"Forbearance Request Form - Campus Partners"

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C
P
AMPUS
ARTNERS
FORBEARANCE REQUEST
READ BEFORE COMPLETING FORM. ALL BLOCKS MUST BE COMPLETED OR INDICATED
“N/A” IF NOT APPLICABLE. INCOMPLETE ITEMS WILL BE CAUSE FOR REJECTION.
If you are experiencing financial difficulties which prevent you from making timely payments on your loan(s), you may be eligible for a
forbearance arrangement. Forbearance is granted at the lender’s option. The following option is provided as an alternative to regular
monthly payments for borrowers. This option is available for six (6) month periods per request and can be renewed upon submission
of a new form. This option is available for a period of 12 months or 24 months depending on your loan program. Accrued and unpaid
interest will be included in the repayment schedule once the forbearance period has ended. If your account is delinquent, the
forbearance to cover the delinquent period will be included in the six (6) month forbearance request.
Return Completed Form To:
BORROWER NAME ______________________________
Campus Partners
P.O. Box 1830
ADDRESS ______________________________________
Winston-Salem, NC 27102-1830
CITY _____________________ STATE _____ ZIP ______
1-800-315-4950
Fax: 336-607-2093
TELEPHONE (DAY) (___) ________________ TELEPHONE (EVENING) (___) _______________
SOCIAL SECURITY NUMBER _______________________
Do You ( ) Rent ( ) Own
If renting, Landlord’s Name __________________________ Telephone Number (___)___________
BORROWER FINANCIAL DATA
EMPLOYER NAME
ADDRESS
CITY
STATE
ZIP
NET MONTHLY SALARY $
OTHER INCOME $
SOURCE OF OTHER INCOME
REASON FOR REQUEST
Unemployment
Illness
Other
(Describe)
FORBEARANCE REQUESTED FROM
/
/
TO
/
/
MM DD YY
MM DD YY
If you have previously applied and been approved for six (6) months of forbearance, you must submit the following additional
documentation: 1040 tax return (most recent year), W-2 form(s) (most recent year); and detailed list of revenues and expenses. If this
information is not included with your request for an additional six (6) months of forbearance, the request may be denied.
I certify that I am unable to make payments according to the present term of my loan. I further understand that any unpaid interest will
be added to my outstanding balance at the end of the forbearance period. My monthly payments will be calculated at the end of the
forbearance based on the then principal balance including any accrued and unpaid interest. I understand that should my situation
under which I applied for forbearance change, I must notify Campus Partners.
The information is true and correct to the best of my knowledge.
BORROWER’S SIGNATURE
DATE
FOR OFFICE USE ONLY
Interest-only Payments
Accrued Interest & Capitalize
Approved θ Denied θ
Date Received
Examiner
forbearance request/Campus Partners-Self Insured (8-06)
C
P
AMPUS
ARTNERS
FORBEARANCE REQUEST
READ BEFORE COMPLETING FORM. ALL BLOCKS MUST BE COMPLETED OR INDICATED
“N/A” IF NOT APPLICABLE. INCOMPLETE ITEMS WILL BE CAUSE FOR REJECTION.
If you are experiencing financial difficulties which prevent you from making timely payments on your loan(s), you may be eligible for a
forbearance arrangement. Forbearance is granted at the lender’s option. The following option is provided as an alternative to regular
monthly payments for borrowers. This option is available for six (6) month periods per request and can be renewed upon submission
of a new form. This option is available for a period of 12 months or 24 months depending on your loan program. Accrued and unpaid
interest will be included in the repayment schedule once the forbearance period has ended. If your account is delinquent, the
forbearance to cover the delinquent period will be included in the six (6) month forbearance request.
Return Completed Form To:
BORROWER NAME ______________________________
Campus Partners
P.O. Box 1830
ADDRESS ______________________________________
Winston-Salem, NC 27102-1830
CITY _____________________ STATE _____ ZIP ______
1-800-315-4950
Fax: 336-607-2093
TELEPHONE (DAY) (___) ________________ TELEPHONE (EVENING) (___) _______________
SOCIAL SECURITY NUMBER _______________________
Do You ( ) Rent ( ) Own
If renting, Landlord’s Name __________________________ Telephone Number (___)___________
BORROWER FINANCIAL DATA
EMPLOYER NAME
ADDRESS
CITY
STATE
ZIP
NET MONTHLY SALARY $
OTHER INCOME $
SOURCE OF OTHER INCOME
REASON FOR REQUEST
Unemployment
Illness
Other
(Describe)
FORBEARANCE REQUESTED FROM
/
/
TO
/
/
MM DD YY
MM DD YY
If you have previously applied and been approved for six (6) months of forbearance, you must submit the following additional
documentation: 1040 tax return (most recent year), W-2 form(s) (most recent year); and detailed list of revenues and expenses. If this
information is not included with your request for an additional six (6) months of forbearance, the request may be denied.
I certify that I am unable to make payments according to the present term of my loan. I further understand that any unpaid interest will
be added to my outstanding balance at the end of the forbearance period. My monthly payments will be calculated at the end of the
forbearance based on the then principal balance including any accrued and unpaid interest. I understand that should my situation
under which I applied for forbearance change, I must notify Campus Partners.
The information is true and correct to the best of my knowledge.
BORROWER’S SIGNATURE
DATE
FOR OFFICE USE ONLY
Interest-only Payments
Accrued Interest & Capitalize
Approved θ Denied θ
Date Received
Examiner
forbearance request/Campus Partners-Self Insured (8-06)
INCOME & EXPENSES SUMMARY
The following information is requested to determine your eligibility for hardship/unemployment deferment, forbearance, or a revision of your
repayment schedule. The information you provide will remain confidential, however, we reserve the right to use this information if collection efforts
become necessary. We also reserve the right to use a credit report to verify the information you provide.
Name:
Account Number(s):
______________________
Address:
Telephone: __________________________ (home)
Date of Birth:
______________________
__________________________ (work)
Social Security Number:
______________________
__________________________ (cell)
1. Marital Status:
6. Monthly Expenses:
Single
Rent/Mortgage:
$ ________
Married
Utilities:
$ ________
Widow(er)
Separated/Divorced
Child Care:
$
2. Number of Dependents: ______
Car Payments:
$ ________
Relationship:
______________ Age:
______
Other Vehicle(s)
$ ________
______________
______
Public Transportation:
$ ________
______________
______
Insurance:
$ ________
______________
______
Telephone:
$ ________
3. Monthly Income from ALL Sources*:
Cellular Phone/Pager:
$ ________
Gross Monthly Salary/Wages
$ ________
Food:
$ ________
Child Support
$ ________
Credit Card(s)
$ ________
Alimony/Support
$ ________
Other Charge Accounts:
$ ________
Unemployment
$ ________
Medical:
$ ________
Public Assistance
$ ________
Cable/Satellite TV:
$ ________
Social Security/Veteran
$ ________
Entertainment:
$ ________
Stocks, Bonds & Investments
$
Clothing:
$ ________
Other: ________________
$ ________
Dry Cleaning:
$ ________
Total Monthly Income:
$ ________
Cleaning/Yard Service:
$ ________
4. Checking Account Balance:
$ ________
Other:
________________________
$ ________
5. Savings Account Balance:
$ ________
________________________
$ ________
________________________
$ ________
________________________
$ ________
Total Monthly Expenses:
$ ________
*Attach documentation to substantiate all income AND expense entries.
inc & exp sum (6-09)
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