"Federal Consolidation Loan Application and Promissory Note - Federal Family Education Loan Program"

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Federal Family Education Loan Program (FFELP)
Guarantor, Program, or Lender Identification
OMB No. 1845-0036
Form approved
Federal Consolidation Loan
Exp. date 01/31/2010
Application and Promissory Note
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or any
accompanying documents is subject to penalties that may include fines, imprisonment, or both, under the
U.S. Criminal Code and 20 U.S.C. 1097.
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW LOAN ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain,
verify, and record information that identifies each person who opens a loan account. What this means for you: Your name, address, date of birth, and other information collected in this form will be used to verify your identity. You may
also be asked to provide your driver’s license or other identifying documents.
Before You Begin
Read the Instructions for Completing the Federal Consolidation Loan Application and Promissory Note. Print using dark ink ballpoint pen or type. This form must be signed and dated by
the applicant.
**PAGES 1, 2, AND 3 OF THIS FORM MUST BE SUBMITTED FOR YOUR APPLICATION TO BE PROCESSED.**
Section A. Borrower Information
1. Last Name
First Name
MI
2. Social Security Number
3A. Permanent Address (Include Number, Street, Apartment Number; or Rural Route Number and Box Number, as applicable) City, State, Zip Code
3B. Permanent Mailing Address, if different from 3A. (Include P.O. Box or General Delivery, as applicable) City, State, Zip Code
4. Area Code/Telephone Number
5. Former Name(s)
(
)
6. Date of Birth (mm-dd-yyyy)
7. Driver’s License State and Number
State
#
8. E-mail Address
9. Employer Name
Address
City
State
Zip Code
Work Area Code/Telephone Number
(
)
10. Consolidating Lender Name
11. Lender Code, if known
Section B. Reference Information
References: You must provide two separate references with different addresses who have known you for at least three years. Both references must be completed in full. Do not include
individuals who live with you (e.g., your spouse) or who live outside the United States.
12. Name
A.
B.
Permanent Address
City, State, Zip Code
E-mail Address (optional)
(
)
(
)
Area Code/Telephone Number
Relationship to Borrower
Section C. Promissory Note (To be completed and signed by the borrower.)
(In this Promissory Note, “lender” refers to, and this Promissory Note benefits, the original consolidating lender and its successors and assigns, including any subsequent holder of this
Promissory Note.)
13. Promise to Pay:
I promise to pay to the order of the lender all sums disbursed (hereafter “loan”) under the terms of this Promissory Note (hereafter “Note”) to pay off my prior loan obligations, plus
interest and other charges and fees that may become due as provided in this Note. Unless I make interest payments, interest that accrues on my loan during forbearance periods and
on the unsubsidized portion of my loan during deferment periods may be added, as provided under the Act, to the principal balance of my loan. If I do not make any payment on this Note
when it is due, I will also pay reasonable collection costs, including but not limited to attorney’s fees, court costs, and other fees.
I will not sign this Note before reading the entire Note, even if I am told not to read it, or told that I am not required to read it. I am entitled to an exact copy of this Note and the Borrower’s
Rights and Responsibilities Statement. My signature certifies I have read, understand, and agree to the terms and conditions of this Note, including the Borrower Certification and
Authorizations and the Borrower’s Rights and Responsibilities Statement.
I UNDERSTAND THAT THIS IS A LOAN THAT I MUST REPAY.
14. Borrower’s Signature
Today’s Date (mm-dd-yyyy)
Submit pages 1, 2, and 3
Page 1 of 8
Federal Family Education Loan Program (FFELP)
Guarantor, Program, or Lender Identification
OMB No. 1845-0036
Form approved
Federal Consolidation Loan
Exp. date 01/31/2010
Application and Promissory Note
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or any
accompanying documents is subject to penalties that may include fines, imprisonment, or both, under the
U.S. Criminal Code and 20 U.S.C. 1097.
