HOMEOWNERSHIP COUNSELING FOREC LOSURE PREVENTION COUNSELING HOME CONSTRUCTION & SALES SINGLE FAM I LY RE NTA LS MULTI FAMILY RENTALS

BUILDING WEALTH FOR FUTURE GENERATIONS

5310 Lenox Avenue, Suite 4 Jacksonville, Florida 32205 (904) 265 - 4736 Phone(904) 265 -1908 Fax

Visit Us Online: www.wealthwatchersfl.com Email:info@wealthwatchersfl.com

REQUIRED SUPPORTING DOCUMENTS> ASSET - 2 MOST RECENT BANK STATEMENTS - ALL NUMBERED PAGES> INCOME - MOST RECENT 60 DAYS PROOF OF INCOME, IE. PAYSTUBS, AWARD LETTERS

- IF SELF EMPLOYED - YEAR TO DATE PROFIT & LOSS, SIGNED AND DATED- MOST RECENT TAX RETURN WITH W2 OR TAX TRANSCRIPT

> PROOF OF RESIDENCY - RECENT UTILITY BILL> IDENTIFICATION - DRIVERS LICENSE AND SOCIAL SECURITY CARD

Updated 07/19/2018

PRE-PURCHASE - CREDIT COUNSELING

APPLICATION

Program applying for (check all that apply)

Credit Counseling __ Financial Capability __ Pre Purchase __

Applicant Please Print Clearly

Name: _____________________________________________________________________________________ First MI Last

Address: ___________________________________________________________________________

___________________________________________________________________________ City State Zip Code

Home: (_____) _______–____________Work: (______) _______–____________ Email: ___________________

Fax: (_____) _______–__________ Pager: (_____) _______–__________ Mobile/Cell (_____) ______–________

SSN: ________–_______–________ Birthdate: ______/______/______

Employer: _____________________________________________ Work # __________________________

Address: _____________________________________________________________________________________ Street City State Zip Code

Job Position/Title:_______________________________________ Starting Date: ________________________

Type of Business: _______________________________

Co-Applicant Please Print Clearly

Name: _____________________________________________________________________________________ First MI Last

Address: ___________________________________________________________________________

___________________________________________________________________________ City State Zip Code

Home: (_____) _______–____________Work: (______) _______–____________ Email: ___________________

Fax: (_____) _______–__________ Pager: (_____) _______–__________ Mobile/Cell (_____) ______–________

SSN: ________–_______–________ Birthdate: ______/______/______

Employer: _____________________________________________ Work # __________________________

Address: _____________________________________________________________________________________ Street City State Zip Code

Job Position/Title: _______________________________________ Starting Date: ________________________

Type of Business: _______________________________

Demographics

Age Group of Applicant(s):

20’s ______ 30’s _____ 40’s _____ 50’s _____ 60’s _____ 70’s and above _____

Race:

White _____ Black or African American ______ American Indian/Alaskan Native _____ Asian _____

Native Hawaiian/Other Pacific Islander _____ American Indian/Alaskan Native and White _____ Asian and White _____

Black/African American and White _____ American Indian/Alaskan Native and Black _____ Other _____

Ethnicity (please select “yes” or “no” for Hispanic Origin. You should select both a “Race” category and a “yes” or “no” for

Hispanic origin :) Hispanic: Yes No

Are you a Veteran: Yes No

Marital Status: (please select): 1. Single 2. Married 3. Divorced 4. Separated 5. Widowed

Gender: (please select): Male Female

Total number of adults and children in household: ________

Handicap Accessible Need: Yes No

If yes, what is your disability? _________________________________________________________________________

Housing Status

If Pre Approved:

Realtor: _______________________________________________ Lender: _________________________

Contact Person: ________________________________________ Phone: __________________________

Date of Occupancy _________________ # of Bedrooms ________________ Rent Amount _____________

How did you hear about the Wealth Watchers Inc.? _______________________________________________________

Are you currently working with any other agencies? Yes No

If yes, please explain:

Have you ever owned a home? Yes No

If yes, please explain (When, Where, Dates of Ownership & Sale, etc.):

__________________________________________________________________________________________________

Have you ever filed for bankruptcy? Yes No

When? ______________ Reason for filing for bankruptcy? _____________________________________________

Has the bankruptcy been discharged? Yes No Date _________________________

Education

Highest level of Education

No High School Diploma __________ Associates Degree __________

High School __________ Bachelor’s Degree __________

Vocational Certificate __________ Master’s Degree __________

Some College Never Completed __________ Doctoral Degree __________

Financial Information

All household information must be disclosed regardless of who is purchasing the home

APPLICANT CO-APPLICANT OTHER Type of Income Monthly Amount Monthly Amount Monthly Amount

Gross Salary _____________ ______________ _____________

Base Pay _____________ ______________ _____________

Alimony/Child Support _____________ ______________ _____________

Other Support Payments _____________ ______________ _____________

SS, SSI, SSDI, etc. _____________ ______________ _____________

Other Income _____________ ______________ _____________

Total Monthly Income _____________ ______________ _____________

Assets

Please provide three (3) months bank statements for all checking and savings, Certificates of Deposit (CD’s),

IRA’s, Money Market, 401K’s, etc.

