Request Form For Deferment Of Repayment - Federal Perkins Student Loan Page 2

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PART II CERTIFICATION (To be completed by appropriate official)
I certify that the information stated in Part I above is true and correct. The borrower was engaged in the activity
during the following dates: from ________________ to _______________.
Signature (Registrar, Commanding Officer, Program Official, etc.)
OPE Code
Date
(Office of
Postsecondary Education)
Name of Institution or Organization
Official Seal or Stamp of School or
Organization
Address (City, State and Zip Code)
Telephone
If none is available, please verify status on
letterhead stationery.
PART III UAS USE ONLY
MONTH/YEAR
MONTH/Y
EAR
# MOS/CODE
# MOS/CODE
PAST DUE AMOUNTS
PAST DUE AMOUNTS
MONTH/Y
MONTH/Y
EAR
EAR
# MOS/CODE
# MOS/CODE
PAST DUE AMOUNTS
PAST DUE AMOUNTS
FORM PROCESSED BY:
FORM PROCESSED BY:
DEFER
PRINCIPAL
PRINCIPAL
INTEREST
INTEREST
LATE
LATE
TOTAL
TOTAL
FORM PROCESSED BY:
FORM PROCESSED BY:
PRINCIPAL
PRINCIPAL
INTEREST
INTEREST
LATE
LATE
TOTAL
TOTAL
DEFER
GE DATE
DATE:
DATE:
DATE:
DATE:
LETTER
PART IV LENDING INSTITUTION ACTION
SIGNATURE OF APPROVING OFFICIAL________________________________TITLE______________________DATE______________
PERK/NSL/HPSL
04/01
DEFERMENT OF REPAYMENT
DEFERMENT OF REPAYMENT
DEFERMENT OF REPAYMENT
DEFERMENT OF REPAYMENT
You are eligible for deferment of repayment under the conditions listed. During periods of
deferment, principal is not due and interest does not accrue. It is your responsibility to submit
forms on time; failure to do so will result in continued billings. If you have loans from more than
one school, you must submit an original form for each school. All forms must be submitted at
least annually. Student deferments should be filed each semester.
NDSL/Perkins
NDSL/Perkins
NDSL/Perkins
NDSL/Perkins

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