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Loan Number: Step 1 - Chase

REQUEST FOR MORTGAGE ASSISTANCE FORMC ompleting this form will help us understand your current 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 orinterested in assuming responsibility for the Note. If another person not on the Note has communityproperty or similar rights per applicable state law, please provide their name : _____CUSTOMERHARDSHIP AFFIDAVITDESCRIBE YOUR HARDSHIP: _____ Date situation began:_____/_____/_____I believe my situation is:TemporaryLong termCheck all boxes that explain your situation:Please send us the documents that apply:Step 1: Tell us about youUnemployment start date: _____ Are you seeking new employment?

document I send as part of this request. 2.If my liability for the mortgage debt was discharged in a Chapter 7 ... 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

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