CONTRIBUTOR FORM
Contributor Acknowledgement and Agreement
1I certify that all of the information in this Contributor Package is truthful.
2I understand and acknowledge that the Servicer, the U.S. Department of the Treasury, the owner or guarantor of the mortgage loan, or their respective agents may investigate the accuracy of my statements, may require me to provide additional supporting documentation and that knowingly submitting false information may violate Federal and other applicable law.
3Although I am not a borrower on the loan for which modification assistance is requested, I currently occupy the property encumbered by the mortgage/deed of trust and agree that my income will be considered in the borrower’s request to obtain modification assistance.
4I authorize and give permission to the Servicer, the U.S. Department of the Treasury, and their respective agents, to pull my credit report to verify occupancy status.
5I certify that the residence I am contributing to is a habitable residential property that is not subject to a condemnation notice.
6I certify that I am willing to provide all requested documents and to respond to all Servicer communications in a timely manner. I understand that time is of the essence.
7I understand that the Servicer will use this information to evaluate the borrower for available relief options and foreclosure alternatives, but the Servicer is not obligated to offer assistance based solely on the representations in this document or other documentation submitted in connection with the request.
8I understand that the Servicer will collect and record personal information that I submit in this contributor package during the evaluation process, including, but not limited to, my name, address, telephone number, social security number, credit score, income, payment history, and information about my account balances and activity. I understand and consent to the Servicer’s disclosure of my personal information and the terms of any relief or foreclosure alternative that I receive to any investor, insurer, guarantor, or servicer that owns, insures, guarantees, or services my first lien or subordinate lien (if applicable) mortgage loan(s) or to any HUD-certified housing counselor.
9I consent to being contacted concerning this request for mortgage assistance at any e-mail address or cellular or mobile telephone number I have provided to the Servicer. This includes text messages and telephone calls to my cellular or mobile telephone.
The undersigned certifies under penalty of perjury that all statements in this document are true and correct.
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Contributor Signature |
Social Security Number |
Date of Birth |
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