Request For Forbearance/hardship/unemployment Deferment Template

ADVERTISEMENT

Request for Forbearance/Hardship/Unemployment Deferment
I understand that all information and supporting documents given will be held in strictest confidence and will not be subject to dissemination outside
the requirements of the lending institution. I further understand that this arrangement will consist of reduced or deferred payments, as determined by
the lending institution based on my financial situation. It may be necessary to make accelerated payments at the expiration of this arrangement to
repay the loan within the maximum ten-year period.
Borrower’s Name/Address:___________________________
Mail form to:
ECSI
___________________________
181 Montour Run Road
Coraopolis, PA 15108-9408
___________________________
Email Address:
Account Number :
Section 1 Applicable Benefits
Benefit type 1: Applicable to federal Perkins, Nursing/Health profession, and selected Institutional loans.
Benefit types 2 and 3: Applicable to Perkins loans.
My other title IV student loans have been granted economic or unemployment deferment and I am requesting the same
for the Perkins Loan. I have attached documentation from the other lender showing the kind of deferment and the
dates granted.
I may qualify for a temporary reduction of monthly payments due to financial hardship. I will contact ECSI,
or my school directly to discuss the options.
Benefit type 1 – I request forbearance on my Loans because (Select one from A-D & check 1 or 2 on E):
(A)____ My title IV SFA loan payments are equal to or greater than 20% of my total monthly income. (Complete section 2 and 3)
(B)____ I am unable to make scheduled payments due to ‘Poor Health’ (temporarily – totally disabled). (complete section 2 and 4)
(C)____ Caring for a dependent who is disabled. (Complete section 2 and 4)
(D)____Other acceptable reason: _____________________________________________________________________ (Complete section 2)
(E)Interest continues to accrue during this benefit type. For interest payment (1)____bill me monthly (2) ____bill me at end of my benefit.
(We recommend paying interest monthly to avoid a lump sum payment at the end of this benefit type or forbearance)
Benefit type 2 – I request economic hardship deferment because
:
(A)____ I have been granted economic hardship for William D. Ford Federal Direct Student Loan (FDSL) or Federal Family Education Loan
(FFEL) for the current period of time. (Satisfactory documentation is required)
(B)____ I am receiving payment under Federal or State Public Assistance. (AFDC, Supplemental Security income, Food Stamps, or State
Public Assistance). (Complete section 2 and 3)
(C)____ My title IV SFA loan payments are equal to or greater than 20% of my total monthly income, and my monthly gross income minus
my Title IV loan payments is less than 220% of the earnings of individuals on minimum wage, or 150% of the poverty level for my family
size. (Complete section 2 and 3)
Benefit type 3 – I request an unemployment deferment for a period of ____ month(s).
1.I am currently unemployed and actively seeking employment. In order to verify that I am actively seeking employment, I must register with
an employment agency and have this form certified.
2.Certification by employment agency: Please complete the following and affix seal or stamp with agency name or attach letter verifying
individual’s original registration date with agency.
I,
, certify that the above-mentioned individual has been duty registered with this employment agency.
Agency Name_________________________________________ Address______________________________________________________________
City______________________________________ State________________ Zip______________ Phone number______________________________
Section 2 Borrower Certification
I certify that all statements made are true and correct. I also certify that I will immediately notify the lending institution of any change in my
employment status or significant change in my financial situation. I authorize a representative of the lending institution to obtain from my applicable
parties’ pertinent information in order to verify this application. Final responsibility for completion and return of this form to the institution rests with
.
the borrower. This account will remain in status quo until this form is approved if this form is incomplete; it will be returned to the borrower
Signature___________________________________ SS Number________________________ Date________________
Day Phone______________________ Evening Phone_______________________ Cell Phone_____________________
Marital Status______________________ Dependents – Number_________________ Age(s)______________________
Please list the name, address, and phone number of someone who will always know your whereabouts:
Name ____________________________________________________________________________________________
Address __________________________________________________________________________________________
Day Phone______________________ Evening Phone________________________ Cell Phone_____________________
Institutional Action
Date_________ - _________ Approved______Disapproved_______Official_______________________Date________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2