Page 5 of 10
MortgageAssistanceApplicationFirst
Loan Number___________________
Mortgage Assistance Application
IMPORTANT – All sections/fields of the application must be complete. Use “0” or “N/A” if a category doesn’t apply to you.
ALL borrowers on the Note/Loan must provide application information and supporting documentation.
If you are not on the Note/Loan and are completing this application, provide a detailed explanation and relevant documents.
(For example: Divorce Decree, Death Certificate and Probate documents, recorded Quitclaim Deed)
For additional foreclosure prevention information and assistance, including a list of HUD-approved housing counselors, contact:
The US Department of Housing and Urban Development at (800) 569-4287 or www.hud.gov/counseling.
Homeowners’ HOPE Hotline (888) 995-HOPE – Call this hotline and let a HUD-approved housing counselor help you
understand your options, prepare your application, and help you work with PennyMac to complete your paperwork.
Borrower Information
Borrower’s name: ___________________________________
Social Security Number (last 4 digits): ___________________
Daytime phone number: _________________________
Alternate phone number: ________________________
E-mail address: _____________________________________
Co-Borrower’s name: __________________________________
Social Security Number (last 4 digits): _____________________
Daytime phone number: ___________________________
Alternate phone number: __________________________
E-mail address: _______________________________________
Preferred contact method: Phone Email Text
*By providing your cell phone number(s), you are giving PennyMac, and companies working on its behalf, permission to contact you at
this number about any PennyMac account. Your consent permits the use of text messaging, artificial or prerecorded voice messages
and automatic dialing technology. Message and data rates may apply. You may contact us at any time to change these preferences.
Is any borrower an active duty service member, the dependent of an active duty service member, or the surviving spouse or dependent
of a service member, who was on active duty at the time of death? Yes No
Are you working with a 3
rd
party that’s authorized to speak on your behalf during the modification review process? Yes No
If yes, provide: Name_____________________________________________ Phone Number: _______________________
E-mail address: _________________________________________________
Property Information
Property Address: _____________________________________________________________________________________________
Mailing address (if different from property address): _________________________________________________________________
The property is currently:
A primary residence
A second home
An investment property
The property is (select all that apply):
Owner occupied
Renter occupied
Vacant
Number of people in household
_________________
Borrower’s preference:
Keep the property
Sell or transfer the property
Undecided
Is the property listed for sale? Yes No; if yes, provide the listing agent’s name and phone number—or indicate “for sale by
owner” if applicable: _________________________________________________
Is the property subject to condominium or homeowners association (HOA) fees? Yes No. If yes, provide the most recent
account statement and indicate dues and frequency: $_____________ Monthly Quarterly Annually
NOTE: If your homeowners insurance is not included in your mortgage payment, include a copy of your insurance declaration page.
Cell
Home
Work
Cell
Home
Work
Cell
Home
Work
Cell
Home
Work
Page 6 of 10
MortgageAssistanceApplicationFirst
Loan Number___________________
Hardship Information
Hardship is defined as a decrease in income or an increase in expenses that make it difficult for you to afford your mortgage payments.
Answering the following questions will help us better assess your financial hardships and determine what relief options are right for
you.
The hardship causing mortgage payment challenges began on approximately (date) ______________________ and is believed to be:
Short-term (up to 6 months) Long-term or permanent (greater than 6 months) Resolved as of (date) __________________
REQUIRED HARDSHIP DOCUMENTATION
A copy of your benefits statement or letter detailing the amount,
frequency and duration of your unemployment benefits; or
If actively seeking employment, sign Acknowledgement and
Agreement section below. No further documentation required.
Documentation to show decreased income. For example:
Paystubs before and after hardship date reflecting decrease in income
Lay Off/Separation Notice from employer
Loss of child support or alimony benefits
Documentation to support the increased expense. For example:
Uninsured home repairs
Car repairs
Medical bills/receipts (do not provide medical records or details of your
illness/disability)
Do not provide medical records or details of your illness/disability
If you are experiencing a reduction in income due to disability or
illness, provide documentation to show the income change (before
and after the reduction)
If you are experiencing increased expenses due to disability or illness,
provide bills or other documentation that show expense amounts and
duration
Insurance claim documentation, OR
FEMA grant or Small Business Administration loan documents, OR
Customer or employer property in federally-declared disaster area
Final divorce decree or final separation agreement
Recorded quitclaim deed
Legally binding agreement evidencing that the non-occupying
borrower or co-borrower has relinquished all rights to the property
Tax returns from previous year (all schedules) or IRS Form 4506-C(*),
Most recent signed and dated quarterly or year-to-date profit and
loss statement
* IRS Form 4506-C can be obtained from our web-site (pennymac.com) or
the IRS website (www.irs.gov/pub/irs-pdf/f4506c.pdf)
Death certificate or other evidence of death
Proof of transfer OR Military Permanent Change of Station (PCS)
Any relevant documentation to support your hardship not covered
above.
