How to fill out this form.
  1. This form must be completed and signed by each contractor you use.
  2. The dollar amount on this form must match the dollar amount on the contractor’s contract.
  3. As the borrower, complete and sign the bottom portion of each form.
  4. Return all completed original forms to us.

Tel:
Fax:

Borrower name: (#000000)

Co-borrower name: (#000000)

Loan Number: (#000000)

Property address:

 

Acknowledgement of Terms

Please complete and sign this form and return in order to begin processing your claim.



* Certification of Intent to Repair

Fill in all required fields below *
The following fields need to be corrected:*

I (We) certify that the loss draft/check will be used to repair the damage that occurred and that the repairs will be made in a workmanlike manner and that no material or labor liens will occur as a result of the labor performed or materials used.



* Current Account Statement

I, (We), the undersigned mortgagor(s), acknowledge that in the event that our account is not current, M&T Bank may apply any remaining insurance loss proceeds resulting from our property loss to our mortgage account, including cost fees or any expenses associated with our account. Any remiaining proceeds will be applied first to any delinquencies in the payment of principal and interest. Once the loan is brought current and all fees & expenses are paid, any remaining proceeds will be returned promptly to the mortgagor(s).
I understnad and agree if the claim funds received from the insurance company are less than the amount agreed to by me on the signed contract I will be responsible for any expenses incurred in excess of the insurance proceeds.
M&T releases draws based on inspection results and will not release the final draw until inspection results show repairs are at or near 100%, and I have paid the difference between the claim amount and the contract amount.



**Borrower's acknowledgement

By signing below, you indicate that you agree with the above information.



 

Return this form by mail or FAX to: .