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW LOAN ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain,
verify, and record information that identifies each person who opens a loan account. What this means for you: Your name, address, date of birth, and other information collected in this form will be used to verify your identity. You may
also be asked to provide your driver’s license or other identifying documents.
Before You Begin
Read the Instructions for Completing the Federal Consolidation Loan Application and Promissory Note. Print using dark ink ballpoint pen or type. This form must be signed and dated by
the applicant.
**PAGES 1, 2, AND 3 OF THIS FORM MUST BE SUBMITTED FOR YOUR APPLICATION TO BE PROCESSED.**
Section A. Borrower Information
1. Last Name
First Name
MI
2. Social Security Number
3A. Permanent Address (Include Number, Street, Apartment Number; or Rural Route Number and Box Number, as applicable) City, State, Zip Code
3B. Permanent Mailing Address, if different from 3A. (Include P.O. Box or General Delivery, as applicable) City, State, Zip Code
4. Area Code/Telephone Number
5. Former Name(s)
(
)
6. Date of Birth (mm-dd-yyyy)
7. Driver’s License State and Number
State
#
8. E-mail Address
9. Employer Name
Address
City
State
Zip Code
Work Area Code/Telephone Number
(
)
10. Consolidating Lender Name
11. Lender Code, if known
Section B. Reference Information
References: You must provide two separate references with different addresses who have known you for at least three years. Both references must be completed in full. Do not include
individuals who live with you (e.g., your spouse) or who live outside the United States.
12. Name
A.
B.
Permanent Address
City, State, Zip Code
E-mail Address (optional)
(
)
(
)
Area Code/Telephone Number
Relationship to Borrower
Section C. Promissory Note (To be completed and signed by the borrower.)
(In this Promissory Note, “lender” refers to, and this Promissory Note benefits, the original consolidating lender and its successors and assigns, including any subsequent holder of this
Promissory Note.)
13. Promise to Pay:
I promise to pay to the order of the lender all sums disbursed (hereafter “loan”) under the terms of this Promissory Note (hereafter “Note”) to pay off my prior loan obligations, plus
interest and other charges and fees that may become due as provided in this Note. Unless I make interest payments, interest that accrues on my loan during forbearance periods and
on the unsubsidized portion of my loan during deferment periods may be added, as provided under the Act, to the principal balance of my loan. If I do not make any payment on this Note
when it is due, I will also pay reasonable collection costs, including but not limited to attorney’s fees, court costs, and other fees.
I will not sign this Note before reading the entire Note, even if I am told not to read it, or told that I am not required to read it. I am entitled to an exact copy of this Note and the Borrower’s
Rights and Responsibilities Statement. My signature certifies I have read, understand, and agree to the terms and conditions of this Note, including the Borrower Certification and
Authorizations and the Borrower’s Rights and Responsibilities Statement.
I UNDERSTAND THAT THIS IS A LOAN THAT I MUST REPAY.
14. Borrower’s Signature
Today’s Date (mm-dd-yyyy)
Submit pages 1, 2, and 3
Page 1 of 8
Borrower Name
Social Security Number
Please print.
Section D.1. Education Loan Indebtedness — Loans You Want to Consolidate
Read the instructions before completing this section. List each federal education loan you want to consolidate, including each loan (if any) currently held by the lender that will be
consolidating your loans. Use the Loan Codes listed in the instructions. The loan holder/servicer is the entity to which you send your payments. If you need to list additional loans, use the
Additional Loan Listing Sheet included in this package. (If an Additional Loan Listing Sheet is not included, you may obtain one from your consolidating lender.) List each loan separately.
Please print. ONLY LIST LOANS THAT YOU WANT TO CONSOLIDATE IN THIS SECTION.
15. Loan Code
16. Loan Holder/Servicer Name and Mailing Address
17. Loan Account Number
18. Interest Rate 19. Estimated Payoff Amount
(See Instructions)
(See Instructions)
20. Grace Period End Date – If any of the loans that you have selected for consolidation are in a grace period, you can delay
the processing of your Federal Consolidation Loan until the end of your grace period by entering your expected grace period end
(month/year)
date in the space provided. If you leave this field blank, your Federal Consolidation Loan will be processed and any selected loans
that are in a grace period will enter repayment immediately upon consolidation.