Hardship is defined as a decrease in income or an increase in expenses.
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MortgageAssistanceApplicationFirst
Loan Number___________________
Household Income
MONTHLY TOTAL HOUSEHOLD INCOME TYPE & AMOUNT
REQUIRED INCOME DOCUMENTATION
Are you receiving any form of income?
Yes No
(see “required income documentation”)
Borrower
Co-Borrower
or Income
Contributor
If yes, complete this section and include required
documentation.
If no, provide an explanation.
Gross (pre-tax) wages, salaries and
overtime pay, commissions, tips, and
bonuses
If you’re a teacher, indicate the number
of months you are paid:_____________
$
$
Include paystubs reflecting the most recent 30
days, or four weeks, of earnings for all employers
and
Documentation reflecting year-to-date earnings,
if not reported on the paystubs (signed letter or
print out from employer)
USDA loans (Rural Housing) also require your
most recent W2 or form IRS Form 4506-C (* see
below)
Self-employment income
* 4506-C can be obtained from our
web-site (pennymac.com) or IRS
website (www.irs.gov/pub/irs-pdf/
f4506c.pdf)
$
$
Most recent signed and dated quarterly OR year-
to-date Profit and Loss Statement AND
Most recent complete business tax return OR
Most recent complete and signed individual
federal income tax return OR IRS Form 4506-C (*)
VA loans require 2 years of above documentation
Unemployment income
$
$
Benefits statement or letter detailing the
amount, frequency and duration of
unemployment benefits
Social Security, pension, disability, death
benefits, adoption assistance, housing
allowance, other public assistance
$
$
Award letters, Benefit Statement or other
documentation showing the amount and
frequency of the benefits OR
Two most recent bank statements showing direct
deposit amounts (or 2 recent cancelled checks)
Rental income (Rents received, less
expenses other than mortgage)
If taxes, insurance and HOA are not
included in your mortgage, provide copies
of most recent bill(s)
$
$
Lease Agreement AND Mortgage Statement
Two most recent bank statements
demonstrating receipt of rent OR
Two most recent cancelled rent checks
Is rental income likely to continue for 12 months
minimum? Yes No
Investment or insurance income
$
$
Two most recent investment statements OR
Two most recent bank statements supporting
receipt of the income
Other income (You are not required to
disclose Child Support, Alimony or
Separation Maintenance income, unless
you choose to have it considered as
income for your loan assistance request)
$
$
Two most recent bank statements showing
receipt of income OR
Other documentation showing the amount and
frequency of the income
Household Assets – excluding retirement funds such as a 401(k) or Individual Retirement Account (IRA), and college savings
accounts, such as a 529 plan.
Checking account(s) and cash on hand Savings, money market funds, and Certificates of Deposit (CDs)
$
Stocks and bonds (non-retirement accounts), Other (e.g. other real estate you own):
$
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MortgageAssistanceApplicationFirst
Loan Number___________________
Recent Employment Information
Provide prior 12 months of employment (VA loans require 24 months). Attach an additional page if needed.
BORROWER
CO-BORROWER
Are you currently employed?
(Y/N)
Are you self-employed?
(Y/N)
Are you currently employed?
(Y/N)
Are you self-employed?
(Y/N)
Current/Most recent employer name:
Current/Most recent employer name:
Business Address:
Business Address:
Business Phone #:
Business Phone #:
Monthly Income (before tax): $
Monthly Income (before tax): $
Start Date
(MM/DD/YY):
End Date
(MM/DD/YY):
Start Date
(MM/DD/YY):
End Date
(MM/DD/YY):
Prior Employer Name :
Prior Employer Name:
Business Address:
Business Address:
Business Phone #:
Business Phone #:
Monthly Income (before tax): $
Monthly Income (before tax): $
Start Date
(MM/DD/YY):
End Date
(MM/DD/YY):
Start Date
(MM/DD/YY):
End Date
(MM/DD/YY):
Expense Information
Provide monthly amounts below. (We may require supporting documentation.)
