Borrower Certification and Agreement
1. I certify and acknowledge that all of the information in this Mortgage Assistance Application is truthful, and the hardship I
identified contributed to my need for mortgage relief. Knowingly submitting false information may violate Federal and
other applicable law.
2. I agree to provide my servicer with all required documents, including any additional supporting documentation as
requested, and will respond in a timely manner to all servicer or authorized third party* communications.
3. I acknowledge and agree that my servicer is not obligated to offer me assistance based solely on the representations in
this document or other documentation submitted in connection with my request.
4. I consent to the servicer or authorized third party* obtaining a current credit report for the borrower and co-borrower.
5. I consent to the disclosure by my servicer, authorized third party,* or any investor/guarantor of my mortgage loan(s), of
any personal information collected during the mortgage assistance process and of any information about any relief I
receive, to any third party that deals with my first lien or subordinate lien (if applicable) mortgage loan(s), including
Fannie Mae, Freddie Mac, or any investor, insurer, guarantor, or servicer of my mortgage loan(s) or any companies that
provide support services to them, for purposes permitted by applicable law. Personal information may include, but is not
limited to: (a) my name, address, telephone number, (b) my Social Security number, (c) my credit score, (d) my income,
and (e) my payment history and information about my account balances and activity.
6. I agree that the terms of this borrower certification and agreement will apply to any modification trial period plan,
repayment plan, or forbearance plan that I may be offered based on this application. If I receive an offer for a
modification trial period plan or repayment plan, I agree that my first timely payment under the plan will serve as
acceptance of the plan.
7. I consent to being contacted concerning this application for mortgage assistance at any telephone number, including
mobile telephone number, or email address I have provided to the lender, servicer, or authorized third party.*
* An authorized third party may include, but is not limited to, a housing counseling agency, Housing Finance Agency (HFA)
or other similar entity that is assisting me in obtaining a foreclosure prevention alternative.
Borrower signature: _________________________________________________ Date: _________________________
Co-Borrower signature: ______________________________________________ Date: _________________________
Please submit your completed application, together with the required documentation, to Affiliate Mortgage Services,
Inc., via mail: 618 S. Creyts Road, Suite C, Lansing MI 48917, fax: 517-481-3072, or online/email: www.affiliatemtg.org /
[email protected]. We will contact you within five business days to acknowledge receipt and let you know if you need to send additional information or documents.
We will use the information you provided to help us identify the assistance you may be eligible to receive.
Fannie Mae/Freddie Mac Form 710 Page 4 of 4 August 2017