Fillable Form 1: REQUEST FOR MORTGAGE ASSISTANCE FORM Tell (Chase)

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Form 1: REQUEST FOR MORTGAGE ASSISTANCE FORM Tell (Chase)

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The Form 1: REQUEST FOR MORTGAGE ASSISTANCE FORM Tell (Chase) form is 5 pages long and contains:

  • 2 signatures
  • 49 check-boxes
  • 154 other fields

Country of origin: US
File type: PDF

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REQUEST FOR MORTGAGE ASSISTANCE FORM
Completing this form will help us understand your current situation.
We’ll work with you to find a solution as quickly as possible.
Loan Number: _____________________________
For the purposes of this form, a Customer is someone who is obligated on the Note for the loan or
interested in assuming responsibility for the Note. If another person not on the Note has community
property or similar rights per applicable state law, please provide their name: ______________________________
CUSTOMER
HARDSHIP AFFIDAVIT
DESCRIBE YOUR HARDSHIP: _____________________________________________________________________
Date situation began:
_
______/_______/_______
I believe my situation is:
Temporary
Long term
Check all boxes that explain your situation:
Please send us the documents that apply:
Step 1:
Tell us about you
Unemployment start date:
_______________________
Are you seeking new employment?
Are you available for employment?
For FHA, we need:
•
An explanation of why the obligations are excessive, and
•
Documents that support excessive obligation - including but not
limited to monthly billing statements and home repair invoices
No hardship documentation is required as long as you have submitted documents that
show your income. If you have an FHA loan, you may need to send more documents.
*
For FHA ONLY: Unemployed customer not currently
receiving benefits
Excessive obligations
Income reduction/underemployment
Payment increase
Yes
Yes
No
No
Unemployment
Customer’s
name
Last four digits of Social
Security number
Date
of birth
Mobile or daytime number with area
code
1
Preferred contact method
Text
Voice
Email
Email address
ADDITIONAL CUSTOMER
Step 2:
Help us understand your unique situation
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Divorce or legal separation; separation of customers
unrelated by marriage, civil union or similar domestic
partnership under applicable law
If your mortgage loan is insured or guaranteed by the Federal Housing Administration (FHA) or the Rural Housing
Service (RHS), you are considered to be facing imminent default if your loan is up to date or less than 30 days past
due and you have a hardship that will keep you from making your next mortgage loan payment in the month it’s due.
1
By providing your mobile phone number(s), you are giving Chase and companies working on its behalf permission to contact you at this number about all your Chase or J.P.
Morgan accounts. Your consent permits the use of text messaging, artificial or prerecorded voice messages and automatic dialing technology for informational or account
servicing purposes, but not for telemarketing or sales. Message and data rates may apply. You may contact us anytime to change these preferences.
• Divorce decree or separation agreement signed by the court; or
• Current credit report showing divorce, separation or different address of
non-occupying customer; or
• Recorded quitclaim deed showing that the non-occupying customer or
additional customer has relinquished all rights to the property
Death of a customer, or death of either the primary or
additional wage earner in the household or a dependent family member
• Death certificate; or
• Obituary or newspaper article reporting the death
Long-term or permanent disability; serious illness of a
customer, additional customer or a dependent family
member
Do not send medical records or any details of your illness or disability. Instead,
please send:
• Written statement from you or other documentation verifying disability or illness; or
• Proof of monthly insurance benefits or government assistance (with expiration date, if
applicable)
Disaster (natural or man-made) adversely affecting
the property or customer's place of employment
• Insurance claim; or
• Proof of a FEMA grant or Small Business Administration loan; or
• Evidence that customer or employer property is in a federally-declared disaster area
Distant employment transfer
• For active duty Servicemembers: Permanent Change of Station (PCS) orders or
letter showing transfer
• For employment transfers/new employment:
• Copy of your signed offer letter, notice from your employer showing transfer to a
new location (if applicable), or written explanation from your employer; and
• Documentation that reflects the amount of any relocation assistance provided
• Tax return from the previous year (including all schedules), and
• Proof of business failure supported by one of the following:
