Foreclosure Prevention Intake Form

Transcription

1 Foreclosure Prevention Intake Form PART 1 Date: Client Number: Reason for Visit: How Did You Hear About SCDHC? Applicant: Name: City: State: Age: Lender Realtor SCDHC Mail Website : Zip: Home #: Cell #: : Co-Applicant: Name: City: State: Zip: Home #: Cell #: : Education: None High School GED Vocational College: Associates Bachelors Masters PhD Birthdate: Employer: Gross Income: Part-Time Income: Co-Applicant s Birthdate: Co-Applicant s Gross Income: Rent Own Persons in household: # of Adults # of Children under 18 Richmond Henrico Chesterfield Hopewell Petersburg Male Female American Indian/Alaskan Native Asian African American or Black Native Hawaiian or other Pacific Islander White American Indian & White Asian & White African American & White American Indian & White American Indian & African American (specify): Hispanic Married Single Divorced Widow Disabled 62+ Female Head of Household Veteran Living in Rural Area: Yes No Office Use: > <80 < 50 The cost for our Credit Report is $ If you wish to have your credit report pulled, you may pay by cash, money order, or credit/debit card during your counseling session, or on our website under the make a donation tab. AN APPLICATION FOR DPA CANNOT BE CONSIDERED UNTIL WE RECEIVED A COMPLETE APPLICATION PACKET. Social Security #: Co-Applicant Social Security:

2 SOUTHSIDE COMMUNITY DEVELOPMENT & HOUSING CORPORATION AUTHORIZATION & DISCLOSURE DISCLOSURE Southside Community Development & Housing Corporation is an organization that provides homeownership counseling to homebuyers and foreclosure prevention counseling for homeowners. Southside Community Development & Housing Corporation assists clients through homeownership counseling and education services. There are many real estate brokers, mortgage lenders and mortgage brokers and you, as a client of Southside Community Development & Housing Corporation, are free to choose whomever you please to provide these types of services to you. AUTHORIZATION FORECLOSURE PREVENTION CLIENTS I/We authorize Southside Community Development & Housing Corporation, its staff or representatives, to act on my/our behalf for the purpose of seeking a resolution with regard to the property listed above. I/We authorize our lending institution/mortgage company to fax, mail, or any items requested by Southside Community Development & Housing Corporation in reference to our mortgage delinquency immediately. I understand that Southside Community Development & Housing Corporation provides foreclosure mitigation counseling after which I will receive a written action plan consisting of recommendations for handling my finances, possibly including referrals to other housing agencies as appropriate. I understand that Southside Community Development & Housing Corporation receives Congressional funds through the National Foreclosure Mitigation Counseling (NFMC) program and, as such, is required to share some of my personal information with NFMC program administrators or their agents for purposes of program monitoring, compliance and evaluation. I give permission for NFMC program administrators and/or their agents to follow-up with me for the purposes of program evaluation. I acknowledge that I have received a copy of the Southside Community Development & Housing Corporation Privacy Policy. AUTHORIZATION ALL CLIENTS Pursuant to Public Law 91-50B, Title VI, Section 604 (2) & (3) A & B and Section 610 (a) (d), I/We hereby authorize any Credit Reporting Agency to disclose any consumer credit information to Southside Community Development & Housing Corporation and hereby name Southside Community Development & Housing Corporation as the authorized person of my choosing. I/We authorize them to obtain my credit report for the purpose of discussing and/or negotiating all matters regarding pre- and post-purchase counseling. Additionally, you may discuss my file with /Southside Community Development & Housing Corporation personnel (Law No (d) 1). I understand that I may be referred to other housing services of the organization or another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. A counselor may answer questions and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance. I understand that Southside Community Development & Housing Corporation provides information and education on numerous loan products and housing programs and I further understand that the housing counseling I receive from Southside Community Development & Housing Corporation in no way obligates me to choose any of these particular loan products or housing programs. PRIVACY STATEMENT Southside Community Development & Housing Corporation is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your nonpublic personal information, such as your total debt information, income, living expenses and personal information concerning your financial circumstances will be provided to creditors, program monitors and others only with your authorization and signature on the Counseling Agreement. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs. I acknowledge that this document also serves as Southside Community Development & Housing Corporation's Privacy Policy. ACKNOWLEDGMENT I/we understand that Southside Community Development & Housing Corporation provides information and education on numerous loan products and housing programs and I further understand that the housing counseling I receive from Southside Community Development & Housing Corporation in no way obligates me to choose any of these particular loan products or housing programs. I/we have read and received a copy of this disclosure form. APPLICANT SIGNATURE _ CO-APPLICANT SIGNATURE DATE DATE SOUTHSIDE COMMUNITY DEVELOPMENT & HOUSING CORPORATION 1624 Hull Street Richmond, VA (804) (Phone) (804) (Fax)