Section D.2. Education Loan Indebtedness — Loans You Do Not Want to Consolidate
Read the instructions before completing this section. List each education loan that you are not consolidating but want considered in calculating your maximum repayment period.
Remember to include each loan (if any) held by the lender that will be consolidating your loans, but that you do not want to include in your Federal Consolidation Loan. Use the Loan Codes
listed in the instructions. The loan holder/servicer is the entity to which you send your payments. If you need to list additional loans, use the Additional Loan Listing Sheet included in this
package. (If an Additional Loan Listing Sheet is not included, you may obtain one from your consolidating lender.) List each loan separately. Please print. ONLY LIST LOANS THAT YOU DO
NOT WANT TO CONSOLIDATE IN THIS SECTION.
21. Loan Code
22. Loan Holder/Servicer Name and Mailing Address
23. Loan Account Number
24. Interest Rate 25. Current Balance
(See Instructions)
(See Instructions)
Submit pages 1, 2, and 3
Page 2 of 8
Borrower Name
Social Security Number
Please print.
Section E. Repayment Plan Selection
26.
Section F. Borrower Certification and Authorizations
27. Under penalty of perjury, I certify that:
unpaid accrued interest, and other costs as permitted by federal regulations in the
payoffs reported to the consolidating lender. I understand that if any collection
A. The information I have provided on this Federal Consolidation Loan Application
costs are owed on the loans selected for consolidation, these costs may be
and Promissory Note and as updated by me from time to time is true, complete,
added to the principal balance of the Federal Consolidation Loan and, in the case
and correct to the best of my knowledge and belief and is made in good faith.
of Federal Stafford, SLS, PLUS, or Consolidation loans in default and held by a
B. I do not have any other application pending for a Federal Consolidation Loan.
guaranty agency, may not exceed 18.5 percent of the outstanding principal and
C. All of the loans selected for consolidation have been used to finance my education
interest on the loan at the time the holders certify the payoff amounts.
or the education of my dependent student(s).
B. I understand that I may no longer be eligible for some deferments and for subsidized
D. All of the loans selected for consolidation are in a grace period or in repayment
deferment periods on some loans being consolidated. I also understand that I may
(including loans in deferment or forbearance).
no longer be eligible for some loan discharges and types of forgiveness that were
available on the loans being consolidated.
E. If I have an outstanding Federal Consolidation Loan, I am eligible for another
C. I authorize the consolidating lender to contact the holders identified on my
Federal Consolidation Loan because: (i) I have another eligible loan(s), or (ii) I am
application to determine the eligibility and/or payoff amounts for the loans I have
consolidating a Federal Consolidation Loan with at least one other eligible loan.
selected for consolidation. I further authorize those holders to release
F. If I owe an overpayment on a Federal Perkins Loan, Federal Pell Grant, Federal
that information.
Supplemental Educational Opportunity Grant, Academic Competitiveness Grant
D. I authorize the consolidating lender to send the proceeds of my Federal Consolidation
(ACG), National Science or Mathematics Access to Retain Talent (SMART) Grant,
Loan to each holder of the loans I have identified to pay off the debts.
or Leveraging Educational Assistance Partnership Grant, I have made satisfactory
arrangements with the holder to repay the amount owed.
E. If the amounts my consolidating lender sends to my holders exceed the amounts
needed to pay off the balances of the selected loans, I understand that the holders
G. I am not now in default on any loan that I am consolidating, or, if I am in default,
will refund the excess to my consolidating lender to be applied against the
I have either (a) made satisfactory arrangements with the holder of the defaulted
outstanding balance of this loan. If the amounts my consolidating lender sends to
loan(s) to repay the amount owed, or (b) for Federal Stafford, SLS, PLUS, or
my holders are less than the amounts needed to pay off the balances of the loans
Consolidation loans, I agree to repay the Federal Consolidation Loan under
selected for consolidation, I will be responsible for notifying my consolidating lender
income-sensitive repayment terms.
about the remaining amounts. I authorize the consolidating lender to include the
H. If I have been convicted of, or pled nolo contendere (no contest) or guilty to, a
remaining amounts in this Federal Consolidation Loan, unless I pay off the remaining
crime involving fraud in obtaining federal student assistance under Title IV of the
balances.