Waiver of Privacy

I/We hereby authorize Wealth Watchers Inc. to act on my behalf in any third party negotiations with lenders, realtors, or appropriate

entities in an effort to resolve any current or future problems related to this transaction. All information pertaining to your case is kept

confidential and shall not be disclosed to any entity without your authorization. It is understood that funding sources may review the

information contained in the counseling agency file, not lender files, as part of a random review process. Additionally, demographic

information is provided to funding sources on each client. Wealth Watchers Inc. is approved by HUD to provide the following housing counseling services: mortgage delinquency/default resolution, pre-purchase, post-purchase and rental counseling. I understand that I am not obligated to receive, purchase or utilize any other services offered by Wealth Watchers Inc. or pesented by partnering agencies or groups in order to receive housing counseling services.

________________________________________________________

Customer

____________________

Date

____________________ ________________________________________________________

Co-Applicant Date

Authorization to Release Information

It is the policy of Wealth Watchers Inc. to have communications, records and programs information on clients and services held in confidence to the extent permitted by law.

Confidentiality is defined as “the individual’s right to privacy; to be assured that any disclosure

he or she makes will not be revealed to others.” Adhering to the Confidentiality Policy includes

not revealing information held in the client’s file to other individuals or organizations without

written consent from the client as well as not discussing clients or client-related matters in the

presence of others unless required by law.

No information concerning a client may be directly or indirectly disclosed, unless a signed

release is present in a client’s file or such information is required to be disclosed in response to a

subpoena or disclosure is otherwise required by law. The release should include the name of the

program which is making the disclosure, the names to which the disclosure is made, the name of

the client, the purpose of need for disclosure, the extent of disclosure, and the signature of the

client.

Signing of an information release may be required in order to provide reports to the funding

agency. All others releases, however, are voluntary and the client has a right not to sign a

release.

When information is being released, only that information that is necessary for the provision of a

service will be released.

I/We, ________________________________________________________________________,

hereby authorize Wealth Watchers Inc. non-profit agency, their employees or agents to contact, cooperate and exchange information with any of my/our creditors, their employees or agents.

Furthermore, I/We authorize any creditor to release and continue to release any and all

information in its files to Wealth Watchers Inc. until I/We revoke this authorization directly to the creditor in writing.

I/We authorize the Wealth Watchers Inc. to pull my/our credit report(s) for credit counseling purposes.

__________ (Applicant Initial) _________(Co-Applicant Initial)

_____________________________________ _____________________________________ Applicant Name (Please Print) Co-Applicant Name (Please Print)

______________________________________ _____________________________________

Applicant Signature Co-Applicant Signature

______________________________________ _____________________________________

Social Security Number Social Security Number

___________________ ___________________

Date Date

A HUD-Approved Affiliate of 5310 Lenox Avenue Suite 4, Jacksonville, FL 32205 * 904-265-4736 * www.wealthwatchersfl.com

DISCLOSURE STATEMENT

I understand that the agency provides information and education on numerous loan products and housing programs and I further understand that the housing counseling and education services I receive from Wealth Watchers Inc. in no way obligates me to choose any particular loan products or housing programs and I may use services other than those provided by Wealth Watchers Inc. Services and products that Wealth Watchers Inc. can assist with are listed below:

1. Pre-Purchase Counseling - Wealth Watchers Inc. provides one-on-one counseling regarding pre-purchase; pre-rental searchassistance/mobility; fair housing; budgeting for mortgage or rent payments; and money management 2. Pre-Purchase Homebuyer Education Workshops - Wealth Watchers Inc. provides group and online education regardinghomeownership readiness and preparation 3. Financial Management/Budget Counseling - Wealth Watchers Inc. provides one-on-one counseling regarding developing a budget,looking at spending habits, reducing existing debt, and developing savings strategies 4. Financial Budgeting and Credit Repair Workshops - Wealth Watchers Inc.provides group education regarding the basics of banking,credit, financial planning, money management and savings and investing 5. Mortgage Delinquency/Default Resolution Counseling - Wealth Watchers Inc. provides education and counseling regarding resolvingor preventing mortgage delinquency 6. Resolving/Preventing Mortgage Delinquency - Wealth Watchers Inc. provide one-on-one counseling regarding how to: restructuredebt, obtain recertification for mortgage subsidy, establish reinstatement plans, seek loan forbearance, and manage household finances 7. Non-Delinquency Post-Purchase Workshop/Counseling - Wealth Watchers Inc. provides group education and one-on-one counselingregarding resolving or preventing mortgage delinquency and default; converting home equity into cash; seeking favorable mortgage loan terms; budgeting and financial management; real estate taxes and insurance; and home maintenance 8. Rental Housing Workshops - Wealth Watchers Inc.provides group education sessions regarding renter-related topics, including:helping clients obtain and utilize rent subsidies; pre-rental search assistance/mobility counseling; budgeting for rent payments; educating clients on landlords’ and renters’ rights 9. Rental Housing Counseling - Wealth Watchers Inc. provides one-on-one counseling regarding renter-related topics, including: helpingclients obtain and utilize rent subsidies; pre-rental search assistance/mobility counseling; budgeting for rent payments; educating clients on landlords’ and renters’ rights 10. Services for Homeless Counseling - Wealth Watchers Inc. provides referrals to social, community, and homeless services such asemergency shelter or transitional housing

Wealth Watchers Inc. does not offer legal counsel or services. Wealth Watchers Inc. staff members will provide counseling, group education and/or instructional information only regarding your housing, personal financial management or credit situation under this program.

Wealth Watchers Inc. does not provide debt consolidation services nor will any member of the Wealth Watchers Inc. staff takeover or assume responsibility for the finances of any participating client.

Wealth Watchers Inc. does not pay or receive fees or other considerations for referrals to or from any program administered by us.

Wealth Watchers Inc. staff members will not recommend that clients participate or engage in any services whereby the staff members themselves or any member of their immediate family have a financial interest.

No staff member of Wealth Watchers Inc. will disclose any personal information without proper authorization of the participant.

Wealth Watchers Inc. strongly believes in and promotes housing choice. To that end, Wealth Watchers Inc. does not endorse any realtor or lender.

Because of the relationship between Wealth Watchers Inc. and Bank of America, Fannie Mae, Ocwen and Wells Fargo, should you choose to utilize the services of this entity, they may provide Wealth Watchers, Inc. with a financial or other benefits.

A HUD-Approved Affiliate of 5310 Lenox Avenue Suite 4, Jacksonville, FL 32205 * 904-265-4736 * www.wealthwatchersfl.com

All of Wealth Watchers Inc. programs and services are required to educate participants. Please be advised that you, the client, are not obligated to receive, purchase or utilize any other services offered by Wealth Watchers Inc. or its exclusive partners, in order to receive housing counseling services. I acknowledge that I have received a copy of the Agency Disclosure Statement and accept its provisions

Applicants Name (print): Date:

Applicants Signature: Date:

Co-Applicants Name (print): Date:

Co-Applicants Signature: Date:

Counselor Signature: Date:

Monthly Budget Income and Expenses

Income $

Gross Wages $

Self Employed Income $

Pension / Retirement $ Total Income:

Rental $

Unemployment $ $

Child Support $

Social Security $

Contribution $

Food Stamp/Welfare $

Other $

Expenses $

First Mortgage $

Second Mortgage $

Homeownr Ins and taxes $

Homeowners Association $

Credit Cards $

Car payment $

Car Insurance $ Total Expenses:Cell Phone $

Child Care / Support $ $Light and water $

Rent or other Mortage $

Groceries $

Gasoline $

Loans $

Cable/Internet $

Home Phone $

Personal Care $

Medical/Life Insurance $

Clothing $

Recreation $

Gifts/Donations $

Maintenance $

____________________ $

____________________ $

____________________ $

Signature _________________________________ Date_______________________

Date of Client

Interaction:

WEALTH WATCHERS INC. Client Action Plan New Client Past Client

Client ID:

Credit Counseling

Making Home Affordable

Partial Claim Foreclosure

Refinance

Brought Mortgage Current

Deed-in-Lieu

Reverse Mortgage

Loan Modification

Bankruptcy

Referral for Legal Assistance

Client Goals: (Check all that apply)

Counselor Information Client Information

Client Name:

Loan Number:

Lender:

According to the National Industry Standards for Foreclosure Intervention Counseling, the Action Plan must be issued within 24 hours of the counseling session and immediately if face to face.

