This form is furnished to give you a statement of actual settlement costs. A mortgage payoff statement details the total amount needed to fully pay off a loan as of a specific date.Do you need a loan payoff request form? Third Party Payoff Request Form. All third-party payoff requests require prior authorization. How do I request a Payoff Statement? 1. 1. Enter the name and contact information of the mortgage servicer. Select the "Documents" tab on the top of the page and then "Statements" Here you can choose Monthly Statements, Escrow Statements, and Year-End Statements. Want to speed up your Utah mortgage loan approval? Having the proper loan documentation is critical for accurate initial approval.