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6-999

G-8—Rescission Model Form (When Adding a Security Interest)

NOTICE OF RIGHT TO CANCEL
1. Your Right to Cancel
You have agreed to give us a [mortgage/lien/security interest] [on/in] your home as security for your existing open-end credit account. You have a legal right under federal law to cancel the [mortgage/lien/security interest], without cost, within three business days after the latest of the following events:
  • (1)
    the date of the [mortgage/lien/security interest] which is
    ; or
  • (2)
    the date you received your Truth-in-Lending disclosures; or
  • (3)
    the date you received this notice of your right to cancel the [ mortgage/lien/security interest].
 If you cancel the [mortgage/lien/security interest], your cancellation will apply only to the [mortgage/lien/security interest]. It will not affect the amount you owe on your account. Within 20 calendar days after we receive your notice of cancellation, we must take the necessary steps to reflect that any [mortgage/lien/security interest ] [on/in] your home has been cancelled. We must also return to you any money or property you have given to us or to anyone else in connection with this increase.
You may keep any money or property we have given you until we have done the things mentioned above, but you must then offer to return the money or property. If it is impractical or unfair for you to return the property, you must offer its reasonable value. You may make the offer at your home or at the location of the property. Money must be returned to the address shown below. If we do not take possession of the money or property within 20 calendar days of your offer, you may keep it without further obligation.
2. How to Cancel
If you decide to cancel the [mortgage/lien/security interest], you may do so by notifying us, in writing, at
(creditor’s name and business address).
You may use any written statement that is signed and dated by you and states your intention to cancel, or you may use this notice by dating and signing below. Keep one copy of this notice no matter how you notify us because it contains important information about your rights.
If you cancel by mail or telegram, you must send the notice no later than midnight of
(date)
(or midnight of the third business day following the latest of the three events listed above). If you send or deliver your written notice to cancel some other way, it must be delivered to the above address no later than that time.
I WISH TO CANCEL.


Consumer’s Signature         Date

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