 -2009
Section III. Letter of Explanation of All Income
Explain all income (After Taxes) that will be utilized to make your modified mortgage payment, and specify such in dollar amounts per month (i.e. $3,000 per
month). In some cases, relatives and other 3rd party income may be considered. If you have income from various sources even if it is not easily documented, provide
information and sources as to such income.
Borrower’s Name (include Jr. or Sr. if applicable): Co-Borrower’s Name (include Jr. or Sr. if applicable):
Explain the circumstances of all the income provided by you below: (i.e. family assistance, recovery from a serious illness or injury, job layoff or termination, etc.)
Provide detailed information on all income that will be used to make your modification payment.
Borrower’s Co-Borrower’s Additional 3rd Party Contributions
Monthly Income: Monthly Income: Not Including Borrower or Co-Borrower
Employment #1 Person A
Gross Pay (Before Taxes) $ $ First and Last Name
Monthly take home pay (After Taxes) $ $ Contact Phone Number
Commission/Bonus (After Taxes) $ $ Relationship
Employment #2 Rent Contribution $
Gross Pay (Before Taxes) $ $ Other Contribution $
Monthly take home pay (After Taxes) $ $ Person B
Commission/Bonus (After Taxes) $ $ First and Last Name
Employment #3 Contact Phone Number
Gross Pay (Before Taxes) $ $ Relationship
Monthly take home pay (After Taxes) $ $ Rent Contribution $
Commission/Bonus (After Taxes) $ $ Other Contribution $
Other Income: Person C
Child Support $ $ First and Last Name
Alimony $ $ Contact Phone Number
Interest Income $ $ Relationship
Social Security $ $ Rent Contribution $
Pension/Retirement Income $ $ Other Contribution $
Disability $ $ Person D
Rental Income #1 $ $ First and Last Name
Rental Property type Residential Commercial Contact Phone Number
Rental Property Address Relationship
Rent Contribution $
Rental Income #2 $ $ Other Contribution $
Rental Property type Residential Commercial
Rental Property Address
Other Income : $ $
Other Income Description
ULMA Form 1090 02/27 Page 2 of 5 Form 1090-V403-20090227
Section IV. Borrower, Co-Borrower Information Worksheet
Property Address You Are Attempting to Get Modified (Subject Property):
Street:
City: State: Zip:
Legal Description Of Property Address You Are Attempting to Get Modified (If available):
Occupancy Status: Are you currently in Chapter 7, or 13 Is the property you’re attempting to modify in
Primary Residence: If so, how long? ____Years ____Months Bankruptcy?: said bankruptcy?:
Secondary Residence Investment Yes No Yes No
Borrower Co-Borrower
Borrower’s Name (include Jr. or Sr. if applicable): Co-Borrower’s Name (include Jr. or Sr. if applicable):
No. Of Dependents: (not listed by Social Security #: No. Of Dependents: (not listed by Social Security #:
Co-Borrower) Borrower)
Borrower’s Marital Status: Co-Borrower’s Marital Status: (Leave blank if you are married to Borrower)
Married Separated Unmarried (single, divorced, widowed) Married Separated Unmarried (single, divorced, widowed
Borrower Home Phone: Best Time to Call: Co-Borrower Home Phone: Best Time to Call:
Borrower Cell Phone: Best Time to Call: Co-Borrower Cell Phone: Best Time to Call:
Borrower Work Phone: Best Time to Call: Co-Borrower Work Phone: Best Time to Call:
Borrower Fax: Co-Borrower Fax:
Borrower Email Address 1: Co-Borrower Email Address 1:
Borrower Email Address 2: Co-Borrower Email Address 2:
Borrower’s Employer: Self Employed Employer Phone #: Co-Borrower’s Employer: Self Employed Employer Phone #:
Job Title: How long employed: Job Title: How long employed:
Years Months Years Months
Current Address (If different than requested Property Address Modified): Current Address (If different than requested Property Address Modified):
Street: Street:
City: State: City: State:
Zip: Own Rent Zip: Own Rent
How Long? Years Months How Long? Years Months
Mailing Address (If different than Property and Current Address): Mailing Address (If different than Property and Current Address):
Street: Street:
City: State: City: State:
Zip: Own Rent Zip: Own Rent
How Long? Years Months How Long? Years Months
ULMA Form 1090 02/27 Page 3 of 5 Form 1090-V414-20090227
Section V. Financial Worksheet (Be as detailed as possible)
Assets Term Based Monthly Expenses General Monthly Expenses
Description Estimated Description Monthly Payment Balance Due Description Monthly Payment
Value
Home
$ 1st Mortgage Payment $ $ Rent $
2nd Mortgage Payment $ $ Child Support $
3rd Mortgage Payment $ $ Alimony $
Real estate taxes (Do not include
if in mortgage payment) $ $ Food $
Homeowner’s insurance (Do not
include if in mortgage payment) $ $ Toiletries $
Other Real Estate
$ 1st Mortgage Payment $ $ Utilities $
2nd Mortgage Payment $ $ Phone(s) $
3rd Mortgage Payment $ $ Child Care $
Real estate taxes (Do not include
if in mortgage payment) $ $ Cable/Satellite $
Homeowner’s insurance (Do not
include if in mortgage payment) $ $ Internet Services $
Automobile #1 HOA Fee
(Total value if sold) $ $ $ Medical Exp. $
Automobile #2 Automobile #1 loan
(Total value if sold) $ $ $ Insurance - Auto $
Checking Accounts Automobile #2 loan
(Current Balance) $ $ $ Insurance - Medical $
Savings/ Student loan(s)
Money market $ $ $ Insurance - Life $
Credit Card #1
IRA account $ $ $ Auto - Gas $
Credit Card #2
401k/ESOP account $ $ $ Auto - Parking $
Stocks, bonds, Credit Card #3
CD’s $ $ $ Auto - Repairs $
Other Investments Credit Card #4
(describe) $ $ $ Dry Cleaning $
Other #1 Credit Card #5 Misc. # 1
(describe) $ $ $ (describe) $
Other #2 Other #1 Misc. # 2
(describe) $ (describe) $ $ (describe) $
Other #3 Other # 2 Misc. # 3
(describe) $ (describe) $ $ (describe) $
Section VI. Loan Modification Work Sheet - First Mortgage (This usually is the largest mortgage on the subject property)
If any item(s) below are unknown you should contact your assigned representative for assistance before your mandatory review appointment.
