Fax to: 866-291-4864 or Email to support@defaultmitigation.com UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA PRO SE DEBTOR REQUEST FOR LOAN MODIFICATION MANAGEMENT ASSISTANCE _________________________________ (name of debtor(s)) hereby request(s) assistance with the preparation of the Debtor Initial LMM Package as required by the Loan Modification Management Program. The debtor(s)' contact information is as follows: Name: Contact Phone: ________________________________ ________________________________ (provide the phone number on which you wish to be contacted) Bankruptcy Case No.: ________________________________ 1. The debtor(s) shall pay the Program Manager a non-refundable fee of one hundred dollars ($100.00) (the "Pro Se Document Preparation Fee"). The Pro Se Document Preparation Fee shall be in lieu of the Document Preparation Software fee of $40.00 to be paid to the Document Preparation Software vendor. 2. The debtor(s) shall cooperate with and work with their assigned document assistant (who will contact the debtor(s) at the phone number provided above) to provide the necessary information and documentation to complete the Debtor Initial LMM Package on a timely basis. Without limiting the generality of the foregoing, the debtor(s) shall promptly respond to all requests for information and documentation from the document assistant. The debtor(s) understands and acknowledges that if the debtor(s) fails to cooperate, the Program Manager may terminate the assistance and the debtor(s) may lose the Pro Se Document Preparation Fee. 3. The debtor(s) understands and acknowledges that the Program Manager is only assisting the debtor(s) in the preparation of the Initial LMM Package. Program Manager is not an attorney and cannot and will not be providing the debtor(s) with any legal advice. LMM 4001-1.6.REQUEST.ASSIST American LegalNet, Inc. www.FormsWorkFlow.com 4. The debtor(s) shall be responsible for providing a translator at the debtor(s)' own expense in the event one is necessary. Signed on ________________, 20__ BY: _____________________________ (Signature) BY: _____________________________ (Signature) _____________________________ (Printed Name) _____________________________ (Printed Name) LMM 4001-1.6.REQUEST.ASSIST American LegalNet, Inc. www.FormsWorkFlow.com