3 Mortgage Loan #1 Loan Co Name: Loan #: FHA Case #: Phone#: Fax #: Date Of Purchase: Origination Date: Loan Amt: $ Amt Owed(Principal Balance):$ Assessed Value: $ Interest rate: # Of months Delinquent: List months you are Delinquent: Monthly Payment Amount: $ Payment History: Payment Plan: Amt. to reinstate: $ Cash On Hand: $ APR: Are you in Bankruptcy: (Yes or No) Date Filed: Attorney: Foreclosure Sale Date? (Yes or No) If yes, When? Do you Have Good Faith Estimate Truth in Lending HUD1 Did you read all loan documents? Y / N Where did the closing take place? How long was the closing? Were you solicited for the loan? Y / N Was a Broker involved? Y / N Name of Broker: Name of Broker Company: Mortgage Loan #2 Loan Co Name: Loan #: FHA Case #: Phone#: Fax #: Date Of Purchase: Origination Date: Loan Amt: $ Amt Owed(Principal Balance):$ Assessed Value: $ Interest rate: # Of months Delinquent: List months you are Delinquent: Monthly Payment Amount: $ Payment History: Payment Plan: Amt to reinstate: $ Cash On Hand: $ APR: Are you in Bankruptcy: (Yes or No) Date Filed: Attorney: Do you Have Good Faith Estimate Truth in Lending HUD1 Did you read all loan documents? Y / N Where did the closing take place? How long was the closing? Were you solicited for the loan? Y / N Was a Broker involved? Y / N Name of Broker: Name of Broker Company: Reason for default / Note:

4 FORECLOSURE PREVENTION SERVICES Household's Current Financial Situation Name: Applicant Income source Monthly net income Wages/salary Benefits Food Stamps Child support Co-Applicant Income source Monthly net income Wages/salary Benefits Food Stamps Child support >18yrs Income source Monthly net income Wages/salary Benefits Food Stamps Child support Summary Total Income Total Expense Debt Payment Deficit/Surplus $ Expense Monthly Amount Mortgage Loan 1 Mortgage Loan 2 Mortgage Loan 3 Taxes / Insurance Electricity Gas / Oil Heat Water / Garbage Cable / Satellite Phone Cell Car Payment Car Payment Car Payment Car Insurance Gas / Fares / Parking Car Maintenance Groceries Work Lunches School Lunches Eating Out Toiletries / Cleaning Products Dry Cleaning Laundry Hair Care Pet Care Child Support Child Care Allowances Medical / Life Insurance Medical / Dental Care/Optical Prescriptions Clothing Entertainment Tobacco / Alcohol Subscriptions / On line Gifts Offerings / Donations savings Recreational Credit Cards

5 Guidelines to Create Hardship Letter 1. Identifying information including: o Name o Address o Phone Number o Mortgage account number 2. The first paragraph should state the workout option you are seeking. For example, loan modification/reduction in mortgage payments. 3. Describe your hardship and reasons for it in detail. 4. Give an overview of your income and expenses and explain any anticipated changes in income and/or expenses if any. 5. List reasons why you think the workout option you are seeking will work and your commitment to see it through. 6. Please be sure to sign and date the letter. 7. If you are handwriting you hardship letter, make sure it is legible.

6 Authorization to Obtain Credit Report I hereby authorize Southside Community Development & Housing Corporation to obtain a copy of my credit report to assist in resolving my housing issue. A fax/copy of this authorization form is sufficient. Client Name: (mortgagor primary person on mortgage loan) Social Security #: Date of Birth: Telephone (home): Present Employer: (other): Occupation: Signature: Date: Not Applicable Client Name: (additional person on mortgage loan or spouse) Social Security #: Date of Birth: Telephone (home): Present Employer: (other): Occupation: Signature: Date: *************For office use Only************** Rev Date Completed: _Staff: Score:

7 Southside Community Development & Housing Corporation 1624 Hull Street Richmond, VA FAX Authorization for Release of Information I/We and hereby give permission to SCDHC, and specifically the following certified housing counselors, Felicia Bolling, and Donna Stallings to provide and obtain information from the following lenders and/or persons necessary to assist in the solution of my mortgage account. Property City State: VA Zip Code: Lender(s) with whom I/we have a mortgage loan(s): First Mortgage Loan# Second Mortgage Loan # Third Mortgage Loan # persons or lenders: Signature Last 4 digits of SSN Printed name Date Signature Last 4 digits of SSN Printed name Date I acknowledge that this authorization may be revoked at any time, but not retroactive to information already released in accordance to the authorization. The revocation may be done verbally or in writing.