Higher Education Act of 1965, as amended, I have completed the repayment of
F. I authorize the consolidating lender, the guarantor, or their agents to investigate
those funds to the U.S. Department of Education (the Department), or to the loan
my credit record and report information concerning my loan status to persons and
holder in the case of a Title IV federal student loan.
organizations permitted by law to receive such information.
I. I am not subject to a judgment secured through litigation or to an order for wage
G. I authorize the release of information pertinent to my loan: (i) by the school(s),
garnishment, except as I have disclosed.
the lender, and the guarantor, or their agents, to the references on this loan and to
members of my immediate family unless I submit written directions otherwise; and
28. I make the following authorizations and statements of understanding:
(ii) by and among my schools, lenders, guarantors, the Department, and their agents.
A. I understand that the amount of my Federal Consolidation Loan will be based
H. If I have HEAL loans serviced by the consolidating lender and such loans are not
on the payoff amounts of my outstanding eligible loans that I selected for
included in this Federal Consolidation Loan, I authorize the establishment of a
consolidation, as provided by the holders of those loans, and may exceed my
combined payment plan on my behalf.
estimate of such payoff amounts. The actual payoff amounts may differ from
the estimated payoff amounts because the holders will include unpaid principal,
Review your Federal Consolidation Application and Promissory Note to ensure you completed all sections, including Section E above.
Submit pages 1, 2, and 3
Page 3 of 8
Federal Consolidation Loan Application and Promissory Note
(continued)
Disclosure of Terms
Repayment
This Note applies to Federal Consolidation Loans made under the Federal Family Education
I must repay the full amount of the loan made under this Note and the accrued interest.
Loan Program. In this Note, the Higher Education Act of 1965, as amended (20 U.S.C. 1070
Repayment begins upon disbursement of the loan, and my first payment will be due within
et seq.), and applicable U.S. Department of Education regulations are collectively referred
60 days after the disbursement.
to as the “Act.” In this Note, references to “the Department” mean the U.S. Department of
Payments will be scheduled in monthly installments according to the disclosure my lender
Education.
will provide to me. The disclosure will state my payment amounts and due dates. The
At or about the time my Federal Consolidation Loan is disbursed, a disclosure statement
maximum scheduled repayment period may be up to 30 years in length, depending upon
and repayment schedule (“disclosure”) will be provided to me. This disclosure will identify
the amount of my student loans and my repayment plan. The minimum payment on my
my Federal Consolidation Loan amount and additional terms of the loan. If I have questions
loan must equal at least the amount of interest that accrues between scheduled payments.
about the information disclosed, I will contact the lender. If the information in this Note
Payments submitted by me or on my behalf (exclusive of refunds) may be applied first to
conflicts with information in the disclosure, the specific terms and information in the
late charges and collection costs that are due, then to accrued interest that has not been
disclosure apply to my loan.
capitalized, and finally to the principal amount. If I am unable to make my scheduled loan
Important additional terms of this loan are disclosed in the Borrower’s Rights and
payments, the lender may allow me to reduce my payment amount, extend the time for
Responsibilities Statement accompanying this Note.
making payments, or temporarily stop making payments as long as I intend to repay my
loan. Allowing me to temporarily delay or reduce my loan payment is called forbearance.
I agree that the lender may sell or assign my loan to another eligible holder.
The lender may grant me a forbearance to align payment due dates on my loans or to
Interest
eliminate a delinquency that persists even though I am making scheduled payments.