• Bankruptcy filing for the business; or
• Two months of recent bank statements for the business account
showing that business activity has stopped; or
• Most recent signed and dated quarterly or year-to-date profit and
loss statement
Business failure
Other (please explain) _______________________________________________________________________________________________
RMA
8/2021
Page 1
Customer’s
name
Last four digits of Social
Security number
Date
of birth
Mobile or daytime number with area
code
1
Preferred contact method
Text
Voice
Email
Email address
A copy of your benefits statement or letter detailing the amount, frequency and duration
of your unemployment benefits.
■
■
Step 3:
Help us determine your options
First and Last Name(s): ____________________________________
Last four digits of SSN: ____________________________________
ADDITIONAL CONTRIBUTOR INFORMATION (Optional)
Does anyone not listed on the loan live in and contribute financially to the household? Yes No
Monthly amount they contribute to the household (including amount contributed to the mortgage): $ ___________________________
MONTHLY HOUSEHOLD INCOME
WAGE:
$ $ $
WAGE:
$ $ $
$ $ $
$ $ $
$ $ $
Gross rents/boarder rents received (Primary recipient)
$ $ $
Unemployment Income Start Date _______ End Date_________
$ $ $
Food stamps/welfare (Primary recipient)
$ $ $
Tips, commissions, bonuses
$ $ $
Other (please specify)____________________________________
$ $ $
Customer Co-Customer Contributor
$ $ $
TOTAL MONTHLY INCOME
All assistance options
Only options that involve moving out of the property
I'm interested in:
REQUEST FOR MORTGAGE ASSISTANCE FORM
Loan Number: _
____________________________
Please indicate any living expenses for this person(s) in
the Contributor column of the Monthly Living Expenses
section of this form (see next page).
For each additional contributor on the property, please complete an Authorization to Obtain Consumer Credit Report form, which you’ll
find in the Forms Center at chase.com/MortgageAssistance. Please also provide proof of the contributor's income.
Employer 1 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you
paid:________
Employer 2 name: __________________________________ Start date: _____/_____/_____
If you work seasonally or in the education field, how many months per year are you
paid:________
Self-employment income:
(Includes 1099 income)
Percentage of business ownership: _______%
Benefits Income:
Social Security benefits, investments, pensions or other retirement benefits
Please specify: ________________________________________
Voluntary Income:
Child support/alimony/separation maintenance
You aren’t required to disclose child support, alimony or separation maintenance income
unless you want us to consider it as qualifying income.
RMA
8/2021
Page 2
0.00
0.00
0.00
ADDITIONAL REQUIRED INFORMATION
MONTHLY LIVING EXPENSES
Expense
Customer(s) Contributor(s)
Food (required field) $ $
Utilities (required field) $ $
Automobile (required field)
(insurance, maintenance, gas)
No automobile
$ $
Life insurance premium $ $
Clothing
$ $
Cable, internet, phone $ $
Medical
$ $
Tuition/school $ $
Child care (daycare, babysitting)
$ $
Child support/alimony
$ $
Total monthly living expenses
$ $
HOUSEHOLD ASSETS
Please provide the most recent statement for each account listed
$
$
$
CDs
$
$
$
Total assets
$
$
Do you have any existing asset accounts as listed below?
Yes
No
If Yes, please complete this
section excluding Retirement
Funds.
$
REQUEST FOR MORTGAGE ASSISTANCE FORM
Loan Number: _
____________________________
Checking account #1
Bank name: ________________________________________________________
Checking account #2
Bank name: ________________________________________________________
Savings/money market #1
Bank name: ________________________________________________________
Savings/money market #2
Bank name: ________________________________________________________
Stocks/bonds
Other cash on hand
Other (please specify) _______________________________________________________
RMA 8/2021 Page 3
0.00
0.00
If you own other properties, please fill out the following section.
OTHER PROPERTIES OWNED
Property address:____________________________________________________________________ Monthly rents received: $______________
1st mortgage servicer name: _______________________________________________________________________________________________
Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________
2nd mortgage servicer name:_______________________________________________________________________________________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:
Vacant Second/seasonal home Owner-occupied Rented
Monthly condominium or HOA fees: $_________________ Comments:_____________________________________________________________
_
_______________________________________________________________________________________________________________________________________________________________
Step 4:
