Unisa Loan Servicing For Higher Education printable pdf download

UNISA INC.

LOAN SERVICING FOR HIGHER EDUCATION

NAME OF BORROWER

ACCOUNT NUMBER

STREET ADDRESS

DATE OF BIRTH

CITY, STATE, ZIP

SOCIAL SECURITY NUMBER

PHONE NUMBER

NAME OF LENDING INSTITUTION

(College/Univ. from which loan originated)

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.

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 pertinent information from

applicable parties for verification purpose.

___________________________________________________________

________________________

Signature

Date

FORBEARANCE

DEFERMENT DATE REQUESTED FROM

Maximum 3 Years, Defers Principal, Interest Billed During, or at the End of the Deferment Period.

I will pay interest during my forbearance period.

I will pay interest after my forbearance period.

** If no box is checked you will be billed for interest during your forbearance period.

Debt to income ratio based on the following:

Income (Attach supporting documentation: check stub or employer statement)

Federal Education Debt (Attach supporting documentation of all educational debt: total loan and monthly

payments.)

For circumstances due to my present financial status, (please explain on reverse side #4).

UNEMPLOYMENT

DEFERMENT DATE REQUESTED FROM

Maximum 3 Years, Defers Principal, Defers Interest, For loans borrowed 7/01/93 and after.

I am seeking and unable to secure full-time employment.

have

have not registered with an employment agency.

If yes, name of agency ____________________________________ phone number __________________

I am receiving unemployment benefits.

I have never been employed.

I am not eligible to receive unemployment benefits.

I have attached any other

supporting documentation.

ECONOMIC HARDSHIP

DEFERMENT DATE REQUESTED FROM

Maximum 3 Years, Defers Principal, Defers Interest, For loans borrowed 7/01/93 and after.

I have been granted economic hardship for Federal Direct Student Loan or Federal Family Education Loan for the

concurrent period of time. (Attach official supporting documentation.)

I am receiving payment under federal or state public assistance. (AFDC, Supplemental Security Income, Food

Stamps, or State General Public Assistance. Attach supporting documentation.)

Debt to income ratio based on the following:

Income (Attach supporting documentation: check stub or employer statement)

Federal Education Debt (Attach supporting documentation of all educational debt: total loan and monthly

payments.)

For extension of benefit, you must attach a copy of your Federal Income Tax return.

PLEASE COMPLETE FINANCIAL STATEMENT ON REVERSE SIDE

Please send completed form to: UNISA INC. 7400 East Arapahoe Rd. Suite 10, Englewood, CO 80112 (303) 221-5626

APPROVED _____ DENIED_____ AUTHORIZED OFFICIAL _______________________________ DATE ____________

Unisa Loan Servicing For Higher Education

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