8/2/2019 Servicer Fraud Client Intake Sheet

1/2

Intake WorksheetPlease complete to the best of your ability. Circle y or n and put N/A if not applicable. All information is treated as confidential.

Date:_______________________________________ How did you hear about us?:____________________

Borrower Information

Name

Phone: ___________________Cell#:

Email:

Subj Property Address: ________

City: ___ _______State:___ Zip :

Current Mkt Value:___________ at purchase:________

Marital Status:_____________ SS#

Employed y/n ? Approx monthly income: $____________

Employer:____________________ No. Months

Co-Borrower Information

Name

Phone: __________________Cell#:

Email:

Borrower Address (if different)

Street: ________ _____________

City: ___ ______State:___ Zip :

Marital Status:_____________ SS#

Employed y/n ? Approx monthly income: $____________

Employer:____________________ No. Months

First Mortgage Information

Original Lender:___________________ Year:

Last Refi Lender:___________________ Year:

Current Servicer:

Investor (if known):

Type: (Fixed/ARM/Neg Am):_____________ Rate: _____%

Loan#:__________________ Balance Due:$

Sale date:________ Mo. payment amount $

Months late: Amount delinquent:$ _______

Notice of Default y/n ? _____ Date:

Notice of Sale y/n ? ____ Date:

Second Mortgage Information

Original Lender:___________________ Year:

Last Refi Lender:___________________ Year:

Current Servicer:

Investor (if known):

Type: (Fixed/ARM/Neg Am):____________ Rate: %

Loan#:__________________ Balance due:$

Mo. payment amount: $ ________

Months late: Amount Delinquent:$

How many properties do you own? (Provide a

separate worksheet for each one you want reviewed.)

1. TimelineSummarize timeline of your situation, including details of servicer misconduct: __

Attorney Notes:

8/2/2019 Servicer Fraud Client Intake Sheet

2/2

2

2. Areas of Liability / Possible DeceptionReason(s) given for denial?_

Name of any firms or companies you hired to help with a modification:

Point of Contact: email: /ph#:

Do you qualify for HAMP (if you know) y/n ? If y, Explain:

Where you in review for HAMP y/n ? Explain:

Did lender say you need to go late y/n ? If y, Explain:

Did you feel lied to y/n ? Why?

Did you ever send Qualified Written Request to servicer y/n ? Did they respond y/n ?

Number of loan mod attempts?____ How long in review?____ Did you get a Trial Plan y/n ? How many trial payments made?_____

Final results?

Did you turn down a trial plan loan mod? y/n If y, why? __

Did you turn down a permanent loan mod? y/n If y, why? __

Did you accept a permanent loan mod y/n ? Explain:

Other efforts youve taken to avoid default/foreclosure? (refinance/short sale/BK)

3. Areas of Possible DamagesCredit harmed y/n ? How:

Have you and/or your spouse lost any money as a result of the bank and/or servicers wrongful conduct y/n ? explain:

Have you and/or your spouse suffered from any physical or mental symptoms or injuries as a result of the bank and/or servicers

wrongful conduct y/n ? Explain:

Have you and/or your spouse been denied the opportunity to purchase an item or another home as a result of your credit score

being ruined y/n ? Explain:

Have you tried to sell your home? y/n ? Explain:

Have you lost time at work or been unable to work as a result of the bank and/or servicers wrongful conduct? y/n ? Explain:

Have your kids suffered at all because of the bank and/or servicers wrongful conduct? (i.e. had to change schools, make new

friends, move, etc.) y/n ? Explain

Summarize any other details regarding how you were damaged?

4. Related ActionsEver filed for Bankruptcy y/n ? If yes, when:______________ If yes, which Chapter 7/11/13 ? Are you in BK now y/n ?

Case No. _____________ BK Attorney:________________ BK Attorney Phone No.____________________

Which borrower filed?:_____________________________ Was it discharged y/n ? When?_______________

Dismissed y/n? When?________________ w/ prejudice y/n ? Are you willing and able to file if needed to stop a sale y/n?

The above information is true and accurate to the best of my knowledge. I agree to cooperate with the attorneys

and the law firm.

(if you check the box) I hereby order a $800 Securitization Audit for evaluation of my case and am sending aform of payment herewith. Payment for the audit will be made to Prosper Law.

Borrower Signature:________________________

Date: Name: ________________________