EMC Mortgage
EMC BORROWER’S FINANCIAL STATEMENT
LOAN #_______________
9/1/06
Borrower Name:
Social Security Number:
Is your home for sale? Yes □ No □ Agent’s Name: Agent’s Phone Number:
Date Listed? Listing Amount: Current Listing Price:
Property Address:
Mailing Address (#, Street, Apt.):
Mailing Address (City, State, Zip):
Total number of persons living at this address:
Number of dependents at this address:
Home Phone:
Work Phone:
Co-Borrower Name:
Social Security Number:
Home Phone:
Monthly Income (Wages): $____________________ / month
Have you contacted Credit Counseling Services? Yes □ No □
Additional Income (not wages): $ ____________________ / month* Source: __________________________________________________
*Notice: Include Alimony, Child Support, Disability, Rental Income, Social Security, Welfare/Food Stamps. All requested information must
be received before a workout plan can be reviewed for approval.
ASSET TYPE:
Estimated Value:
LIABILITY TYPE:
Payment per Month:
Balance Due:
Home
Alimony - Child support
Other Real Estate
Dependent Care / Child Care/ Tuition
Checking Accounts
Cable/ Cell phone
Savings - Money Market
Other Mortgage(s) / Rent
IRA/Keogh Accounts
Personal Loan(s) - Credit Cards
401K/ESOP Accounts
Medical Expenses
Stocks, Bonds, CD’s
HOA Fees/Taxes/ Hazard Insurance
Rental Property
Automobile(s)
Auto 1, Auto 2, Boat
Tax Liens & Homeowners Insurance
Utilities (water, gas, electric, phone)
Food
Other Investments
Auto Expenses (gas/maintenance)
Reason for delinquency (dates of hardship):
I (we) agree that the financial information provided is an accurate statement of my (our) financial status. I (we) understand and
acknowledge th