Form VA Form 26-68608 VA Form 26-68608 Loan Service Report

OMB Approved No. 2900-0249
Respondent Burden: 25 minutes
OFF. JURIS.

OFF. ORIG.

TYPE

LOAN NUMBER

NAME CODE

LOAN SERVICE REPORT
1. INTERVIEW CONDUCTED
IN FIELD

2. DATE OF
INTERVIEW

A. HOME

4. NAME(S) OF PERSON(S) INTERVIEWED

3. TELEPHONE NUMBER
B. BUSINESS

BY PHONE
IN OFFICE

SECTION I - FINANCIAL INFORMATION
5. PLEASE CHECK THE APPROPRIATE BOX(ES). IF ONE OR MORE ARE CHECKED, THIS REPORT MUST INCLUDE INFORMATION CONCERNING THE BORROWER’S
SPOUSE (OR FORMER SPOUSE IF BOX "D" IS CHECKED). IF NO BOXES ARE CHECKED, NO INFORMATION CONCERNING THE SPOUSE NEED BE FURNISHED.
A. THE SPOUSE IS OR WILL BE
JOINTLY OBLIGATED WITH
THE BORROWER ON THE
LOAN

B. THE BORROWER IS MARRIED AND
THE PROPERTY SECURING THE
LOAN IS LOCATED IN A COMMUNITY
PROPERTY STATE

6. NAME AND ADDRESS OF EMPLOYER

7. LENGTH OF
EMPLOYMENT

C. THE BORROWER IS
RELYING ON THE SPOUSE’S
INCOME AS A BASIS FOR
REPAYMENT OF THE LOAN

8. TYPE OF WORK

D. THE BORROWER IS RELYING
ON ALIMONY, CHILD SUPPORT,
OR SEPARATE MAINTENANCE
PAYMENTS FROM A SPOUSE OR
FORMER SPOUSE AS A BASIS
FOR REPAYMENT OF THE LOAN

9. MONTHLY EXPENSES
A. MORTGAGE PAYMENT

$

B. FOOD
10. NAME AND ADDRESS OF SPOUSE’S EMPLOYER 11. LENGTH OF
EMPLOYMENT

12. TYPE OF WORK

C. HEATING OIL
D. GAS
E. ELECTRIC

13A. NAME AND ADDRESS OF NEXT OF KIN

13B. TELEPHONE NO. OF NEXT OF KIN
HOME
BUSINESS

F. TELEPHONE
G. TRANSPORTATION
H. GASOLINE

14. AGE(S) OF OTHER DEPENDENT(S)

I. AUTO INSURANCE
J. LIFE INSURANCE

15. AVERAGE MONTHLY INCOME FROM ALL SOURCES
A. SALARIES (Take-home

B. COMP. OR
PENSION

$

C. RENTAL OR OTHER
$

$

K. MEDICAL

D. TOTAL
$

N. LOAN (Specify lender)

16. DISCRETIONARY INCOME
A. TOTAL MONTHLY INCOME (Item 15D)

$

16E. TOTAL DELINQUENCY

P. CREDIT CARD (Co. name)

$

-

C. TOTAL MONTHLY DISCRETIONARY INCOME
AVAILABLE TO REPAY THE DELINQUENCY
16D. REG. INSTALLMENT

O. CREDIT CARD (Co. name)

$

B. MINUS TOTAL MONTHLY EXPENSES
(Item 9R)

L. CLOTHING
M. LOAN (Specify lender)

$

Q. MISC.-PERSONAL

16F. TOTAL DELINQUENCY AS OF (Date)

R. TOTAL MONTHLY EXPENSES

$

$

17. ASSETS
A.CASH AVAILABLE (Checking and savings accounts, building and loan accounts,
on-hand, etc.)

E. SAVINGS BONDS (Current value)
$

B. FURNITURE AND HOUSEHOLD GOODS (Resale value)

G. REAL ESTATE OWNED (Resale value)
H. OTHER ASSETS (Itemize)

C. AUTOMOBILES (Resale value)
MAKE

YEAR

$

F. STOCKS AND OTHER BONDS (Current value)

MODEL

D. TRAILERS, BOATS, CAMPERS (Resale value)
18. BORROWER’S EXPLANATION OF DELINQUENCY

I. TOTAL ASSETS

$

SECTION II - CERTIFICATIONS (See Privacy Act Information)
I (WE) AFFIRM That the information contained herein is true, correct, and complete to the best of my (our) knowledge and belief.
19A. SIGNATURE OF BORROWER/APPLICANT

19B. DATE

20A. SIGNATURE OF SPOUSE

20B. DATE

PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of a statement or evidence
of a material fact, knowing it to be false.
VA FORM
FEB 2007

26-6808

EXISTING STOCK OF VA FORM 26-6808, MAY 2004,
WILL BE USED.

Continued on Reverse

SECTION III - PROPERTY INFORMATION
21. PROPERTY ADDRESS

22. NO. OF LIVING UNITS

23. MAILING ADDRESS (If different from Item 21)

24. GENERAL CONDITION OF PROPERTY

25A. PROPERTY IS (Check appropriate box)
OWNER
OCCUPIED

VACANT

25B. NAME OF TENANT

25C. AMOUNT OF RENT

25D. RENT PAID TO

RENTED (Complete
Items 25B, C, and D)

26A. MAJOR REPAIRS REQUIRED

27. YOUR OPINION AS TO CAUSE OF DELINQUENCY

26B. ESTIMATED COST

28. DELINQUENCY REGARDED AS
TEMPORARY

29. DOMESTIC SITUATION

PERMANENT

30. PROPOSED REPAYMENT SCHEDULE (Should be realistic and within borrower’s ability to repay)

31. RECOMMENDATIONS
FORBEARANCE

OTHER (Explain - Use Item 32, Remarks, if

32. REMARKS

33. SIGNATURE OF REPRESENTATIVE

34. DATE SIGNED

PRIVACY ACT INFORMATION - VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy
Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA
system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records - VA, and published in the Federal Register. Your
obligation to respond is voluntary, but without this information VA may be unable to provide financial counseling or assistance in dealing with your mortgage loan
holder.
RESPONDENT BURDEN: We need this information to provide financial counseling under Title 38 USC 3732 (a)(4). We estimate that you will need an average of 25
minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the
OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send
comments or suggestions about this form.