Student Loan Program - Short-Term Application Form

NOT FOR SALE
SLPTE-ST
Form 01 - s. 2019
Unified Student Financial Assistance System Staple a recent 1x1 ID
picture with your
for Tertiary Education printed name and
signature at the back
Student Loan Program Short-Term
Application Form
Type or print all entries clearly and use additional sheets if necessary. Do not leave blanks. Indicate N/A if not applicable. Please submit the fully accomplished
form in triplicate copies and attach the following:
1. Photocopy of Certificate of School Registration of the applicant
2. Income Tax Return of the applicant, if employed or other proof of family income (e.g Certificate of Employment, Payslips, Audited Financial Statements)
3. Income Tax Return or other proof of family income of the co-maker
4. Photocopy of School ID of the applicant
5. Photocopy of the Government issued ID of the co-maker
6. Two (2) copies of 1x1 picture of the applicant and co-maker
PERSONAL DATA
Last Name First Name Middle Name Maiden Name (if married)
Age Date of Birth (MM-DD-YY) Place of Birth Citizenship Civil Status Religion Sex
Present Address
Permanent Address
E-mail Address Mobile Number
Loan Purpose: Income and Assets:
No. of members in the household: _________
Annual Family Income: ___________________________
Main Source of Income: __________________________
House: ( ) Owned ( ) Mortgaged ( ) Rented Others: ___________
EDUCATIONAL BACKGROUND
School School Address Public/Private Degree/Course Level
EMPLOYMENT RECORD (Start from the most recent. Indicate history of employment; whether on a permanent, temporary or casual basis)
Inclusive Dates (MM-DD-YY) Status of Gov't Service
FROM TO Position/Title Employer Address of Employer Monthly Salary
Employment (Y/N)
FAMILY BACKGROUND
Name of Spouse (if married) Age
Birthdate of Spouse (MM-DD-YY) Date of Marriage (MM-DD-YY)
Occupation of Spouse Spouse's Employer/Address
Parents and In-Laws Age Address Occupation Employer
Father
Mother
Father-in-Law
Mother-in-Law
Name of Dependents Age Relationship Date of Birth
Name of Siblings Age Occupation Employer Civil Status
CO-MAKER
Last Name First Name Middle Name Maiden Name (if married)
Birthdate (MM-DD-YY) Age Mobile No. Civil Status Citizenship
Present Address
Permanent Address
Occupation Monthly Net Income
Current Employer & Address of Employer
ADDITIONAL INFORMATION (Please mark your responses. Use additional sheets if necessary.)
1. Have you ever been found guilty or been penalized for any offense or violation involving moral turpitude? If yes, please check the nature of the
YES NO offense, and specify the name of the court or administrative board and disposition/status of case:
Administrative Civil Criminal Provide details:
2. Have you applied for any scholarship, grants-in-aid or student loan before? If yes, provide details:
YES NO
Grantor/Scholarship Provider: Date Granted: Status:
3. Do you have any relative within the fourth degree of consanguinity or affinity working in UniFAST, CHED or school where you are enrolled in? If
YES NO yes, provide details:
Name/s of Relative/s: Relationship:
REFERENCES (Person not related by consanguinity or affinity to applicant.)
Name Occupation Address Contact Details
I hereby certify that the statements made by me are true, complete, accurate, and correct to the best of my knowledege and belief. Any false information
contained herein may be a ground for disapproval of the loan. This serves as an authorization to conduct investigation on my personal background.
FOR MINOR (15-17 YO) APPLICANTS:
Father's Signature Over Printed Name Mother's Signature Over Printed Name Guardian's Signature Over Printed Name
Date Accomplished Applicant's Signature Over Printed Name

List of Valid and Acceptable Government Issued IDs
1. Passport 11. IBP ID - Issued by Integrated Bar of the Philippines

2. Driver's License 12. OWWA ID - Issued by Overseas Worker's Welfare Administration
3. SSS UMID Card 13. Government Office ID or GOCC - Issued by a branch or agency of the government
4. PhilHealth ID 14. NSO Birth Certificate
5. TIN Card 15. NBI Clearance
6. Postal ID 16. Police Clearance
7. Voter's ID 17. Barangay Clearance
8. PRC ID
9. OFW ID
10. GSIS ID

Student Loan Program - Short-Term Application Form

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NOT FOR SALE

Name of Siblings Age Occupation Employer Civil Status

Birthdate (MM-DD-YY) Age Mobile No. Civil Status Citizenship

FOR MINOR (15-17 YO) APPLICANTS:

Date Accomplished Applicant's Signature Over Printed Name

1. Passport 11. IBP ID - Issued by Integrated Bar of the Philippines

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