Property Information
Third-Party Authorization:
If you want, you can authorize someone to work with us on your behalf. This is optional.
I/We hereby authorize JPMorgan Chase Bank, N.A., to release, furnish and provide information related to my/our account to:
Name of third party ____________________________________________________ Phone number (________)___________________________
Address of third party____________________________________________________________________________________________________
Property address: ____________________________________________________________________________________
Number of vehicles: _______________
Second Home
Investment
Number of people in household: ________________
The property is my: Primary Residence
The property is: Owner Occupied
Renter Occupied
Vacant
Condominium or HOA fees? Yes No If yes, how much each month? $___________ Are payments up to date? Yes No
Servicer: ______________________________________________________________ Account #: _____________________________________
LIENS, MORTGAGES OR JUDGMENTS (if applicable)
REQUEST FOR MORTGAGE ASSISTANCE FORM
Loan Number: _
____________________________
If any customer or occupant of the property is a military Servicemember who is currently on Active Duty or has been on Active Duty within the last 12
months, or is a dependent of a Servicemember, please call Chase Military Services at 1-877-469-0110.
Please list any other mortgages or liens associated with this property. If you have more than one loan with us, we'll need you to complete a
Request for Mortgage Assistance form for each account you’d like us to review for assistance.
Servicer: ______________________________________________________________ Account #: _____________________________________
Servicer: ______________________________________________________________ Account #: _____________________________________
Customers with more than two additional properties, please download the Schedule of Real Estate Owned form from the
Forms Center at chase.com/MortgageAssistance. Please include the completed form with this application.
Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________
Property address:____________________________________________________________________ Monthly rents received: $______________
1st mortgage servicer name: _______________________________________________________________________________________________
Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________
2nd mortgage servicer name:_______________________________________________________________________________________________
Escrow payment (taxes, insurance, PMI): $___________ Property is:
Vacant Second/seasonal home Owner-occupied Rented
Monthly condominium or HOA fees: $_________________ Comments:_____________________________________________________________
_
_______________________________________________________________________________________________________________________________________________________________
Loan #: __________________________________________________________ Monthly principal and interest payment: $__________________
RMA 8/2021 Page 4
When we receive this form and all required documents, we’ll assign a team of dedicated specialists
to your loan who will call you within five business days to talk about your next steps.
For additional forms, please visit chase.com/MortgageAssistance
Si tiene alguna pregunta sobre asistencia hipotecaria, por favor llame al 1-877-496-3138.
ACKNOWLEDGMENT AND AGREEMENT
By signing this document, I/we certify that all the information is truthful.
I/We understand that knowingly submitting false information may constitute fraud.
Customer Signature______________________________________________________ Date ______/_____/________
Step 5:
Please read carefully and sign
mm
dd
yyyy
REQUEST FOR MORTGAGE ASSISTANCE FORM
Loan Number: _
____________________________
In making this request for consideration, I certify under penalty of
perjury that I understand and agree that:
1. The servicer of my mortgage loan may pull a current credit report for
all customers obligated on the Note for the loan.
2. If my liability for the mortgage debt was discharged in a Chapter 7
bankruptcy proceeding after I signed the mortgage documents, or if I
am entitled to the protections of any automatic stay in bankruptcy, the
servicer is providing information about the mortgage assistance
program at my request and for informational purposes, and not as an
attempt to impose personal liability for the mortgage debt.
3. If I am eligible for a Trial Period Plan, Repayment Plan or Forbear-
ance Plan, and I accept and agree to all the terms of such a plan, I
also agree that the terms of this Acknowledgment and Agreement are
incorporated into that plan.
4. If I'm eligible for an assistance option that requires an escrow
