FINANCIAL STATEMENT

Uniform Loss Mitigation Request Form

FINANCIAL STATEMENT

INSTRUCTIONS: 1.) Complete the Uniform Loss Mitigation Request Form in its entirety. 2.) Send the completed form and requested documentation identified in the attachment by fax to 916-288-6850, by email to lossmitigation@, or mail by mail to Golden 1 Credit Union, c/o Loss Mitigation, 8945 Cal Center Drive, Sacramento, California 95826.

For questions, please call Loss Mitigation at 1-844-670-9545.

ACCOUNT OR LOAN NUMBER:

MEMBER

Member's Name: (Please Print)

CO-MEMBER

Co-Member's Name: (Please Print)

Social Security No.:

Date of Birth:

Social Security No.:

Date of Birth:

Home or Cellphone No.:

Home or Cellphone No.:

Email:

Email:

Preferred Method of Contact (Please check all that apply):

o HOME/MOBILE

o WORK

o EMAIL

Mailing Address:

Preferred Method of Contact (Please check all that apply):

o HOME/MOBILE

o WORK

o EMAIL

I/We are requesting financial assistance with my/our:

o AUTO LOAN o HOME LOAN

o VISA CREDIT CARD o LINE OF CREDIT

Year of Automobile:

AUTO LOAN

Make of Automobile:

Workout options I/we are interested in:

o DEFERMENT* o SURRENDER

o MODIFICATION

o SHORT SALE

o REPAYMENT PLAN o OTHER

Property Address:

HOME LOAN

Model of Automobile:

Mileage:

Condition:

o EXCELLENT

o GOOD o AVERAGE

If applicable, please provide a brief description of needed repairs:

o POOR

Have you filed for Bankruptcy? If, yes, what Chapter? Bankruptcy Case Number:

BANKRUPTCY

o YES

o NO

o 7 o 11 o 12

o 13

Filing Date:

Has your Bankruptcy been discharged? Discharge Date:

o YES

o NO

I/We want to:

o KEEP

o VACATE o SELL o UNDECIDED

This property is my/our:

o PRIMARY RESIDENCE o SECOND HOME o RENTAL

This property is currently:

o OWNER OCCUPIED o RENTER OCCUPIED

Any member on active duty military service?

o YES

o NO

o VACANT

If yes, are you/they deployed away from primary residence or have you/they received a

Permanent Change of Station order? o YES

o NO

MONTHLY HOUSEHOLD INCOME

Gross Wages (include overtime and tips)

$

Child Support/Alimony Received*

$

Non-Taxable Social Security/SSDI

$

Taxable Social Security

$

Retirement, Annuities and/or Pension

$

Rental Income Received

$

Unemployment Income Received

$

Food Stamps/Welfare Received

$

Other Income

$

TOTAL MONTHLY INCOME

$

MONTHLY HOUSEHOLD EXPENSES

Total Primary Mortgage or Rent Payment

$

Credit Cards/Installment Loans

$

Child Support and/or Alimony Payments

$

Auto Loan or Lease Payment

$

Mortgage Payments on Other Properties

$

HOA or Condo Fees

$

Judgments

$

Garnishments

$

Other Expenses

$

TOTAL MONTHLY EXPENSES

$

* Alimony, child support, or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.

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 Uniform Loss Mitigation Request Form

DETAIL OF HARDSHIP

HARDSHIP AFFIDAVIT

If the Workout Option that you selected was "Deferment," please specify the number of payments, one or two months:

If the Workout Option that you selected was "Other," please specify what financial assistance you are requesting:

If you are seeking financial assistance with an account other than an auto loan or home loan, please identify the account (ex. Visa or personal loan):

By signing the Uniform Loss Mitigation Request Form, I/we agree that Golden 1 Credit Union may discuss or obtain credit information about my loan and financial situation from a third party. Negotiations for possible financial assistance do not constitute a waiver of or defense to Golden 1 Credit Union's right to commence or continue any adverse action. Financial assistance will be provided only if an agreement has been approved in writing by Golden 1 Credit Union.

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

I/We understand that all open-end line of credit and credit card accounts that I/we have with Golden 1 Credit Union be closed upon Golden 1 Credit Union's receipt of this request.

I/We understand that the finance charges will continue to accrue during the deferral period. I/We understand that a deferment will increase the finance charges and may increase the number of payments required to pay off the loan. I/We understand following the deferral period all finance charges due will be applied prior to any application of payments to principal.

I/We understand that the If I/we have added any insurance products to my/our loan, the terms of coverage will not be extended to my/ our new maturity date. I/We understand that a deferred payment may impact GAP claims on vehicle loans.

X ________________________________________ X ________________________________________

Member Signature

Date

Co-Member Signature

Date

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EQUITY LOAN ATTACHMENT A

Please submit the following information to be considered for our Loss Mitigation Alternative Program. 1. Hardship letter (a detailed letter explaining what caused your financial problems) signed and dated by all borrowers 2. Completed financial statement (form enclosed) signed and dated by all borrowers with the Asset & Liability box also completed 3. Verification of all income you show in the income boxes 4. Copies of your last two pay stubs if you are currently working or copies of your stubs for one month if you are currently collecting unemployment 5. A copy of your signed federal tax returns (including all schedules) for the last two years and your current W2 6. Signed 4506T form 7. A copy of your bank statements for the last three months 8. Current copy of your first mortgage statement

* Alimony, child support, or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.

