SECTION D

Direct Loan Forms

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_
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-1

Sample Master Promissory Note Manifest
Report Date: 99/99/9999
Report Time:
99:99:99

U.S. DEPARTMENT OF EDUCATION
Federal Direct Loan Program
Promissory Note Shipping Manifest

Page:

99

THIS DOCUMENT CONTAINS SENSITIVE INFORMATION PROTECTED BY THE PRIVACY ACT
***********************************************************************************
PROMISSORY NOTE SHIPPING BATCH NUMBER:

#AX99999999999999999999

BORROWER’S NAME
STUDENT’S NAME
STUDENT’S CURRENT SSN
-----------------------------

LOAN MPN ID

XXXXXXXXXXXXXXXX, XXXXXXXXX X
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999XM99999999999

ABCDEFGHIJKLMNOP, QRSTUVWXY Z
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999XM99999999999

BCDEFGHIJKLMNOPQ, RSTUVWXYZ A
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999XM99999999999

NUMBER OF NOTES FOR SHIPPING

____________

---------------------

I hereby certify that each borrower named on the enclosed notes/disclosures is
accepted for enrollment on at least a half-time basis and is making satisfactory
progress in a program that is eligible for the loan type(s) awarded. I certify that
each student is an eligible borrower in accordance with the Act. I further certify
that each borrower's eligibility for a Pell Grant has been determined, that each
borrower is not incarcerated, and that each borrower has been determined eligible
for loan(s) in the amount(s) certified. I further certify that the disbursement
schedules comply with the requirements of the Act and hereby authorize the
Department of Education to adjust disbursement dates if necessary to ensure
compliance with the Act. I further certify that, based on records available and due
inquiry, each borrower has met the requirements of the Selective Service Act, that
each borrower is not liable for an overpayment of any Federal grant made under the
Act, and that the information provided in the Borrower and the School sections of
the promissory notes/disclosures (including information supplied in electronic
format) is true, complete and accurate to the best of my knowledge and belief.
SCHOOL CODE:

X99999

NAME:

XXXXXXXXXTXXXXXXXXXTXXXXXXXXXTXXXXX

SIGNATURE:___________________________________
FAA NAME:

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

_______________________________________________________________________________________________________________
_
February 2000 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-2

Sample PLUS Manifest
Report Date: 99/99/9999
Report Time:
99:99:99

U.S. DEPARTMENT OF EDUCATION
Federal Direct Loan Program
Promissory Note Shipping Manifest

Page:

99

THIS DOCUMENT CONTAINS SENSITIVE INFORMATION PROTECTED BY THE PRIVACY ACT
***********************************************************************************
PROMISSORY NOTE SHIPPING BATCH NUMBER:

#AX99999999999999

BORROWER’S NAME
STUDENT’S NAME
STUDENT’S CURRENT SSN
-----------------------------

LOAN ID

XXXXXXXXXXXXXXXX, XXXXXXXXX X
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999X99999999999

ABCDEFGHIJKLMNOP, QRSTUVWXY Z
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999X99999999999

BCDEFGHIJKLMNOPQ, RSTUVWXYZ A
XXXXXXXXXXXXXXXX, XXXXXXXXX X
999999999

999999999X99999999999

NUMBER OF NOTES FOR SHIPPING

____________

---------------------

I hereby certify that each student named on the enclosed
applications/promissory notes is accepted for enrollment on at least a halftime basis and is making satisfactory progress in a program that is eligible
for the loan type certified. I certify that each borrower is an eligible
borrower in accordance with the Act and has been determined eligible for a
loan in the amount certified. I further certify that the disbursement
schedules comply with the requirements of the Act and hereby authorize the
Department of Education to adjust disbursement dates if necessary to ensure
compliance with the Act. I further certify that, based on records available
and due inquiry, each student has met the requirements of the Selective
Service Act, that each student is not liable for an overpayment of any
Federal grant made under the Act, and that the information provided in the
Borrower, Student and School sections of the applications/promissory notes
(including information supplied in electronic format) is true, complete and
accurate to the best of my knowledge and belief.
SCHOOL CODE:

X99999

NAME:

XXXXXXXXXTXXXXXXXXXTXXXXXXXXXTXXXXX

SIGNATURE:___________________________________
FAA NAME:

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

_______________________________________________________________________________________________________________
_
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-3

Borrower Information
1. Name (last, 1. Name (last, first, middle initial) and Address (street, city, state, zip
2.code
Identification Number(s)

Trejo, Rosa A
4200 Wilson Blvd.
Arlington, VA 22033

111222333S01G99999001
111222333U01G99999001
3. Area Code/Telephone Number

(703) 741-9999

School Information
4. School Name and Address (street, city, state,
zip code)

Technical University
1111 Main St.

