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{\title Assessment Submission Worksheet}{\author Karen Knott}{\operator George Karl}{\creatim\yr2003\mo2\dy13\hr14\min50}{\revtim\yr2003\mo2\dy13\hr14\min50}{\version2}{\edmins0}{\nofpages1}{\nofwords97}{\nofchars555}
{\*\company Pino Training Organization}{\nofcharsws681}{\vern16411}}\margl1627\margr1224\margt720\margb720 \ftnbj\aenddoc\ftnrestart\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\hyphcaps0\horzdoc\dgmargin\dghspace120\dgvspace120\dghorigin1627
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\tx10800\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\cgrid {\b\f1\fs26 Assessment Submission Worksheet}{\f1\fs24 
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\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs22 CCFC/Broker Information
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx6742\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 Name\tab  Date\tab }{\b\f1\fs22 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 Company\tab \tab 
\par Address \tab \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tlul\tx5280\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 City\tab State ____________ ZIP\tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tx5040\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 Phone \tab Fax\tab }{\b\f1\fs22 
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\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs22 Client Information}{\f1\fs22 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 Name of client\tab 
\par Contact person\tab 
\par Address \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 City\tab State _____________ ZIP\tab 
\par Phone \tab Fax\tab 
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\par }{\b\f1\fs22 Collateral Information                       }{\f1\fs22 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs22 Description of collateral\tab \tab 
\par \tab \tab 
\par \tab \tab 
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\par Portfolio Summary}{\f1\fs22 
\par 
\par }\trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4770 \cellx9172\pard \nowidctlpar\intbl\faauto\adjustright\rin0\lin0 {\f1 Item}{\fs24 \cell }\pard \qc\nowidctlpar\intbl\faauto\adjustright\rin0\lin0 {\f1 Amount or number}{\fs24 \cell }\pard 
\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4770 \cellx9172\row }\trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4770 \cellx9172\pard \nowidctlpar\intbl\faauto\adjustright\rin0\lin0 {\f1 
Total amount of assessments in package}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
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Total number of assessments in package}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4770 \cellx9172\row }\pard \nowidctlpar\intbl\faauto\adjustright\rin0\lin0 {\f1 
Average amount of assessment/fee}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
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Amount delinquent 0 to 30 days}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
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Amount delinquent 31\endash 60 days}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
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Amount delinquent 61\endash 90 days}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
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Amount delinquent 91\endash 120 days}{\fs24 \cell \cell }\pard \widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs24 \trowd \trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4770 \cellx9172\row }\trowd 
\trgaph110\trrh403\trftsWidth1\trpaddl110\trpaddr110\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4402 \cellx4402\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 
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\par /assess}{
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