VA Form 26-6808 Loan Service Report

OFF. JURIS.

OFF. ORIG.

TYPE

OMB Control No. 2900-0249
Respondent Burden: 25 minutes
Expiration Date: XX/XX/XXXX

LOAN NUMBER

NAME CODE

LOAN SERVICE REPORT
2. DATE OF INTERVIEW

1. INTERVIEW CONDUCTED
IN FIELD

EMAIL

IN OFFICE

BY PHONE

4. EMAIL ADDRESS

3. TELEPHONE NUMBER
B. BUSINESS

A. HOME
5. NAME(S) OF PERSON(S) INTERVIEWED

SECTION I - FINANCIAL INFORMATION
6. 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

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

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

7. NAME AND ADDRESS OF EMPLOYER

8. LENGTH OF
EMPLOYMENT

9. 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

10. MONTHLY EXPENSES
A. MORTGAGE PAYMENT

$

B. FOOD
11. NAME AND ADDRESS OF SPOUSE'S EMPLOYER 12. LENGTH OF
EMPLOYMENT

13. TYPE OF WORK

C. HEATING OIL
D. GAS
E. ELECTRIC

14A. NAME AND ADDRESS OF NEXT OF KIN

14B. TELEPHONE NO. OF NEXT OF KIN
HOME

BUSINESS

F. TELEPHONE
G. TRANSPORTATION
H. GASOLINE

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

I. AUTO INSURANCE
J. LIFE INSURANCE

16. AVERAGE MONTHLY INCOME FROM ALL SOURCES
A. SALARIES (Take-home
B. COMP. OR
C. RENTAL OR OTHER D. TOTAL
pay)
PENSION
$

$

$

$

$

O. CREDIT CARD (Co. name)

- $

P. CREDIT CARD (Co. name)

B. MINUS TOTAL MONTHLY EXPENSES

(Item 9R)

C. TOTAL MONTHLY DISCRETIONARY INCOME
AVAILABLE TO REPAY THE DELINQUENCY

$

Q. MISC.-PERSONAL

17D. REG. INSTALLMENT 17E. TOTAL DELINQUENCY 17F. TOTAL DELINQUENCY AS OF (Date)

$

L. CLOTHING
M. LOAN (Specify lender)
N. LOAN (Specify lender)

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

K. MEDICAL

R. TOTAL MONTHLY EXPENSES
$

$

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

B. FURNITURE AND HOUSEHOLD GOODS (Resale value)
YEAR

$

F. STOCKS AND OTHER BONDS (Current value)
G. REAL ESTATE OWNED (Resale value)
H. OTHER ASSETS (Itemize)

C. AUTOMOBILES (Resale value)
MAKE

E. SAVINGS BONDS (Current value)

MODEL

D. TRAILERS, BOATS, CAMPERS (Resale value)

I. TOTAL ASSETS

$

19. BORROWER'S EXPLANATION OF DELINQUENCY

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.
20A. SIGNATURE OF BORROWER/APPLICANT

20B. DATE

21A. SIGNATURE OF SPOUSE

21B. 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
XXX XXXX

26-6808

SUPERSEDES VA FORM 26-6808, MAR 2014,
WHICH WILL NOT BE USED.

Page 1

SECTION III - PROPERTY INFORMATION
22. PROPERTY ADDRESS

24. MAILING ADDRESS (If different from Item 21)

23. NO. OF LIVING UNITS

25. GENERAL CONDITION OF PROPERTY

26A. PROPERTY IS (Check appropriate box)
OWNER
VACANT
RENTED (Complete
OCCUPIED
Items 26B, C, and D)

26B. NAME OF TENANT

26C. AMOUNT OF RENT

27A. MAJOR REPAIRS REQUIRED

28. YOUR OPINION AS TO CAUSE OF DELINQUENCY

26D. RENT PAID TO

27B. ESTIMATED COST

29. DELINQUENCY REGARDED AS

TEMPORARY

30. DOMESTIC SITUATION

PERMANENT

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

32. RECOMMENDATIONS
FORBEARANCE

OTHER (Explain - Use Item 33, Remarks, if necessary)

33. REMARKS

34. SIGNATURE OF REPRESENTATIVE

35. DATE SIGNED

PRIVACY ACT NOTICE - 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, Specially Adapted Housing Applicant Records, and Vendee
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.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions
about this form.
VA FORM 26-6808, XXX XXXX

Page 2