disbursment form.pdf

In any correspondence on This subject please quote: HESFB/96/121/014 Caution: any student who in filling this loan application form, knowingly makes a false statement whether orally or in writing for any matter affecting the request for a loan shall be guilty of an...

In any correspondence on This subject please quote: HESFB/96/121/014 Caution: any student who in filling this loan application form, knowingly makes a false statement whether orally or in writing for any matter affecting the request for a loan shall be guilty of an offence and shall be dealt with according to the law Name(s) Registration No. National ID No. Institution Name Course of Study Year and Semester of study E-mail address Facebook address Twitter address WhatsApp No. Telephone Amount applied for (Ugx.) Financial Card No. PART A: Academic registrar (other Authorised Officer)’s Certification (Name, Signature & Stamp) Please find attached (names of Student) ………………………………………………………. statement of results for the previous semester(s). I confirm that this is a student of this university and is on normal / probation academic progress. Name Signature & Official stamp Date PART B: Agreement Certify as follows: I understand that this is a loan and must be repaid and do hereby bind myself to repay to the order of the board of all sums disbursed to me (hereinafter called; the loan), together with the interest thereon and other charges that may become due and payable under terms and conditions set hereinafter. I understand that the acceptance of any disbursements issued to me at any time will signify obligation to repay the loan and I shall abide by all the obligations as bestowed upon me by the Higher Education Students’ Financing Board Act. The Higher Education Students’ Financing Board, hereinafter called the Board shall refer to the current Board and its successors and assigns. TERMS AND CONDITIONS 1. I hereby declare that the above particulars and information availed above is true to the best of my knowledge and the same shall form the basis of any arrangement for a facility (Student’s Loan, and any other products the Board might develop from time to time) if any is granted to me. 2. The loan must be repaid with interest as may be determined by the Board from time to time. 3. The Board retains the right to evaluate all loan applications and determine the number of beneficiaries.(this application is not a guarantee that the loan shall be approved) 4. In the event that the loan beneficiary discontinues studies for whichever reason before full disbursement is made, the Board shall not disburse the remaining allocation and shall recall the loan so far advanced in full together with the interest thereon. 5. The loan shall be repaid in equal monthly instalment as per schedule determined by the Board. 6. As prescribed by article 27 of the act, I undertake to make early repayments when funds allow and I shall do so in a manner that shall be approved by the board 7. If a loan beneficiary deliberately defaults in repayment when the loan is due, the whole amount shall become due and payable and the loan beneficiary shall be bound to pay all other charges that may arise as a result of the default including but not limited to the advocates fees and penalties. 8. The signature of the applicant shall certify the reading, understanding and being in agreement with the terms and conditions herein. 9. No loan shall be disbursed unless the loan agreement form is signed by the successful applicant. 10. I am aware that the Board, at my cost, will protect its funds i.e. The Students’ Loan against any such risk for such amount the Board has approved and disbursed to me. In the event that any Student’s Loan is granted and accepted by me, I agree to be bound by the rules, terms and conditions of the Board, and undertake to sign all such documents as may be required to secure the Loan from the Board. I acknowledge liability for the administration fees and wasted costs incurred by the Board or its lawyers in the event of my withdrawing from the Student’s Loan facility. I further acknowledge that the commitments I have made in this application shall continue to bind me from now onwards until the entire loan is fully paid and I accept full responsibility for and shall fully indemnify the Board 11. I undertake to notify the Board or its successors or assignees in title of any change which materially changes any representation first above mentioned. 12. I, the Applicant, hereby consent to you, the Credit Provider: Receiving, compiling and retaining any confidential credit information about me for purposes of (i) assisting you perform your statutory assessment of my creditworthiness (ii) deciding whether to grant credit to me and (iii) monitoring my credit profile, should you grant me credit; Filing my consumer and business credit information with any other credit provider and, Compuscan a registered Credit Reference Bureau (CRB) who is licensed in terms of the Financial Institutions Credit Reference Bureau regulations of 2005 Sharing my consumer credit information with any tracing agent or Collection Company in the event I default in my credit repayment obligations to you. I further hereby consent to the Credit Reference Bureau: Providing you with a credit report which you may rely on (i) to assess my creditworthiness and (ii) to base your decision whether to grant credit to me; Accepting the filing of my consumer credit information from any credit provider; Issuing a report to any person who requires it for lawful purposes. My signature hereto signifies my consent as aforesaid and my agreement to hold you and any credit bureau and other credit provider to whom you may provide my consumer credit information in terms of my aforesaid consent harmless against any and all liability, loss, claim, demand, cost, fees and expenses arising out of or from or in connection with my aforesaid consent. Applicant Full Names: ……………………………………………………………… Signature: ……………………………………………………………… Date : ……………………………………………………………