Cash For Mortgage Notes And Settlements
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Settlement Questionnaire
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Mortgage Note Questionnare
SETTLEMENT / ANNUITY QUESTIONNAIRE FORM
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Indicates required field
Full Name (as per contract)
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First
Last
Email
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Type of Settlement / Annuity: (i.e. Auto Accident, Pension Military/Civil , Personal Injury, Worker Comp, Inheritance, etc.)
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Is this derived from a Workmans Compensation Claim: Yes/No
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What State Settled In:
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State of Residency at that time:
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Date Settlement was created:
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Settled In or Out of Court:
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Settlement/Auunitants Age at time:
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Date Of Birth:
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Settlement/Annuity Maker:
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Does this Settlement/Annuity Allow for Assignment: Yes/No
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If Yes; Who is the Owner of this Policy?
Settlement/Annuity Payor:
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Full Name of Company making the payments to you?
Annuity check Issuer:
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Full Name of Company making the payments to you?
City & State of Insurance Co:
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Gross Payment $ Amount:
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Tax Withholdings from Payments:
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Other Withholdings from Payments:
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Net Payment $ Amount:
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Is there any Cost of Living Adjustments to the Payments:
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If Yes; what is the increase % or $ and how often?
Guaranteed Payments:
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How many Years/Months are the Guaranteed Payments for?
Date of First Payment:
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How many Paid Payments to Date?
How many Payments Remain:
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What are the Remaining Payments?
Terms of Settlement/Annuity:
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Lump Sums:
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Monthly Payments:
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Sell Full or Partial Payments:
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Schedule of Payments:
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Your Credit Situation:
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Excellent, Good, Average, Poor?
Details - If any Bankruptcy
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If Bankruptcy: When Discharged and What Chapter?
Other Income Support:
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Do you have other income to support yourself?
Additional Comments: (more the better)
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Enter Validation Code (required): 345Q
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Required
Submit
settlement_questionnaire.pdf
File Size:
18 kb
File Type:
pdf
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settlement_questionnaire.doc
File Size:
43 kb
File Type:
doc
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