Expense Category
N/A
Monthly Payment
Expense Category (cont)
N/A
Monthly Payment
Child Care
$
Sewer
$
Personal Loans
$
Auto Gas
$
Groceries
$
Auto Insurance
$
Gas for home
$
Uninsured Medical Expenses
$
Water and Electric
$
Life Insurance (not deducted
from paycheck)
$
Home Phone
$
Health Insurance (not
deducted from paycheck)
$
Cell Phone
$
Child Support
$
Cable / Internet
$
Alimony
$
Trash
$
Other (specific)
$
Page 9 of 10
MortgageAssistanceApplicationFirst
Loan Number___________________
Acknowledgment and Agreement
I certify, acknowledge, and agree to the following:
1. All of the information in this Mortgage Assistance Application is truthful, and the hardship I identified contributed to my need for
mortgage relief. Knowingly submitting false information may violate Federal and other applicable law.
2. I may be required to provide additional supporting documentation. I will provide all requested documents no later than the due
date specified in the document request.
3. PennyMac will use the information I am providing to determine if I’m eligible for mortgage assistance, but PennyMac isn’t
obligated to offer me assistance based solely on the statements in this or any other document I’ve sent as part of this request.
4. PennyMac or its authorized agents may obtain a current credit report for me.
5. I consent to the disclosure by PennyMac, and its authorized agents, of any of my personal information collected during the
mortgage assistance process and information about any relief I receive, to any investor, insurer, guarantor, or servicer of my
mortgage loan(s) or any companies that provide support services to them. Personal information may include, but is not limited
to: (a) my name, address, telephone number; (b) my Social Security number; (c) my credit score; (d) my income; and (e) my
payment history and information about my account balances and activity.
6. The property securing the mortgage for which I’m requesting assistance is able to be lived in and hasn’t been or isn’t at risk of
being condemned.
7. If I, or someone on my behalf, instructed PennyMac to stop contacting me about my mortgage loan, I withdraw that instruction
so that I may apply for mortgage assistance.
8. If I’m eligible for an assistance option that requires an escrow account to pay property taxes and/or hazard insurance and my loan
didn’t have one, PennyMac may establish one to make tax and/or insurance payments on my behalf.
9. I consent to being contacted concerning this application for mortgage assistance at any telephone number, including mobile
telephone number, or email address I have provided to PennyMac or its authorized agents
10. I understand that if I have misrepresented any fact(s) in connection with this document, PennyMac may cancel any Agreement,
proceed with foreclosure on my home, and/or pursue any other available legal remedies.
Borrower signature: _____________________________________________ Date: _________________________
Co-Borrower signature: __________________________________________ Date: _________________________
Non-Borrower (Income Contributor) Authorization Form (If indicated on Income page)
The undersigned Non-Borrower authorizes PennyMac
Loan Services, LLC to obtain, share, and release, as provided above, his/her public
and non‐public personal information including (but not limited to) the name, address, telephone number, social security number, credit score,
credit report, income, government monitoring information, loss mitigation application status, account balances, program eligibility, and payment
activity of the Non-Borrower.
I reside in the home at ______________________________________________ and request my income be included in the review for a modification
on the loan secured by the property address that is the subject of this application for mortgage assistance. I consent to allow PennyMac or its
authorized agents to order a current credit report for me in connection with this application for mortgage assistance.
________________________/____________________/_____________________/$__________________/________________________/_____
Name Relationship to Borrower Social Security Number Contribution Amount Signature Date
________________________/____________________/_____________________/$__________________/________________________/_____
Name Relationship to Borrower Social Security Number Contribution Amount Signature Date
Page 10 of 10
MortgageAssistanceApplicationFirst
Loan Number___________________
Important Information
Property Valuation
We may order an appraisal or other forms of valuations to determine the property's value in the course of reviewing your
application. If we do order any valuations in connection with the application in determining whether your loan qualifies for
a loan modification, a copy of the valuation(s) will be provided to you.
Beware of Scams
Please beware of foreclosure rescue scams. Foreclosure rescue and mortgage modification scams are a growing problem
that could cost you thousands of dollars – or even your home. Scammers make promises they cannot keep, such as
guaranteeing to “save” your home or lower your mortgage, usually for a fee, and often pretending they have direct contact
with PennyMac – which they do not.
Beware of anyone who asks you to pay a fee in exchange for counseling services or the modification of a delinquent
loan.
Beware of people who pressure you to sign papers immediately or who try to convince you that they can “save”
your home if you sign or transfer over the deed to your house.
Do not sign over the deed to your property to any organization or individual unless you are working directly with
PennyMac to forgive your debt.
Never make a mortgage payment to anyone other than PennyMac without our approval.
If you think you have been scammed, please go to www.preventloanscams.org or call (888) 995-HOPE.