Counselor Name:

Mode of Counseling:

(phone, face to face)

Follow up Documentation Required:(Check all that apply)

Signed Authorization Form

Copy of Bills/Pay Stubs

Bank Statements

Additional Docs

State briefly why the homeowner is delinquent or in danger of becoming

delinquent (Check all boxes that are applicable to the

homeowner’s situation)

Loss of income

Increase in expenses

Unemployed

Underemployed

Illness

Bankruptcy

Other (if other, please explain)

Actions & Additional Counselor Notes(State what steps the client will take to and what steps the counselor will take to assist in this process)

Counselor Actions

Assessment of Property (if applicable)

Excellent

Good

Fair

Poor

Financial Assessment (Given the documentation acquired to

date such as bills, pay stubs, bank statements, and credit report, state how the client’s delinquency can be

resolved)

Contact Information for Community Referrals

(if applicable)

Estimated Value of

Home

$________________

Counselor Signature Date

Client Signature Date

Client Signature Date

Credit Report

Follow up w/ CounselorOther

Client Actions

WEALTH WATCHERS INC. PASSPORT TO SUCCESS ASSESSMENT SURVEY

Thank you for taking the time to participate in this survey.

All information you share is kept confidential and is used to improve our services for you and the community.

1. First Name:

2. Last Name:

3. Date Assessment Completed:

MM/DD/YYYY:

Tracking and Spending

We are interested in what you do to keep track of your income and spending.

4. Which of the following statements best describes how you keep track of your income?

I keep a written record of my income as it comes in. I have a general idea of my income, but do not keep a written record as it comes in. I do not keep track of my income.

5. Which of the following statements best describes how you keep track of your spending?

I keep a written record of my spending as it occurs. I have a general idea of my spending, but do not keep a written record as it occurs. I do not keep track of my spending.

6. Regardless of whether or not you are always able to follow it, do you have some kind of written budget orspending plan?

Yes No

7. Please describe how you use that budget or spending plan to guide your expenses for the coming month.

Building and Managing Credit — Credit Report and Score

We are now interested in knowing a little about your credit score and credit report.

8. Do you happen to know your current credit score?

Yes No

9. What is that credit score?

10. Date of credit score (month, day, year)

Formal Financial Resources — Alternatives

We are interested in how you use different types of financial services.

11. Below is a list of ways in which people sometimes obtain cash that they want or need. Please indicate whetheror not you have used the following activities during the past 3 months by answering “yes” or “no” for each one.

For those you answered “yes,” please also indicate the approximate number of times you have done so duringthe past 3 months.

Yes No If yes, # of times

I obtained cash using a debit card

I obtained cash from a payday loan in anticipation of an upcoming pay check

I used a check cashing store where I paid a fee to get cash in exchange for a check

I sold something to a pawn shop

I obtained a loan that required me to transfer the title of my automobile

I obtained a tax refund on the same day I filed my income tax return

I over-withheld income taxes throughout the year so that I would get a big refund when I filed my tax return

Formal Financial Resources — Accounts

We are interested in how you view different types of bank and credit card accounts.

12. Do you currently have, or have you ever looked into opening, a checking account at a bank or credit union?

Yes No

13. Below is a list of things that people sometimes consider when they decide about opening a checking account.Please indicate whether or not you considered these factors when you looked into opening a checking accountby answering “yes” or “no” for each one.

Yes No

The minimum account balance required

The cost for different types of transactions

The penalty fees that could be incurred for things like a bounced check

Overdraft protection, that is, the availability of funds when you do not have sufficient money in your account to cover a check

Some other factor. Please specify.

14. In the previous question, if you answered some other factor, please specify.

15. Do you currently have, or have you ever had a credit card in your name?

Yes No

16. Below is a list of things that people sometimes consider when they decide about getting a credit card. Pleaseindicate whether or not you considered these factors when you looked into getting a credit card by answering“yes” or “no” for each one.

Yes No

The introductory interest rate charged

The interest rate charged after the introductory period

The annual fee for the card

The credit limit available

The penalty fees that could be incurred for things like late payments

Points, rebate dollars, or rewards that could be earned

Some other factor. Please specify.

17. in the previous question, if you answered some other factor, please specify.

Savings

We are interested in how often you save money.

18. Do you currently have savings?

Yes No

19. If yes, what is the amount of savings you currently have?

($)

20. How often do you put money aside as savings?

On a regular basis Every once in a while Rarely Never

21. Do you currently have any secured debt?

Yes No Unknown

22. If yes, what is the amount?($)

Financial Goal Setting

We are interested in your financial goals.

23. Have you established a financial goal?

Yes No

24. If yes, what was the goal?

25. Have you met that financial goal?

Yes No

26. It is always our pleasure to assist you. Do you have any additional questions, requests or suggestions we canhelp you with at this time?

Thank you for completing this assessment survey!

Debt

We are interested in the amount of debt you have.