If you currently have a purchase offer on your home, please forward the following documentation along with your financial documentation:

? Sales & Purchase Agreement signed by both you and the buyer ? Net Sheet or proposed Settlement Statement showing itemized breakdown of all costs related to the sale

transaction, i.e. realtor commissions and closing costs ? Listing Agreement(s) ? Copy of buyer's earnest money check deposit ? Copy of buyer's loan approval letter ? $5,000.00 is the minimum Golden 1 will accept on a short sale for liens in second or third position

(exceptions must be approved by Senior Management)

We will schedule an appraiser to conduct an inspection of your property. Please provide the name and phone number of a contact person who can schedule the appointment and accompany the appraiser

Name: _______________________________________________

Phone: (__________)___________________________________

? Other ____________________________________________

If you do not presently have an offer, please forward the above documentation immediately when a purchase offer comes in.

To expedite the process, please send all the required information and documentation at the same time. After reviewing the completed package, we will determine the best course of action. Additional information and documentation may be required.

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CONSUMER LOAN ATTACHMENT A

The following is the documentation that is required to be considered for Golden 1 Credit Union's Loss Mitigation programs listed below:

DEFERMENT DOCUMENTATION REQUIREMENTS:

1. Completed Uniform Loss Mitigation Request Form (including a detailed hardship explanation of your financial difficulties) signed and dated by all borrowers on the note.

2. Verification of all income you show in the income boxes*. 3. Copies of your last two pay stubs if you are currently working, or copies of your last pay stub if you are currently

collecting unemployment.

CONSUMER LOAN MODIFICATION DOCUMENTATION REQUIREMENTS:

1. Completed Uniform Loss Mitigation Request Form (including a detailed hardship explanation of your financial difficulties) signed and dated by all borrowers on the note.

2. Verification of all income you show in the income boxes*. 3. Copies of your last two pay stubs if you are currently working, or copies of your last pay stub if you are currently

collecting unemployment 4. A copy of your most recent signed federal tax returns (including all schedules) and the corresponding Form W-2. 5. Your most recent Form W-2. 6. Copies of your bank statements for the last two months

To expedite the process, please send all the required information and documentation at the same time. After reviewing the completed package, we will determine the best course of action. Additional information and documentation may be required.

* Alimony, child support, or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.

I/We understand the documents listed above are required to be considered for Golden 1 Credit Union's Loss Mitigation programs.

Your Name: _______________________________________________

Your Phone: (__________) _________________________________

* Please be advised that due to the Credit Union Guidelines and California Civil Code 10 CCR ? 30.801 we may defer no more than twice during the life of the loan and any one deferment may not exceed two consecutive contractual payments.

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Servicemembers Civil Relief Act Notice Disclosure

U.S. Department of Housing and Urban Development Office of Housing

OMB Approval 2502 - 0584 Exp 3/31/2021

Legal Rights and Protections Under the SCRA

Servicemembers on "active duty" or "active service," or a spouse or dependent of such a servicemember may be entitled to certain legal protections and debt relief pursuant to the Servicemembers Civil Relief Act (50 USC ?? 39014 043) (SCRA).

Who May Be Entitled to Legal Protections Under the SCRA?

? Regular members of the U.S. Armed Forces (Army, Navy, Air Force, Marine Corps, and Coast Guard).

? Reserve and National Guard personnel who have been activated and are on Federal active duty

? National Guard personnel under a call or order to active duty for more than 30 consecutive days under section 502(f) of title 32, United States Code, for purposes of responding to a national emergency declared by the President and supported by Federal funds

? Active service members of the commissioned corps of the Public Health Service and the National Oceanic and Atmospheric Administration.

? Certain United States citizens serving with the armed forces of a nation with which the United States is allied in the prosecution of a war or military action.

What Legal Protections Are Servicemembers Entitled To Under the SCRA?

? The SCRA states that a debt incurred by a servicemember, or servicemember and spouse jointly, prior to entering military service shall not bear interest at a rate above 6 % during the period of military service and one year thereafter, in the case of an obligation or liability consisting of a mortgage, trust deed, or other security in the nature of a mortgage, or during the period of military service in the case of any other obligation or liability.

? The SCRA states that in a legal action to enforce a debt against real estate that is filed during, or within one year after the servicemember's military service, a court may stop the proceedings for a period of time, or adjust the debt. In addition, the sale, foreclosure, or seizure of real estate shall not be valid if it occurs during or within one year after the servicemember's military service unless the creditor has obtained a valid court order approving the sale, foreclosure, or seizure of the real estate.

? The SCRA contains many other protections besides those applicable to home loans.

How Does A Servicemember or Dependent Request Relief Under the SCRA?

? In order to request relief under the SCRA from loans with interest rates above 6% a servicemember or spouse must provide a written request to the lender, together with a copy of the servicemember's military orders. Golden 1 Credit Union P.O. Box 15966 Sacramento, CA 95852-0966

? There is no requirement under the SCRA, however, for a servicemember to provide a written notice or a copy of a servicemember's military orders to the lender in connection with a foreclosure or other debt enforcement action against real estate. Under these circumstances, lenders should inquire about the military status of a person by searching the Department of Defense's Defense Manpower Data Center's website, contacting the servicemember, and examining their files for indicia of military service. Although there is no requirement for servicemembers to alert the lender of their military status in these situations, it still is a good idea for the servicemember to do so.

How Does a Servicemember or Dependent Obtain Information About the SCRA?

? Servicemembers and dependents with questions about the SCRA should contact their unit's Judge Advocate, or their installation's Legal Assistance Officer. A military legal assistance office locator for all branches of the Armed Forces is available at

? "Military OneSource" is the U. S. Department of Defense's information resource. If you are listed as entitled to legal protections under the SCRA (see above), please go to militaryonesource.mil/legal or call 1-800-342-9647 (toll free from the United States) to find out more information. Dialing instructions for areas outside the United States are provided on the website.

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