Unless my lender notifies me in writing of a lower rate(s), the rate(s) of interest for my loan
I may prepay all or any part of the unpaid balance on my loan at any time without penalty.
is that specified in the Act. Interest rate information is presented in the Borrower’s Rights
Upon payment in full of this Note, I agree to accept written notification of the payoff in
and Responsibilities Statement accompanying this Note. The interest rate is presented in a
place of receiving the original Note.
disclosure that is provided to me.
Acceleration and Default
Interest accrues on the unpaid principal balance of my Federal Consolidation Loan from the
At the option of the lender, the entire unpaid balance will become immediately due and
date of disbursement by the lender until the entire principal balance is paid in full.
payable when either of the following events occurs: (i) I make a false representation that
This includes interest accruing during any period of deferment or forbearance. I agree to
results in my receiving a loan for which I am not eligible; or (ii) I default on the loan.
pay all interest charges on my loan except for interest payable by the federal government
under the Act.
The following events shall constitute a default on my loan: (i) I fail to pay the entire unpaid
balance after the lender has exercised its option under item (i) in the preceding paragraph,
I will be responsible for the interest that begins accruing upon disbursement of my loan.
(ii) I fail to make installment payments when due and my failure persists for at least 270
If I do not make payments of interest before the beginning of principal repayment, or
days, or (iii) I fail to comply with other terms of the loan, and the lender or guarantor
during a period of authorized deferment or forbearance, I agree that the lender may
reasonably concludes I no longer intend to honor my repayment obligation. If I default, the
capitalize such interest to the extent permitted by the Act.
guarantor may purchase my loan and capitalize all outstanding interest into a new principal
Except for any portion of the Federal Consolidation Loan attributable to a HEAL Loan, this
balance. The new principal balance and collection fees will become immediately due
loan will bear simple interest at an annual rate that is fixed for the term of the loan. The
and payable.
maximum interest rate on this loan will be equal to the weighted average of the interest
If I default, the default will be reported to all national credit bureaus and will significantly
rates (as certified by the holder) on the loans being consolidated, rounded up to the nearest
and adversely affect my credit history. I acknowledge that a default will have additional
higher one-eighth of one percent, not to exceed 8.25 percent.
adverse consequences to me as disclosed in the Borrower’s Rights and Responsibilities
If I choose to consolidate a fixed rate Federal ALAS/SLS Loan(s) or Federal PLUS Loan(s),
Statement. Following default, the loan may be subject to income-contingent repayment
I request that the existing interest rate of each loan be converted before consolidation to
(including potential collection of amounts in excess of the principal and interest) in
the refinancing rate provided for in the Act, if that rate is lower than the existing rate. If my
accordance with the Act.
lender grants this request, I understand there will be no separate document evidencing
Governing Law and Notices
this refinancing.
The terms of this Note will be interpreted according to the Act, other applicable federal
For the portion of the Federal Consolidation Loan attributable to a HEAL loan (if applicable),
statutes and regulations, and the guarantor’s policies. Applicable state law, except as
the interest rate is a variable rate and is adjusted annually on July 1. The variable rate for
preempted by federal law, may provide for certain borrower rights, remedies, and defenses
each 12-month period will be equal to the average of the bond equivalent rates of the
in addition to those stated in this Note.
91-day Treasury Bills auctioned for the quarter ending June 30, plus 3.0 percent; there is
no maximum interest rate on this portion of the loan.
