COVID-19 Hardship Relief ApplicationBorrower Name* First Last Subject Property Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Loan ID*Loan Amount ($)*Loan Type*Select a loan typeFixNFlipRentalMultifamilyConstructionRequest*COVID-19Affected Area (District/State)*Please outline the active Government order/advisory level* Government ordered full lockdown for all nonessential businesses Social distancing advisory - essential businesses still in operation No official government action/advisory Other (provide detail) Provide Detail*Personal Income and AssetsName and Address of Employer*Self Employed? List Dates of Employment*What were monthly household income and net worth prior to March 1, 2020?Monthly Income*Net Worth*What were (or expected) monthly household income and net worth for the next three months?Monthly Income*Net Worth*Last Mortgage Payment*Most recent Bank Statement(s) (Statement(s) requested with Hardship Application)*Please provide the last 3-6 month's rent roll for the property*ConstructionHas construction of the project halted due to COVID-19? (if applicable)* Yes No Current % of project completion*Further delay reasoning/explanation*Borrower's Financial ConditionHow have Borrower’s financial condition, the value of the property, and the property’s viability as an investment been adversely impacted due to COVID-19 leading to this request for hardship relief?* Yes No Further reasoning/explanation*Each of the undersigned specifically represents to Lima One Capital LLC, its affiliates, and their successors and/or assigns acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite their signature and that any intentional or negligent misrepresentation of the information in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I has been made on this application; (2) all statements made in this application are made for the purpose of obtaining a mortgage loan modification; (3) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and the undersigned is obligated to amend and/or supplement the information provided in this application if any of the material facts that have been represented herein should change prior to signing the amendment; (4) in the event that Borrower’s payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (5) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; and (6) my transmission of this application and any amendment as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws(excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature. The undersigned acknowledges and agrees that Lender may assign, transfer or hypothecate this Loan opportunity to another lender or funding source and to that end, share the information in this application with other lenders and investors in furtherance of closing the requested Loan. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or re-verify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency. Acknowledgment and AgreementSignature*Date* Date Format: MM slash DD slash YYYY Name*Title*Guarantor*Date* Date Format: MM slash DD slash YYYY Guarantor*Date* Date Format: MM slash DD slash YYYY
