NOTICE TO BORROWERS
1. That all of the information in this document is truthful and the event(s) identified on page 1 is/are the reason that I
need to request a modification of the terms of my mortgage loan, short sale or deed-in-lieu of foreclosure.
2. I understand that the Servicer, the U.S. Department of the Treasury, or their agents may investigate the accuracy of my
statements and may require me to provide supporting documentation. I also understand that knowingly submitting false
information may violate Federal law.
3. I understand the Servicer will pull a current credit report on all borrowers obligated on the Note.
4. I understand that if I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any
fact(s) in connection with this document, the Servicer may cancel any Agreement under Making Home Affordable and
may pursue foreclosure on my home.
5. That: my property is owner-occupied; I intend to reside in this property for the next twelve months; I have not received
a condemnation notice; and there has been no change in the ownership of the Property since I signed the documents
for the mortgage that I want to modify.
6. I am willing to provide all requested documents and to respond to all Servicer questions in a timely manner.
7. I understand that the Servicer will use the information in this document to evaluate my eligibility for a loan modification
or short sale or deed-in-lieu of foreclosure, but the Servicer is not obligated to offer me assistance based solely on
the statements in this document.
8. I am willing to commit to credit counseling if it is determined that my financial hardship is related to excessive debt.
9. I understand that the Servicer will collect and record personal information, including, but not limited to, my name,
address, telephone number, social security number, credit score, income, payment history, government monitoring
information, and information about account balances and activity. I understand and consent to the disclosure of my
personal information and the terms of any Making Home Affordable Agreement by Servicer to (a) the U.S. Department
of the Treasury, (b) Fannie Mae and Freddie Mac in connection with their responsibilities under the Homeowner
Affordability and Stability Plan; (c) any investor, insurer, guarantor or servicer that owns, insures, guarantees or services
my first lien or subordinate lien (if applicable) mortgage loan(s); (d) companies that perform support services in
conjunction with Making Home Affordable; and (e) any HUD-certified housing counselor.
If you have questions about the program that your servicer cannot answer or need further counseling,
you can call the Homeowner’s HOPE™ Hotline at 1-888-995-HOPE (4673). The Hotline can help with questions about
ACKNOWLEDGEMENT AND AGREEMENT
Be advised that by signing this document you understand that any documents and information you submit to your servicer in connection with the Making
Home Affordable Program are under penalty of perjury. Any misstatement of material fact made in the completion of these documents including but not
limited to misstatement regarding your occupancy in your home, hardship circumstances, and/or income, expenses, or assets will subject you to potential
criminal investigation and prosecution for the following crimes: perjury, false statements, mail fraud, and wire fraud. The information contained in these
documents is subject to examination and verification. Any potential misrepresentation will be referred to the appropriate law
enforcement authority for investigation and prosecution. By signing this document you certify, represent and agree that:
“Under penalty of perjury, all documents and information I have provided to Lender in connection with the Making Home
Affordable Program, including the documents and information regarding my eligibility for the program, are true and correct.”
If you are aware of fraud, waste, abuse, mismanagement or misrepresentations affiliated with the Troubled Asset Relief Program,
please contact the SIGTARP Hotline by calling 1-877-SIG-2009 (toll-free), 202-622-4559 (fax), or www.sigtarp.gov. Mail can be sent
to Hotline Office of the Special Inspector General for Troubled Asset Relief Program, 1801 L St. NW, Washington, DC 20220.
HOMEOWNER’S HOTLINE
Borrower Signature Date
Co-Borrower Signature Date
page 3 of 3
REQUEST FOR MODIFICATION AND AFFIDAVIT (RMA) page 3 COMPLETE ALL THREE PAGES OF THIS FORM