If I reside in the state where the guarantor’s principal office is located, the guarantor may
sue to enforce the loan in the county where the guarantor’s office is located. However, if I
180-Day Add-On Provision
object to being sued there and I mail a written objection to the guarantor that is postmarked
If I do not consolidate all eligible loans at this time, I understand that I may later add to
no later than 30 days after I am served with the lawsuit, the guarantor will either have the
this Federal Consolidation Loan an eligible loan(s) made before or after the date of this
court transfer the lawsuit to the county where I live or will dismiss the lawsuit.
consolidation. To add an eligible loan(s), I understand I must complete a Request to Add
Any notice required to be given to me will be effective if sent by first class mail to the latest
Loans form which is available from the lender and which must be received by the lender
address the lender has for me or by electronic means to an address that I have provided.
within 180 days after the date this Federal Consolidation Loan is disbursed. If I add a
I will immediately notify the lender of any change of address or status as specified in the
loan during this period, the lender will disclose new terms to me. The new terms and
Borrower’s Rights and Responsibilities Statement. Failure by the lender to enforce or
information will supersede the terms and information in any prior disclosure. After the
insist on compliance with any term of this Note shall not waive any right of the lender.
180-day period, no loan can be added to this Federal Consolidation Loan and I will need to
No provision of this Note may be modified or waived except in writing by the lender of
apply for a new Federal Consolidation Loan to consolidate any eligible loan(s).
the Note. If any provision of this Note is determined to be unenforceable, the remaining
Late Charges and Collection Costs
provisions remain in force.
The lender may collect from me: (i) a late charge for each late installment payment if I fail
to make any part of a required installment payment within 15 days after it becomes due,
and (ii) any other charges and fees that are permitted by the Act for the collection of my
loans. If I default on the loan, I will pay reasonable collection fees and costs, plus court
costs and attorney’s fees.
Page 4 of 8
Federal Family Education Loan Program (FFELP)
Guarantor, Program, or Lender Identification
Instructions for Completing the Federal Consolidation Loan Application
and Promissory Note
Section D. Education Loan Indebtedness
Before You Begin
Before beginning, gather all of your education loan records, account statements, and
Education Loans
bills so that you have the information you need to complete the Federal Consolidation
Loan Application and Promissory Note.
The following types of education loans (except those represented by the code OTHER)
are eligible for consolidation:
Print using a dark ink ballpoint pen or type. Enter dates as month-day-year
(mm-dd-yyyy). Use only numbers. Example: June 24, 1982 = 06-24-1982. This form
Loan Code
Education Loans
must be signed and dated by the applicant. If an item has been completed for you and
SS
Subsidized Federal Stafford Loans
it is incorrect, cross out the incorrect information and print the correct information.
DSS
Direct Subsidized Stafford/Ford Loans
Incorrect or incomplete information may delay processing of your application.
US
Unsubsidized and Nonsubsidized Federal Stafford Loans
DUS
Direct Unsubsidized Stafford/Ford Loans
If you have any questions about completing this application, contact the entity
PLUS
Federal PLUS Loans (for parents)
identified above.
GB
Federal PLUS Loans (for graduate/professional students)
DPLUS
Direct PLUS Loans (for parents)
Section A. Borrower Information
D3
Direct PLUS Loans (for graduate/professional students)
SLS
Federal Supplemental Loans for Students
Item 1: Enter or correct your last name, first name, and middle initial.
PERK
Federal Perkins Loans and National Direct Student Loans
SCON
Subsidized Federal Consolidation Loans
Item 2: Enter or correct your Social Security Number.
DSCON
Direct Subsidized Consolidation Loans
Item 3: Enter your permanent address (number, street, apartment number, or rural
UCON
Unsubsidized Federal Consolidation Loans
route number and box number, then city, state, zip code). If your mailing address
DUCON
Direct Unsubsidized Consolidation Loans, including Direct PLUS
is a post office box or general delivery, you must list your mailing address in 3B, in
Consolidation Loans
addition to your home address in 3A.
HPSL
Health Professions Student Loans, including Loans for
Item 4: Enter the area code and telephone number at which you can most easily be
Disadvantaged Students
reached. (Do not list your work telephone number here.) If you do not have a tele-
HEAL
Health Education Assistance Loans
phone, enter N/A.
FISL
Federal Insured Student Loans
NSL
Federal Nursing Loans
Item 5: Enter any former names under which one or more of your loans may have
OTHER
Other education loans not eligible for consolidation that you want used to
been disbursed. If you do not have a former name, enter N/A.
calculate the maximum repayment period
Item 6: Enter the date of your birth. Be careful not to enter the current year.