First Mortgage Company: Current First Mortgage Balance:
$
Account#: Have you modified this loan within the last 12 months?
Yes No
Type Of Loan: Do You Pay Your Taxes & Tax per month: Insurance per month:
Fixed (Fixed Rate Mortgage) Insurance In Monthly Payment?
ARM (Adjustable Rate Mortgage)
NegAm (Negative Amortization) Yes No $ $
Current Mortgage Payment: Original Mortgage Payment: Current Interest Rate: Original Interest Rate:
$ $ % %
When does your interest rate adjust next (the Recast Date)? What will be the new interest rate when it adjusts next (the Recast Rate)?
Date: %
Delinquent Amount: Last Payment Accepted: Number of Payments Behind: Notice of Default (NOD) Filed?
$ $ Yes No I don’t know
ULMA Form 1090 02/27 Page 4 of 5 Form 1090-V414-20090227
Section VI-B. Second Mortgage (Leave blank if not applicable)
If any item(s) below are unknown you should contact your assigned representative for assistance before your mandatory review appointment.
Second Mortgage Company: Current Second Mortgage Balance:
$
Account #: Have you modified this loan within the last 12 months?
Yes No
Type Of Loan: Do You Pay Your Taxes & Tax per month: Insurance per month:
Fixed (Fixed Rate Mortgage) Insurance In Monthly Payment?
ARM (Adjustable Rate Mortgage)
NegAm (Negative Amortization) Yes No $ $
Current Mortgage Payment: Original Mortgage Payment: Current Interest Rate: Original Interest Rate:
$ $ % %
When does your interest rate adjust next (the Recast Date)? What will be the new interest rate when it adjusts next (the Recast Rate)?
Date: %
Delinquent Amount: Last Payment Accepted: Number of Payments Behind: Notice of Default (NOD) Filed?
$ $ Yes No I don’t know
Section VI-C. Estimated Mortgage Modification Budget
Be realistic with the information you provide below. 1st Mortgage 2nd Mortgage (Leave blank if not
applicable)
Maximum estimated affordable payment* per customer’s request:
$ $
Plus Tax:
$ $
Plus Insurance:
$ $
Estimated Term (Length of Loan In Total Months)* (Be realistic):
$ $
Estimated Annual Interest Rate*:
$ $
*DISCLAIMER: The information you provide in the above Estimated Mortgage Modification Budget section is used only for the purpose of assessing your
expectations and in no way implies any guarantee with respect to interest rates, payments and/or principal reductions.
I/We can manage a maximum monthly payment of $ without hardship.
Any higher monthly payment than $ per month, and I/we will be forced to sell or lose my home. I declare that the information provided
above is truthful and accurate.
Section VII. Acknowledgement and Agreement
DISCLAIMER: In order for your loan modification to begin, you are required to provide all of the information requested above. It is EXTREMELY important to
submit a complete package because MISSING INFORMATION WILL DELAY THE PROCESSING OF YOUR REQUEST. Check off each item in the check lists
provided above as you complete or gather it for your package. Normal collection proceedings up to and including foreclosure, will continue during the reviewing
process. It is mandatory that this application be reviewed with your representative during your scheduled phone appointment before proceeding with your loan
modification.
DECLARATION: I(We) declare that the information that has been provided above is truthful and accurate to the best of my (our) knowledge.
Borrower Signature: Date: Co-Borrower Signature: Date:
Internal Use Only
Borrower Name: Client ID:
Representative: Supervisor:
Ron Collins Ron Collins
ULMA Form 1090 02/27 Page 5 of 5 Form 1090-V414-20090227
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