Records Code: APFG/PAFFD
Revision Date: 04/2019
PA Forward Deferment / Forbearance Request
For Private Loans
BORROWER INFORMATION
ACCOUNT NUMBER:
ADDRESS:
CITY:
STATE: ZIP:
BORROWER NAME:
TELEPHONE NUMBER:
MOBILE PHONE NUMBER:
EMAIL ADDRESS:
COSIGNER INFORMATION (if applicable)
ACCOUNT NUMBER:
ADDRESS:
CITY:
STATE: ZIP:
COSIGNER NAME:
TELEPHONE NUMBER:
MOBILE PHONE NUMBER:
EMAIL ADDRESS:
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 phone number, or electronic mail address, it will
not affect the consideration or disposition of my forbearance request.
Section 1: Forbearance Options
*
In lieu of completing this application, you may request these forbearance options verbally at the contact number listed on the cover letter.
SELECT ONE OF THE FOLLOWING
TEMPORARY HARDSHIP FORBEARANCE
I am unable to make the monthly installment payment on my loans(s) due to financial difficulty. The forbearance may
be requested for up to six months into the future and is limited to a total of 12 months.
Requested Forbearance Period
to
(not more than six months)
NATURAL DISASTER FORBEARANCE
I am unable to make the monthly installment payment on my loans(s) due to a natural disaster. The forbearance may
be requested for up to three months from the effective date.
Type of Disaster:
Effective Date:
Home/Work/School Affected:
Requested Forbearance Period
to
(not more than three months)
Section 2: Deferment Options (AUTHORIZED OFFICIAL'S CERTIFICATION REQUIRED)
SCHOOL DEFERMENT
*Only qualifies if the student has been continuously enrolled at least half time.
The following section must be completed by an authorized official
PROGRAM BEGIN
DATE:
PROGRAM END
DATE:
EXPECTED GRAD
DATE:
INSTITUTION ORGANIZATION NAME: OPEID CODE:
ADDRESS: TELEPHONE NUMBER:
SIGNATURE OF AUTHORIZED OFFICIAL NAME/TITLE OF OFFICIAL
DATE
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.
ARMED FORCES DEFERMENT
Requested Deferment Period
to (Dates must fall within your Active Duty period)
In lieu of having an authorized official complete this section, you may submit a verbal or written request for deferment and at least one of the
following documents as proof of active duty: orders and any extension of orders, military short form, DD214, DMDC certification, or a letter
on military letterhead from the servicemember's executive or commanding officer. The documentation must include all information needed
to establish the borrower's eligibility for the requested deferment, including the period of the qualifying service.
-The following section must be completed by an authorized official (your executive or commanding officer)-
ACTIVE DUTY BEGIN DATE: ACTIVE DUTY END DATE: (IF KNOWN):
NAME OF MILITARY BRANCH OR NATIONAL GUARD COMPONENT:
ADDRESS: CITY:
STATE: ZIP: TELEPHONE NUMBER:
SIGNATURE OF AUTHORIZED OFFICIAL NAME/TITLE OF OFFICIAL
DATE
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.
Section 3: Borrower/Cosigner Signature
(Optional)
I request to pay the interest while on the deferment or forbearance, by leaving blank the accrued interest will set to capitalize and be added to
the principle balance.
(Parent loan must continue to make Interest payments while on the School deferment)
I certify I am unable to make payments according to the Terms and Conditions of my Promissory Note(s). I further understand any unpaid interest
will be added to my outstanding balance at the end of the deferment/forbearance period. My monthly payments will be recalculated at the end of
the deferment/forbearance period based on the outstanding principal balance including any accrued and unpaid interest. I understand that should
my situation under which I applied for the deferment/forbearance change; I must notify American Education Services (AES). I understand the lender
or its agent may view my credit history at its discretion in order to validate the information provided.
I certify, under penalty of law, all information provided is true and accurate to the best of my knowledge
.
Borrower Signature:
Cosigner Signature:
(if applicable)
DATE:
DATE:
PLEASE RETURN COMPLETED FORM TO
American Education Services
P.O. Box 2461 Harrisburg, PA, 17105-2461
FAX: 717-720-3916
ENROLLMENT
STATUS:
Borrower
Student of Parent Loan*