SC-MRUD-PS 08/12
MRU HOLDINGS, INC
PLEASE COMPLETE ALL FIELDS BELOW. YOUR REQUEST MAY BE DENIED IF THE FORM IS NOT COMPLETED
CORRECTLY.
ACCOUNT NUMBER
BORROWER NAME
ADDRESS
CITY
STATE ZIP CODE
TELEPHONE NUMBER
ALTERNATE TELEPHONE NUMBER
ACCOUNT NUMBER
STUDENT BORROWER
I consent to the lender and any other owner, holder, servicer, guarantor or insurer of my account to contact me about my account via
autodialer or similar device and/or using a prerecorded or artificial voice or message for any lawful purpose utilizing any cellular
telephone number(s) I provide, even if I am charged for the call under my phone plan. Providing my mobile or alternative telephone
number(s) and electronic mail address(es) to the lender is voluntary and I am under no obligation to do so. If I do not elect to provide a
mobile or alternative telephone number, or electronic mail address, it will not affect the consideration or disposition of my deferment
request.
SCHOOL DEFERMENT
INTERNSHIP/RESIDENCY
MILITARY / PUBLIC HEALTH
PEACE CORPS
PARENTAL LEAVE
ARMED FORCES
AUTHORIZED OFFICIAL'S CERTIFICATION REQUIRED FOR DEFERMENT
PLEASE PRINT OR TYPE
ZIP CODE
TELEPHONE NUMBER
DATE
NAME/TITLE OF OFFICIAL
STATE
PROGRAM BEGIN DATE
CITY
INSTITUTION/ORGANIZATION NAME
EXPECTED GRAD DATE
DOE CODE
PROGRAM END DATE
ADDRESS
SIGNATURE OF AUTHORIZED OFFICIAL
My signature indicates that I am an Authorized Official and I have read and agree that the certification above is true to the best of
my knowledge.
I meet the qualifications as stated in the cover letter for the deferment type checked above and request my lender/servicer to defer repayment of my
educational loan(s). If my loan program allows, accrued and unpaid interest may be capitalized, added to the principal balance, in accordance with the
terms of my original promissory note. I understand that, should my situation under which I applied for the deferment change, I must notify my lender/
servicer immediately.
BORROWER SIGNATURE
RETURN COMPLETED FORM TO: American Education Services * P. O. Box 2461 * Harrisburg, PA 17105-2461
DATE
FAX: 717-720-3916
I would NOT like to invoke the Servicemembers Civil Relief Act (SCRA)
REQUEST FOR DEFERMENT
FULL TIME
- I will enclose a copy of my current Active Duty orders. I understand that my request may be denied if my orders are not
enclosed.
HALF TIME
