University of the Philippines Los Baos STUDENT LOAN BOARD PROGRAM

Application Number:
pls sp((pls

New Year 20 - 20

Old

specify last sem of application______

OSA-SFAD Form 4a
Revised July 31, 2012

Semester: Date Filed: STUDENT LOAN APPLICATION FORM

4

1. STUDENT BORROWER Name of Student ____________________________________________________________________ (Surname) ( First Name) ( MI) Student /ID Number ____________________ College ________ Course __________ Classification ________ Parents Name ___________________________Contact Number ___________ Email Address ________ Permanent Mailing Address _______________________________________________________________________ (House No./Street/Subdivision) (Barangay) _______________________________________________________________________ (Town) (Province) 2. LOAN (For computation of OSA Loan Staff Only)

Total Matriculation Fee (TMF) (100%) Amount of SLB Loan applied for (TMF X 0.8) Cash Payment upon Enrollment (TMF X 0.2) 6% rate of Interest per annum

. . . . . . . . Php . . . . . . . . .Php . . . . . . . . .Php . . . . . . . Php

_______________________________

Terms of Payment: (Please check your preference and indicate the preferred amount of payment to the dates stated below) 3 Payments Dec 14 Amount ___________ February 8 Amount __________ Amount________ 2 Payments January 18 Amount ___________ March 21 Amount __________ Full Payment March 21 Amount ___________ March 21

I have the honor to apply for Student Loan from the University Student Loan Board Fund. For value received, I am aware of my accountability to be paid on the dates stated above and promise that I shall adhere to the deadline. I also understand that failure to comply shall mean that I may not be able to register in the succeeding semester nor seek clearance from the university. ________________________________ Signature 3. Co-Debtor I am willing and capable of serving as co-debtor of the above-named student who is applying for SLB Loan. Name of Co-Debtor: Relationship to Debtor (Pls. Check) Co-Debtors Complete Address: Printed Name Parent Signature Relative

Contact Number Landline:___________ Cellphone No__________ Email Address 4. a. RECOMMENDING APPROVAL:

__________________________ Head, SFAD (Member, SLB)

b. APPROVED / DISAPPROVED
______________________________ Director, OSA (Chairman, SLB)

Procedures/Requirements for SLB Loan

1. Present assessed Form 5 and submit a photocopy of valid ID (with signature) of student applicant and parent or
guardian (co-debtor). A co-debtor shall guarantee any loan application. Acceptable co-debtors are parents and
relatives of the student.

2. Maximum loan is 80% of total assessed fees at 6% rate of interest per annum.
3. All payments must be made in cash payable to the Student Loan Board Program, UPLB. 4. Unused forms must be returned to OSA-SFAD for cancellation of application. NOTE: Please photocopy (1 clear copy) this form.