NOT FOR SALE

SLPTE-ST Staple a recent 1x1 ID

Form 01 - Updated 052020
Unified Student Financial Assistance System picture with your
Printed Name and
for Tertiary Education Signature at the back
(Applicant)
Student Loan Program Short-Term
Application Form
Type or print all entries clearly and use additional sheets if necessary. Do not leave blanks. Indicate N/A if not applicable. Please submit the fully accomplished
Staple a recent 1x1 ID
form in triplicate copies and attach the following:
picture with your
1. Photocopy of Certificate of School Registration of the applicant
Printed Name and
2. Income Tax Return of the applicant, if employed or other proof of family income (e.g Certificate of Employment, Payslips, Audited Financial Statements)
Signature at the back
3. Income Tax Return or other proof of family income of the co-maker
(Co-Maker)
4. Photocopy of School ID of the applicant
5. Photocopy of the Government issued ID of the co-maker
6. Two (2) copies of 1x1 picture of the applicant and co-maker

PERSONAL DATA
Last Name First Name Middle Name Maiden Name (if married)

Age Date of Birth (MM-DD-YY) Place of Birth Citizenship Civil Status Religion Sex

Present Address
Permanent Address
E-mail Address Mobile Number
Loan Purpose: Loan Amount: Income and Assets:
No. of members in the household: _________
Annual Family Income: ___________________________
Main Source of Income: __________________________
House: ( ) Owned ( ) Mortgaged ( ) Rented Others: ___________
EDUCATIONAL BACKGROUND
School School Address Public/Private Degree/Course Level

EMPLOYMENT RECORD (Start from the most recent. Indicate history of employment; whether on a permanent, temporary or casual basis)
Inclusive Dates (MM-DD-YY) Status of Gov't Service
FROM TO
Position/Title Employer Address of Employer Monthly Salary
Employment (Y/N)

FAMILY BACKGROUND
Name of Spouse (if married) Age
Birthdate of Spouse (MM-DD-YY) Date of Marriage (MM-DD-YY)
Occupation of Spouse Spouse's Employer/Address
Parents and In-Laws Age Address Occupation Employer
Father
Mother
Father-in-Law
Mother-in-Law
Name of Dependents Age Relationship Date of Birth

Name of Siblings Age Occupation Employer Civil Status

CO-MAKER
Last Name First Name Middle Name Maiden Name (if married) Relationship to the borrower

Birthdate (MM-DD-YY) Age Mobile No. Civil Status Citizenship

Present Address
Permanent Address
Occupation Monthly Net Income
Current Employer & Address of Employer
ADDITIONAL INFORMATION (Please mark your responses. Use additional sheets if necessary.)
1. Have you ever been found guilty or been penalized for any offense or violation involving moral 4. Are you a member of any indigenous group?
turpitude? If yes, please check the nature of the offense, and specify the name of the court or
administrative board and disposition/status of case: YES NO

YES Administrative Civil Criminal

If YES, please specify: ____________________________
NO Provide details:
2. Have you applied for any scholarship, grants-in-aid or student loan before? If yes, provide 5. Are you a person with disability?
details:
YES NO
YES Grantor/Scholarship Provider: Date Granted: Status:
If YES, please specify ID No: ____________________________
NO
3. Do you have any relative within the fourth degree of consanguinity or affinity working in 6. Are you a solo parent/child of a solo parent?
UniFAST, CHED or school where you are enrolled in? If yes, provide details:
YES NO
YES Name of Relative/s: Relationship:
If YES, please specify your solo parent ID No: ____________________________
NO
REFERENCES (Person not related by consanguinity or affinity to applicant.)
Name Occupation Address Contact Details

I hereby certify that the statements made by me are true, complete, accurate, and correct to the best of my knowledege and belief. Any false information contained herein may
be a ground for disapproval of the loan. This serves as an authorization to conduct investigation on my personal background.
FOR MINOR (15-17 YO) APPLICANTS:

Father's Signature Over Printed Name Mother's Signature Over Printed Name Guardian's Signature Over Printed Name

Date Accomplished Applicant's Signature Over Printed Name Co-Borrower's Signature Over Printed Name
 List of Valid and Acceptable Government Issued IDs

1. Passport 11. IBP ID - Issued by Integrated Bar of the Philippines

2. Driver's License 12. OWWA ID - Issued by Overseas Worker's Welfare Administration
3. SSS UMID Card 13. Government Office ID or GOCC - Issued by a branch or agency of the government
4. PhilHealth ID 14. NSO Birth Certificate
5. TIN Card 15. NBI Clearance
6. Postal ID 16. Police Clearance
7. Voter's ID 17. Barangay Clearance
8. PRC ID
9. OFW ID
10. GSIS ID