account to pay taxes and/or insurance and my mortgage loan doesn’t
have one, the servicer may establish one. If my loan previously had
an escrow account and the servicer agreed to remove this require-
ment, this agreement has been revoked.
5. All the information in this document is true, and the hardships listed in
Step 2 explain why I’m requesting mortgage assistance.
6. The servicer, owner, or guarantor of my mortgage or their agents may
investigate the accuracy of my statements and I may need to provide
additional documentation.
7. The servicer may directly obtain copies of account statements,
including, but not limited to, checking and savings accounts,
certificates of deposit (even if held for an extended period of time),
mutual funds, money market funds, stocks or bonds, on accounts that
are held by the servicer, its subsidiaries and affiliates for the review of
my request for mortgage assistance.
8. If I have intentionally defaulted on my existing mortgage or engaged
in fraud, or if any of the information I’ve provided is false, I may be
ineligible for assistance under applicable investor/insurer programs or
guidelines. This includes ineligibility now and for any future benefits
and incentives that would otherwise have been available. I also
understand that the servicer may recover any benefits or incentives
I’ve previously received.
9. The property securing the mortgage I’m requesting assistance for
can be lived in and hasn’t been or isn’t at risk of being condemned.
10. The servicer will use the information I provide to determine my
eligibility for mortgage assistance, but isn’t obligated to offer me
assistance based solely on the statements in this or any other
document I send as part of this request.
11. The servicer will collect and record personal information, including
my name, address, phone number, Social Security number, credit
score, income, payment history and information about account
balances and activity. I understand and consent to the disclosure of
my personal information and the terms of any mortgage assistance
option I receive by the servicer to (a) any investor, insurer,
guarantor or servicer of my mortgage loan(s); (b) companies that
perform support services in conjunction with any other mortgage
relief program; and (c) any HUD-certified housing counselor.
12. The Servicer, Lender, and Other Loan Participants can obtain, use
and share tax return information for purposes of (i) providing an
offer; (ii) originating, maintaining, managing, monitoring, servicing,
selling, insuring, and securitizing a loan; (iii) marketing; or (iv) as
otherwise permitted by applicable laws, including state and federal
privacy and data security laws. References to “Servicer” and
“Lender” in the first sentence shall be deemed to include both
parties’ vendors, affiliates, agents, service providers, and any of
the aforementioned parties’ successors and assigns. The reference
to “Other Loan Participants” in the first sentence shall also include
any actual or potential owners of the loan, or acquirers of any
beneficial or other interest in the loan, any mortgage insurer,
guarantor, any servicers or service providers for these parties and
any of the aforementioned parties’ successors and assigns.
13. If I, or someone on my behalf, have submitted a Fair Debt
Collection Practices Act cease and desist notice to my Servicer, I
withdraw that notice and understand that the servicer must contact
me throughout the mortgage assistance process.
14. I consent to being contacted about this request for mortgage
assistance at any email address I have provided.
Additional Customer Signature_____________________________________________ Date ______/_____/________
mm
dd
yyyy
Step 6:
Here’s how to send your documents
Here’s how you can send your information.
After you have submitted your documentation,
please call us at 1-877-496-3138 to let us know.
Overnight Mail:
Chase
720 S. Colorado Blvd., STE 210
Glendale, CO 80246-1904
Regular Mail:
Chase
PO Box 469030
Glendale, CO 80246-9030
Fax:
1-866-282-5682
Online: chase.com
If you have questions about this document or the assistance process, please call Chase. If you have questions
about government programs that we cannot answer or you need further counseling, call the Homeowner’s
HOPE™ Hotline at 1-888-995-HOPE (4673). The hotline can answer questions about the program and offers free
HUD-certified counseling services in English and Spanish.
For a list of HUD-approved counseling agencies that can provide foreclosure prevention information, contact
the U.S. Department of Housing and Urban Development (HUD) at 1-800-569-4287 or hud.gov/counseling.
888-995-
HOPE
TM
Homeowner’s
HOPE
TM
Hotline
RMA
8/2021
Page 5
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Form 1: REQUEST FOR MORTGAGE ASSISTANCE FORM Tell (Chase)

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Completed 1 December 2021

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