(SELF) APPLICATION FORM

University of the Philippines Manila PHOTO STUDENT EMERGENCY LOAN FUND (SELF) APPLICATION FORM Name of StudentApplicant Student Number Degree Program College Amount of Loan Applied (P) Semester School Year Purpose of Loan [ ] TuitionBalance of SLB only (Php) [ ] Books [maximum of P15,000.00] (Php) [ ] Tuition and Books (Php) Mode of Payment Payable in full Installments Do you have an outstanding account with the Student Loan Board or any loan from the CollegeUniversity [ ] NO [ ] YES how much Verified (Person in-charge of loanfinancial assistance program of the College) Printed Name and Signature Position Date I hereby certify that I have read and understood the instructions indicated I affirm that all information supplied herein is complete and accurate I am aware that any or all of the information furnished in this application maybe checked and that withholding or giving false information will make me ineligible for loan and subject to disciplinary action (Signature of StudentApplicant) (Printed Name & Signature of ParentGuardian) Address while in UP Manila Home Address Contact Nos. Contact Nos. Date Date Endorsed by Date (Printed Name & Signature of Faculty) PHOTO University of the Philippines OFFICE OF STUDENT AFFAIRS Ermita Manila PROMISSORY NOTE Name Date P Mailing Address Amount For value received we as Principal and as co-debtor hereby jointly and severally promise to pay the SELF Loan the sum of (P) with interest of 6% per annum or of 0.5% per month Manner of Payment to be as follows Semester AY P P P Principal Debtor It is understood that in the case of non-payment of the amount on the dates above set forth I shall be prohibited from taking the final examinations final grades will be withheld andor non-enrollment for the next semester Co-Debtor (ParentGuardian) Printed Name Signature Action Taken ( ) APPROVED Php ( ) DISAPPROVED Director Office of Student Affairs ACKNOWLEDGEMENT REPUBLIC OF THE PHILIPPINES) City of Manila) s.s. BEFORE ME a Notary Public for and in the above jurisdiction this day of 20 personally appeared  (name of student) with Community Tax Certificate No. issued at on known to me to be the same person who executed the foregoing instrument and all attachments and acknowledged to me that the same is hisher true act and deed IN WITNESS WHEREOF have hereunto set my hand and seal on the date and place herein above stated Doc. No. Page No. Book No. NOTARY PUBLIC Series of 20 Until December 31 20