University of the Philippines Los Baos STUDENT LOAN BOARD PROGRAM OSA-SFAD Form 4a Revised October 8, 2013 APPLICATION

1. STUDENTS PERSONAL INFORMATION Name of Student: (Surname) Student/ID Number 2013Telephone No. Permanent Home Address College Mobile No. FORM

Application Number: 2ND Semester School Year Date Filed: STFAP Bracket: FOR NEW FRESHMEN

New 2013 -

Old 2014

Old Students: Please login to www.uplbosa.org to generate SLB application form.

(First Name) Course Classification Email Address

M.I.
NEW FRESHMAN

(House No./Street/Subdivision)

(Barangay)

(Town/City) 2. LOAN (For computation of OSA Loan Staff Only) Total Matriculation Fee (TMF) (100%) Amount of SLB Loan applied for (TMF X 80%) Cash Payment upon Enrollment (TMF X 20%) 6% Interest Rate per Annum
1 Payt.Due Date Dec. 16, 2013 Jan. 16, 2014
st

(Province)

... ... ... ...

2 Payt.Due Date Jan. 31, 2014
nd

PhP PhP PhP PhP

Full Payt.Due Date Mar. 21, 2014 Mar. 21, 2014 Mar. 21, 2014

TERMS OF PAYMENT: (Please check your preference and indicate the preferred amount of payment to the dates stated below).

Terms of Payment 3-Installment Payments 2-Installment Payments Full Payment

Amount

Amount

Amount

I would like to apply for loan from the University Student Loan Board Program. I am aware of my accountability to pay the loan I applied for with interest on the date(s) stated above. I promise to adhere to the deadline and I understand that failure to comply shall mean that I may not be able to register in the succeeding semesters nor be given clearance from the university. I certify that all the information in this form are true and correct. I understand that cases of dishonesty such as forgery and falsification of records shall be filed at the Student Disciplinary Tribunal.

Students Signature

3. CO-DEBTOR
I am willing and capable of serving as co-debtor of the above-named student who is applying for loan from SLB. As a sign of willingness, my valid ID card is with him/her which will be presented upon application. I share the same responsibility for the payment of the loan in case the debtor fai ls to pay his/her obligation.

Name of Co-Debtor: Printed Name Relationship to Debtor (Pls. Check) Co-Debtors Complete Home Address: Contact Number: Landline 4. a) RECOMMENDING APPROVAL: Parent Mobile No.
Relative (pls. specify relationship to the debtor)

Signature

Email Address: b. APPROVED/DISAPPROVED:

ELISA S. NAVARRETE Head, SFAD-OSA and Member, SLB

Procedures/Requirements for SLB
1. 2. 3. 4.

LETICIA E. AFUANG Director, OSA and Chairman, SLB

Present assessed UPLB Form 5 and submit a clear photocopy of valid ID (with photo and signature) of co-debtor (parent or relative). Acceptable codebtors are parents and relatives of the student. Bring the original ID of co-debtor for verification and authentication. Maximum loan is 80% of total assessed fees at 6% interest rate per annum. 100% loan may be granted provided a letter of request is approved by the chancellor. Students with outstanding loans will not be allowed to avail of any further SLB. If loan remains unsettled, student cannot be issued clearance. All payments must be made in cash payable to the Student Loan Board Program, UPLB.

NOTE TO STUDENT: Submit two (2) copies of SLB application form (1 original copy and 1 photocopy). If you decide to pay your matriculation fees in full after approval, return this form to SFAD-OSA for loan cancellation.