5. School Code/Branch

Fairfax, VA 22222

G99999

Loan Information
6. Loan Period

8. The

From: MM/DD/YYYY

To: MM/DD/YYYY

06/01/1999
06/01/1999

06/01/1999
04/15/2000

7. Date of This Disclosure Statement (MM/DD/YYYY)

05/05/1999

chart below shows anticipated disbursement amounts and dates. Actual amounts and dates may vary.
NOTE: THE INTEREST RATE ON YOUR DIRECT SUBSIDIZED AND DIRECT UNSUBSIDIZED LOANS IS VARIABLE.
Anticipated Disbursement
Loan Fee
Dates (Month/Day/Year)Loan Amount Percentage
Loan Fee AmountNet Disbursement
Direct
04/01/2000
$ 100.00
3.00
$ 3.00
$ 97.00
Subsidized
04/01/2000
$ 100.00
3.00
$ 3.00
$ 97.00
Loan
04/01/2000
$ 100.00
3.00
$ 3.00
$ 97.00

04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000

Total:
Direct
04/01/2000
Unsubsidized
04/01/2000
Loan
04/01/2000

04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000

Total:

$
$
$
$
$
$
$
$
$

100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00

$ 1200.00

$
$
$
$
$
$
$
$
$
$
$
$

100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$
$
$
$
$
$
$
$
$

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$
$
$
$
$
$
$
$
$

97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$
$
$
$
$
$
$
$
$
$
$
$

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$
$
$
$
$
$
$
$
$
$
$
$

97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00
97.00

$ 1200.00

_________________________________________________________________________________________________________________
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-4

P

Antic

IMPORTANT ADDITIONAL LOAN INFORMATION IS PROVIDED ON THE REVERSE SIDE. ANTICIPATED
DISBURSEMENT AMOUNTS AND DATES MAY BE CONTINUED ON THE REVERSE SIDE OF THIS STATEMENT

_________________________________________________________________________________________________________________
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-4

Disclosure Statement (continued)

THIS DISCLOSURE STATEMENT REPLACES ANY PREVIOUS DISCLOSURES YOU RECEIVED FOR YOUR LOAN(S)
IF YOU HAVE ANY QUESTIONS ABOUT THIS STATEMENT OR YOUR PROMISSORY NOTE, CONTACT YOUR SCHO
The total of the Loan Amount for both Direct Subsidized Loans and Direct Unsubsidized Loans is the total principal amount certified by
your school on the loan(s) as of the date of this Disclosure Statement. The Net Disbursement Amount reflects the amount you will
actually receive after loan fees are deducted.
For terms applicable to the loan(s), please refer to the Master Promissory Note and the Borrower’s Rights and Responsibilities Statement.
YOU WILL BE NOTIFIED BY YOUR SCHOOL AND BY THE DIRECT LOAN SERVICING CENTER WHEN DISBURSEMENTS ARE
MADE. BEFORE DISBURSEMENTS ARE MADE YOU MUST HAVE SIGNED A PROMISSORY NOTE.

IF YOU DO NOT WANT ALL OR A PORTION OF ANY DISBURSEMENTS REFLECTED ON THIS DISCLOSURE, YOU MAY DECLINE
THE LOAN(S) OR REDUCE THE AMOUNT OF THE LOAN(S) BY NOTIFYING YOUR SCHOOL IN WRITING OR BY RETURNING THE
FUNDS WITHIN THE FOLLOWING TIMEFRAMES:
     IF YOUR SCHOOL CREDITS YOUR LOAN(S) TOYOUR STUDENT ACCOUNT, YOU MAY CANCEL ALL OR A PORTION OF THE LOAN(S) BY
     INFORMING YOUR SCHOOL WITHIN 14 DAYS AFTER THE DATE YOUR SCHOOL SENDS YOU A DISBURSEMENT NOTICE, OR BY THE FIRST
     DAY OF THE PAYMENT PERIOD, WHICHEVER IS LATER.(YOUR SCHOOL CAN TELL YOU THE FIRST DAY OF YOUR PAYMENT PERIOD.)
     YOU MUST RETURN ANY FUNDS RECEIVED WITHIN 120 DAYS OF DISBURSEMENT TO AVOID INCURRING INTEREST CHARGES AND LOANS
     FEES. (THE LOAN FEE WILL BE REDUCED OR ELIMINATED IN PROPORTION TO THE AMOUNT OF THE DISBURSEMENT RETURNED.)

NOTE: THE INTEREST RATE ON YOUR DIRECT SUBSIDIZED AND DIRECT UNSUBSIDIZED LOAN IS VARIABLE.
KEEP THIS DOCUMENT FOR YOUR RECORDS.

