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Affidavit of Hardship

This request correspondence has been sent to:

1. Federal Corona Virus Task Force

2. North Carolina State Representative

3. Department of Justice
Criminal Section
Civil Rights Division
950 Pennsylvania Avenue NW
Washington, DC 20530

Hardship Request form submitted by ________________________________

Address: _______________________________________________________

To: Company Name:

Company Address:

Electronic Signature Legally Binding

1. UNCITRAL Model Law on Electronic Commerce, Articles 5, 6, and 7.
3. This e-mail legal notice is enforceable and binding on the recipient / addressee in terms of sections 11(1) to 11(3)
of the Electronic Communications and Transactions (“ECT”) Act 25 of 2002.

I, _________________________________________ am experiencing financial hardship due to the

current state of emergency/ Corona Virus. This affidavit of Hardship is pursuant to the following
Congressional Act.

H.R. 748: Coronavirus Aid, Relief, and Economic Security Act

Protections against foreclosures and evictions

The bill includes housing protections against foreclosures on mortgages and evictions for renters.
The bill states that anyone facing a financial hardship from coronavirus shall be given a
forbearance on a federally backed mortgage loan of up to 60 days, which can be extended for
four periods of 30 days each. The legislation says that servicers of federally backed mortgage
loans may not begin the foreclosure process for 60 days from March 18.
The bill also does not allow fees, penalties or additional interest to be charged as a result of
delayed payments. It includes similar protections for those with multifamily federal mortgage
loans, allowing them to receive a 30-day forbearance and up to two 30-day extensions.
Those with federally backed mortgage loans who have tenants would also not be allowed to evict
tenants solely for failure to pay rent for a 120-day period, and they may not charge fees or
penalties to tenants for failing to pay rent.

Hardship Relief Request Form

Today’s Date: ___________________
Mortgage/ Rental Company: _______________________________________________
Mortgagee/ Renter_______________________________________________________
Address: _______________________________________________________________
Amount: ______________________________________
Email: ________________________________________


I have been directly impacted by COVID-19 and am experiencing a financial hardship. I am

looking for assistance with regard to paying the rent referenced above. I/we are interested in
deferring 4 (#) payments. We understand that loan interest continues to accumulate and the term
of the loan/rent will be extended as a result of this deferment.

Please explain your hardship in the space provided:






By signing the Disaster Relief Request Form below, I/we agree that
__________________________________________ may discuss or obtain information about my
loan/rent and financial situation from a third party.

I/We affirm that the information provided in the Financial Statement and Hardship Affidavit of
the Loss Mitigation Disaster Relief Request Form and the information provided in the supporting
documentation is true and correct to the best of my/our knowledge:

X _____________________ _____________
Borrower/ Renter Signature Date

X ________________________________________________________________ _________________
Co-Borrower/ Renter Signature Date