Loss Mitigation Disaster Relief Deferment Request Form

INSTRUCTIONS

Complete the Loss Mitigation Disaster Relief Request Form in its entirety. QUESTIONS: Contact Loss Mitigation at 1-916-386-1418

Member

Mailing Address

Co-Member

Auto/RV/Boat/Loan

Bankruptcy

Detail of Hardship

By signing the Loss Mitigation Disaster Relief Request Form, I/we agree that California Community 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 California Community 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 California Community Credit union.

I/we affirm that the information provided in the Financial Statement and Hardship Affidavit of the Loss Mitigation Relief 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 the finance charge will continue to accrue during the deferral period. I/we understand that a deferment will increase the finance charge 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 if I/We have added any insurance products to my/our loan, the term 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.