Tpd Disharge Assignment Form - U.s. Department Of Education - 2010 Page 2

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UNITED STATES DEPARTMENT OF EDUCATION
TPD DISCHARGE ASSIGNMENT FORM
For Loans Guaranteed Under Title IV, Part B, HEA
All rights, title, and interest of the undersigned is hereby assigned to the United States of America.
This form is for the assignment of loans for Total and Permanent Disability Discharge.
Name of Guarantor
Signature of Officer
Date
Type Name of Officer
Title
SECTION A - BORROWER INFORMATION (Complete once for all loans for this borrower)
1. Borrower Current Name (Last, First, Middle)
2. Borrower SSN
3. Borrower Birth Date (MM/DD/CCYY)
4. Mail Delivery Indicator (U or D)
5. FDP Indicator (Y or N)
6. Borrower Previous Last Name
7. Borrower Work Phone
8. Borrower Home Phone
9. Borrower Street Address (1)
10. Borrower Street Address (2)
11. Borrower City
12. Borrower State
13. Borrower Zip Code
14. Foreign Country
Number of Loans Assigned for This Borrower
This page may be detached and used once for all loans to be assigned for a specific borrower

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