Request For Cancellation Benefit Or Deferment Prior To Cancellation

Request For Cancellation Benefit Or Deferment Prior To Cancellation - State Of Illinois Page 2

IV. Certification of Employment, Service, or Enlistment Period:

This space is

provided for the

organization's

Name of Specific School, Employer, Service Unit: _____________________________

official seal or

stamp. If one is not

Address: _____________________________________________________________

available, provide a

letter of

certification

City: _______________________ State: _______________ Zip: ________________

confirming the

borrower's service,

Telephone Number: (______)____________________

employment, or

enlistment. This

If borrower is a shortage teacher, please specify subject: ________________________

letter should

include employee's

start date and full-

I certify borrower is employed full-time. I further certify that the information provided

time status.

by the borrower regarding his/her service/employment is true and correct.

Signature of Official: ________________________________________________

Title: ____________________________________ Date: ___________________

For Internal Use Only

Deferred From:_______________ To:_____________ #Mos:______________ Grace Ending Date:______________________________

Processed by:___________________________________________________

Date:__________________________________________

Letter:

Cancelled at__________________% Code:__________________ End Date:____________________________

Fund_______________ Principal_______________ Interest________________ Balance__________________

Dates:

Fund_______________ Principal_______________ Interest________________ Balance__________________

Lending Institution Only:_________________________________________

__________________________

(Signature of Approving Official)

(Date)

Request For Cancellation Benefit Or Deferment Prior To Cancellation - State Of Illinois Page 2