Borrower Financial Information

Certificate:_______________________ Loan Number: _____________________ Borrower

Borrower's Name Social Security Number Mailing Address Date of Birth Home Phone Work Phone Cell Phone Best Time to Call Co-Borrower's Name Social Security Number Mailing Address Date of Birth Home Phone Work Phone Cell Phone Best Time to Call

Co-Borrower

Property Information
Property Address: Number of Dependants Do you occupy the property? Yes No No No Is it a rental property? Is it leased?

Yes Yes

No No

Would you like to keep the home? Yes Is the property Listed? Agent's Phone Yes

If yes to either of Above please provide copy of Agreement Agent's Name Agent's Email I do Yes Yes Lender No No

Do you receive, and pay the Real Estate Tax bill on your home or does your lender pay it for you? If you pay the bill, please enclose of copy of your tax and hazard statement Are the taxes current? Do you pay for a hazard insurance policy? Yes No Is that policy current?

Involuntary Inability To Pay

I (We) _________________________________________________ am/are requesting that Triad Guaranty Insurance Corporation (Triad Guaranty) review my/our financial situation to determine if I/we qualify for a workout option. I am having difficulty making my monthly payment because of the financial difficulties created by(please check all that apply) Business Failure Excessive Obligations Moved/Vacated Unemployment Bankruptcy Fraud Military Service Unknown Casualty Loss Illness Other________________ Death Inability to Rent Payment/Rate Adjustment Death in family Inability to Sell Payment Dispute Short Term Distant Employment Transfer Incarceration Servicer Problem Long Term Dissatisfied with Property Martial Problems/Divorce Temporary Loss of Income

Please provide a detailed explanation of the hardship on a separate sheet of paper. Additional Properties
Property Address: Property Address: Property Address: Vacant Occupied Vacant Occupied Vacant Occupied
Monthly Payment Primary

Residence Residence Residence

Second Home Second Home Second Home

Investment Property Investment Property Investment Property

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Monthly Payment Primary

Monthly Payment Primary

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Borrower Financial Information

Certificate:_______________________ Loan Number: _____________________ Borrower
Wages/Frequency of Pay Unemployment Income Disability Income/SSI Rental Income Other Less: Federal and State Tax, FIC Less: Other deductions(401K,etc.) Commissions, Bonus,& Self-employment income Total Income

Co-Borrower $ $ $ $ $ $ $ $ $
Wages/Frequency of Pay Unemployment Income Disability Income/SSI Rental Income Other Less: Federal and State Tax, FIC Less: Other deductions(401K,etc.) Commissions, Bonus,& Self-employment income Total Income

$ $ $ $ $ $ $ $ $

All income must be documented. Current paystubs must be enclosed. Expenses

Monthly mortgage payment Other mortgages/Liens Auto Loans Auto Expenses/Insurance Credit Cards/Installment Loans Health Insurance/Costs (not withheld from pay) Child Care/Alimony/Support Food/Spending Money Phone Expenses/Cell Phone Water/Sewer/Utilities Cable/Satellite HOA/Condo Fees/Property management Life Insurance (not withheld from pay) Other_____________________ Total Expenses

Assets $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
Checking Account Savings/Money Market Stocks/Bonds/CDs IRA/Keogh Accounts 401k/ESPO Accounts Home Value Other Real estate

$ $ $ $ $ $ $ $ $ $

Address :___________________________________________ Cars Owned #

Life Insurance (whole life) Other _________________________

Total Assets

I agree as follows: My lender may discuss, obtain, and share information about my mortgage and personal financial situation with third parties such as purchasers, real estate brokers, insurers, financial institutions, creditor and credit bureaus. Discussions and negotiations of a possible foreclosure alternative will not constitute a waiver of defense to my lender's right to commence or continue any foreclosure or other collection action, and an alternative to foreclosure will be provided only if an agreement has been approved in writing by my lender. The information herein is an accurate statement of my financial status.

Signature of Borrower Date

Signature of Co-Borrower Date

Before mailing or faxing information, make sure you have signed and dated the form and attached appropriate documentation
101 South Stratford Road Winston-Salem, NC 27104 Triad Guaranty Insurance Corporation 800-917-2650 (Fax) 336-723-1001 Email: hope@tgic.com www.triadguaranty.com
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