____________________________________________________________________________________________________________________
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-5

Sample Disclosure Statement Text Printed by EDExpress
Below is a sample of the Disclosure Statement text that EDExpress prints on a pre-printed Disclosure Statement form. The pre-printed
form has a header with the Department logo, a footer with an instruction box, and a large blank space in the middle for EDExpress to
print the Disclosure Statement text.
BORROWER INFORMATION---------------------------------------------------------------------1. Name (last, first, middle initial)
2. Identification Numbers(s)
and Address (street, city, state, zip code)
123456789012345678901
L234567890123456, F23456789, M.
111222333S01G99999001
A234567890123456789012345678
C234567890123456, ST 12345
3. Area Code/Telephone Number
(703) 741-9999
SCHOOL INFORMATION-----------------------------------------------------------------------4. School Name and Address (street, city, state, zip code) 5. School Code/Branch
George Mason University
12345 Chain Bridge Road Fairfax, VA 22222
G99999
LOAN INFORMATION-------------------------------------------------------------------------6. Loan Period From: MM/DD/YYYY To: MM/DD/YYYY
7. Date of This Disclosure Statement
09/01/1999
05/15/2000
(MM/DD/YYYY)
06/01/1999
04/15/2000
09/05/1999
----------------------------------------------------------------------------------------8. The chart below shows anticipated disbursement amounts and dates. Actual amounts and
dates may vary.
NOTE: THE INTEREST RATE ON YOUR DIRECT SUBSIDIZED AND
DIRECT UNSUBSIDIZED LOANS IS VARIABLE.
Anticipated Disbursement
Loan Fee
Dates (Month/Day/Year)
Loan Amount Percentage
Direct
Subsidized
Loan

04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
Total:

Direct
04/01/2000
Unsubsidized 04/01/2000
Loan
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000
04/01/2000

$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00

Loan Fee Amount

Net Disbursement

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00

$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00

3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00

$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00
$3.00

$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00
$97.00

$1200.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00

_________________________________________________________________________________________________________________
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-6

04/01/2000
04/01/2000
04/01/2000
04/01/2000
Total:

$100.00
$100.00
$100.00
$100.00

3.00
3.00
3.00
3.00

$3.00
$3.00
$3.00
$3.00

$97.00
$97.00
$97.00
$97.00

$1200.00

_________________________________________________________________________________________________________________
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)
D-6

Sample Master Promissory Note
(The Sample MPN will be provided as soon as available.)

November 1999 (2000-2001)
(188 H)

Direct Loan Technical Reference

Appendix
D-7

Sample PLUS Promissory Note/Application
(The PLUS Prom Note/Application will be provided as soon as available.)

____________________________________________________________________________________________________
_
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)

D-8

02/10/2008
Dear School/Borrower:
While processing the enclosed promissory note(s) batch, we identified the following
missing or incorrect information:
_____Alterations to preprinted text without authorized initials
_____Invalid/Missing loan identification number
_____No original signature (Xerox or faxed copy)
_____Driver license incomplete
_____Document in pencil
_____Section/Block ___not completed
_____No signature on document
_____Manifest errors
_____Missing legal text
_____Student or Parent is in default
_____This is a duplicate; we already have a copy
_____This document was torn or damaged at LOC/DLSC
_____Year five loans must be on year five-promissory note
_____Section block numbers 20 and 21 on Plus note needs signature and date
_____Invalid signature. Please provide official state or federal document
to verify/validate signature provided on Promissory Note
_____Immediately, return promissory notes as they are generated and
signed
_____Other_____________________________________________________
Because we are not permitted by law to alter the original promissory note, we are
enclosing it for correction(s) as noted above. Please assist the borrower in completing
the promissory note, assuring that the correct information has been incorporated where
needed. When the promissory note(s) has been completed and corrected, please return
it to the Loan Origination Center so that processing of the loan may continue.
If you have any questions, the Loan Origination Center is available to assist you from
8:00 AM to 8:00 PM, Eastern Standard Time, Monday through Friday. We can be
reached, toll-free, at 1-800-848-0978. Our toll-free TDD number for the hearing
impaired is 1-800-557-7395.
Please return the corrected promissory note(s) to:

Regular Postal Delivery
Delivery
U.S. Department of Education
Loan Origination Center
School Relations
P. O. Box 5692
Montgomery, AL 36103-5692

Express/Overnight
U. S. Department of Education
Loan Origination Center
School Relations
474 South Court Street Suite 400
Montgomery, AL 36104

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_
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)

D-9

LCEX1V01
Our Mission is to Ensure Equal Access to Education and to Promote Educational Excellence Throughout the Nation

___________________________________________________________________________________________________
_
November 1999 (2000-2001)
Direct Loan Technical Reference
Appendix
(188 H)

D-9