University of the Philippines Los Baos Application Number: New Old

STUDENT LOAN BOARD PROGRAM 2ND Semester School Year 2013 - 2014
Date Filed:
OSA-SFAD Form 4a STFAP Bracket:
Revised October 8, 2013
Old Students: Please login to www.uplbosa.org to generate SLB application form.

A P P L I C A T I O N F O R M F O R N E W F R E S H M E N

1. STUDENTS PERSONAL INFORMATION
Name of Student:
(Surname) (First Name) M.I.
Student/ID Number 2013- College Course Classification
NEW FRESHMAN
Telephone No. Mobile No. Email Address
Permanent Home Address
(House No./Street/Subdivision) (Barangay)

(Town/City) (Province)


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

Terms of Payment
1
st
Payt.-
Due Date Amount
2
nd
Payt.-
Due Date Amount
Full Payt.-
Due Date Amount


3-Installment Payments Dec. 16, 2013 Jan. 31, 2014 Mar. 21, 2014


2-Installment Payments Jan. 16, 2014 Mar. 21, 2014

Full Payment Mar. 21, 2014

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 Signature

Relationship to Debtor (Pls. Check) Parent
Relative (pls. specify
relationship to the debtor)

Co-Debtors Complete Home Address:
Contact Number: Landline Mobile No. Email Address:

4. a) RECOMMENDING APPROVAL: b. APPROVED/DISAPPROVED:


ELISA S. NAVARRETE LETICIA E. AFUANG
Head, SFAD-OSA and Member, SLB Director, OSA and Chairman, SLB

Procedures/Requirements for SLB

1. Present assessed UPLB Form 5 and submit a clear photocopy of valid ID (with photo and signature) of co-debtor (parent or relative). Acceptable co-
debtors are parents and relatives of the student. Bring the original ID of co-debtor for verification and authentication.
2. 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.
3. Students with outstanding loans will not be allowed to avail of any further SLB. If loan remains unsettled, student cannot be issued clearance.
4. 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.
2. LOAN (For computation of OSA Loan Staff Only)

Total Matriculation Fee (TMF) (100%) ... PhP
Amount of SLB Loan applied for (TMF X 80%) ... PhP
Cash Payment upon Enrollment (TMF X 20%) ... PhP
6% Interest Rate per Annum ... PhP