Information you need to answer items in this section is available in loan documents,
Item 7: Enter the two-letter abbreviation for the state that issued your driver’s license
such as:
followed by the driver’s license number. If you do not have a driver’s license,
enter N/A.
n The last monthly billing statement you received,
n Your quarterly interest statement or annual statement,
Item 8: Enter your preferred e-mail address for receiving communications. You are
not required to provide this information. If you do, the lender or holder of your loan
n Your coupon book, or
may use your e-mail address to communicate with you. If you do not have an e-mail
n The Internet site of your loan holder or servicer.
address, or do not wish to provide it, enter N/A.
If you are unsure of the correct information on your loans, contact the entity to which
Item 9: It is important that the consolidating lender is able to reach you during the
you send your payments or check the most recent correspondence from that entity.
process of making your loan and during repayment. Enter your employer’s name,
You may also obtain information on your loan(s) by accessing the National Student
address (including number, street, suite number, city, state, and zip code), and your
Loan Data System at http://www.nslds.ed.gov.
work telephone number (or the number of your work cellular telephone or other
wireless device). If you are self-employed, enter the name, address, and telephone
Step 1: Begin by listing (according to the instructions that follow for Items 15-19)
number of your business (or the number of your business cellular telephone or other
eligible loan(s) that you wish to consolidate, including any loan(s) currently held by the
wireless device). If you are not employed, enter N/A.
lender that will be consolidating your loan(s). You may consolidate a Federal Consolidation
Item 10: Enter the name of the lender you would like to finance your Federal
Loan only if you are combining that loan with at least one other eligible loan.
Consolidation Loan.
If you are in default on any loan that you wish to consolidate, you must have made
Item 11: Enter the lender code, if known. Otherwise, leave this item blank.
satisfactory repayment arrangements with the holder to repay the loan before it is
eligible for consolidation. Satisfactory arrangements usually involve making a series
of payments on the defaulted loan. For Federal Stafford, Federal SLS, Federal PLUS,
Section B. Reference Information
or Federal Consolidation loans, satisfactory repayment arrangements involve making
Items 12A and 12B: Enter the requested reference information for two adults with
a series of reasonable and affordable payments or agreeing to repay the new Federal
different addresses who have known you for at least three years. References with
Consolidation Loan under an income-sensitive repayment plan. Contact the holder of
addresses outside the United States are not acceptable. Do not include individuals
your defaulted loan for specific information.
who live with you. If a reference does not have a telephone number or e-mail address
Item 15: Enter the code that corresponds to the loan type from the Education Loans
or does not wish to provide an e-mail address, enter N/A. If you provide an e-mail
list. If you are not sure about the loan type, leave this item blank.
address for a reference, the lender or holder of your loan may use it to communicate
with the reference. All requested items must be completed or processing of your
Item 16: Enter the full name and mailing address of the holder of each of your federal
application will be delayed.
education loans or the holder’s servicer. (This is the address to which you are or will
be sending your payments.) Do not use initials instead of full names. For a defaulted
FFELP loan, the holder is the guaranty agency or the Department of Education. For a
Section C. Promissory Note
defaulted Federal Direct Loan, the holder is the Department of Education. For a Perkins
This is a legally binding contract.
Loan, the holder is the school.
Item 13: Carefully read the entire Promissory Note, Borrower Certification and
Item 17: Enter the account number for each loan. This may be listed on your
Authorization, Borrower’s Rights and Responsibilities Statement, and the other
monthly billing statement or coupon or in other information your holder or
materials provided in connection with this loan.
holder’s servicer provides.
Item 14: Sign and date the Promissory Note.
Item 18: Enter the interest rate you are paying on each loan.
Note: Signature is required. If you fail to sign the Promissory Note, your application
Item 19: Enter the estimated payoff amount, including any unpaid interest, late fees,
will be delayed.
and collection costs.
Continued on next page.
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