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GENERAL FORBEARANCE REQUEST
Mohican Loan Department
A forbearance is a period during which you are allowed to postpone making payments temporarily, allowed an extension of time for making payments, or
temporarily allowed to make smaller payments than scheduled. A forbearance can be a mandatory forbearance meaning that the Mohican Loan Department
must grant the forbearance if you qualify for the forbearance and supply all supporting documentation. A forbearance can also be a discretionary
forbearance, meaning that the Loan Department may grant the forbearance but is not required to do so.
SECTION 1: BORROWER INFORMATION
Please enter or correct the following information.
Check this box if any of your information has changed.
Name
Address
City State Zip Code
Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: FORBEARANCE REQUEST
Carefully read the entire form before completing it. Answer all questions in Section 2. The Mohican Loan Department
has sole discretion in whether to grant your general forbearance request, and, if granted, for what period your
forbearance will be applied. COVID-19 forbearances are a special one-time forbearance for up to four (4) months.
1. I am requesting a forbearance because I am
experiencing a temporary hardship related to one
of the following situations (check one):
Hospitalization
Approved FMLA leave from work
Involuntary lay off or Termination
Natural Disaster
Active Duty or Active Service
COVID-19 Related (4 month maximum forbearance)
2. If approved for a forbearance, I would like to:
Temporarily stop making payments.
Temporarily make smaller
payments of per month.
3.
I would like my forbearance to begin with the
monthly payment that is due in the month and
year below:
4.
If approved for forbearance, I would like my
forbearance to end in the month and year below,
and begin making payments the following month:
Page
1 of 2
Bor
rower Name
SECTION 4: ACCOUNT INFORMATION
Please disclose which type of loan you are requesting forbearance and the appropriate account number.
Student Loan Account Number: ______________
Personal Loan Account Number: ______________
Home or Home Improvement Loan Account Number: ______________
Land Contract Account Number: ______________
Business Loan Account Number: ______________
SE
CTION 4: BORROWER/ENDORSER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I understand that:
• I am not required to make payments of loan principal or interest during my forbearance.
• Mohican Loan Department has sole discretion in whether to grant my general forbearance request and for
what dates it will be granted.
• My forbearance will end on the earlier of the end date that I requested, no more than 6 months from the
date my forbearance begins, or when I exhaust any limit that my loan holder has on forbearance.
• I can request another forbearance after my forbearance ends if I am still experiencing financial hardship.
• Forbearances are processed in accordance with Mohican Loan Department policies.
I certify that:
• The information I have provided on this form is true and correct.
• I will provide additional documentation to my loan holder, if requested, to support my general forbearance request.
• I will repay my loans according to the terms of my promissory note, even if my request is not granted.
Si
gnature is not required if form is submitted by an online request. The borrower's electronic submittal of a completed
form provides evidence of borrower's intent.
Borrower's/Endorser's Signature Date
SECTION 5: WHERE TO SEND THE COMPLETED FORBEARANCE REQUEST
Return the completed form and any documentation to:
Mo
hican Loan Department
PO Box 70
Bowler, WI 54416
am
anda.stevens@mohican-nsn.gov and allen.quinney@mohican-nsn.gov
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Completed 27 January 2021

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