A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. Do you need a loan payoff request form?A secured lender shall prepare and deliver a payoff demand statement to the person who has requested it within fourteen days after receipt of the demand. A copy of the payoff statement for the first mortgage. How to fill out the Mortgage Payoff Statement Request Form? For example, if you have funds set aside to complete needed repairs to your home, you will see a figure in the "Repair SetAside" column. A payoff statement or a mortgage payoff letter will typically show the balance you must pay in order to close your loan. One form tells borrowers the remaining principal amount and interest they have to pay to close out the loan. We're concerned that not all fees and costs included in a payoff statement would be included in a modification.