Request For Forbearance Template
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1
2REQUEST FOR FORBEARANCE
ALL ITEMS MUST BE COMPLETED OR INDICATE “N/A”
**ANY INCOMPLETE ITEM MAY BE CAUSE FOR DENIAL**
If you are experiencing financial difficulties which prevent you from making timely payments on your loan(s),
you may be eligible for forbearance. FORBEARANCE IS GRANTED AT THE LENDER/OWNER’S OPTION.
Forbearance is provided as an alternative to regular monthly payments. The forbearance is available in
increments up to six (6) months for a maximum of eighteen (18) monthly installments. Accrued and unpaid
interest will be capitalized (added to the principal balance of your loan) and included in a new repayment
schedule which will be reduced by the months of forbearance used. If your account is delinquent, the
forbearance can be used retroactively to cover the period of delinquency.
Please note: ANY NEGATIVE REPORTS THAT WERE SUBMITTED TO ALL NATIONAL CREDIT BUREAUS
WILL NOT BE REMOVED IF THE FORBEARANCE IS APPLIED RETROACTIVELY.
Name __________________________________________________ Last 4 of SSN_________ Loan id(s)_______________________
Address __________________________________________________________________________________________________________
City, State, Zip Code _____________________________________________________________________________________________
Cell Phone ____________________ Work Phone ___________________
Home Phone_________________________
E-Mail Address __________________________________________________________________________________________________
Employment History
Current Employer _________________________________________________ Years Employed _________________________
Address _____________________________________________________________ Phone # __________________________________
Income Asset Summary (PLEASE INCLUDE SUPPORTING DOCUMENTATION)
Monthly Gross Income
$_______________
Checking Account Balance
$_______________
Total Other Monthly Income
$_______________
Savings Account Balance
$_______________
Total Income
$_______________
Mortgage/Rent $______________
Utilities
$______________
Medical/Dental $______________
Food
$______________
Clothing
$______________
Child Care
$______________
Transportation $______________
Entertainment $______________
Insurance
$______________
Miscellaneous
$______________
Misc. Explanation______________
Student Loans
$______________
Credit Cards
$______________
Total Debt
$______________
ARE YOU EMPLOYED BUT EXPERIENCING FINANCIAL DIFFICULTY?
YES
NO
ARE YOU UNEMPLOYED WITH ZERO INCOME?
YES
NO
ARE YOU UNEMPLOYED DUE TO ILLNESS OR DISABILITY?
YES
NO
FORBEARANCE REQUEST DATES: FROM: _____/______/_______
TO: _____/______/_______
MM
DD
YYYY
MM
DD YYYY
Forbearance type
NO PAYMENT
INTEREST ONLY
REDUCED PAYMENT OF: ________________
IF EMPLOYED:
IF UNEMPLOYED:
IF ILLNESS/DISABILITY:
*1040 tax return (most recent year)or * W-2 form (most recent year)or
* statement from physician
*2 wage statements (check stubs)or
* statement from unemployment
regarding illness or disability
*W-2 form (most recent year)
or school placement office
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