Non- Borrower Occupant Certification Form
Non- Borrower Occupant Certification Form
This form is for any individual committed to residing at your property address who is not on the loan as a borrower, but whose income you are requesting be considered in the review for loss mitigation options. Borrower Name (s): ____________________________________________________________________
Mortgage Account Number: _____________________________________________________________
Property Address: ______________________________________________________________________
Information to be completed by the Non-Borrower Occupant(s):
Name:
_____________________________________________________________________________________
First
Middle
Last
Suffix
Date of birth: _________________________ Social Security number: ______- ______- ______
Relationship to the borrower/homeowner: ____________________________________
By signing below, I agree to the following:
? I reside at the borrower's principal residence and request that my income be considered in the review for loss mitigation options.
? I contribute the following income to the household expenses and mortgage payments each month and will continue to do so for the foreseeable future (Check 1 option below):
_______ 100% of my income
________ other amount $____________
? I direct ServiSolutions, a Department of Alabama Housing Finance Authority, to obtain copies of
my credit report to verify my occupancy at the borrower's principal residence.
? I understand my consent for a credit bureau report shall expire upon completion of any loss
mitigation program that the borrower completes.
? Has the mortgage on any other property that you own had a final Home Affordable Modification?
___ Yes ___ No If yes, how many? _____
? Information and documents submitted are subject to examination and verification. Any potential
misrepresentation will be referred to the appropriate law enforcement authority for investigation
and prosecution.
Signature of Non-Borrower Occupant:
____________________________________ Signature
____________________________ Date
................
................
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