2020/21 (aa) hesre HIGHER EDUCATION STUDENTS’ FINANCING BOARD Increasing Access to Higher Education sae ne ome Attach 3 passport Photographs * ‘STUDENTS’ LOAN APPLICATION FORM 2020/21 Taman? BE COMPLETED BY ALL STUDENTS APPLYING FOR STUDENTS’ LOAN EA ort econ os Eon es rong A nap wha ie tenet a idan rene cf 500s ete ona. sso sca tog aren pare tos eT et ns nds br an rer atv Sra fe ne ee 3 PERSONAL DETAILS OF THE APPLICANT (conpetalzactonsn opal Bbc eters hee spate FER eral neon ota tck eters vere penton) | 1141 Applicant’: Blo - Data simame * Fist Name * ther Name(s) sie ey Gender = Date fais = Oo Poo § 1.2 Applicant's Contact Informat Eat ares tent rat Adss Meble Phone Wurber* icant entation ba pcan Gooaamonom CG nasortionowvn+l PTT] LL] Cresson | 7 Ti pranctene Ol Dotter { Number: (Specify) a sreyouemptoyesr [] ts [] no. eves res pv aed wy Oi twinamber Ci nsse number 1.4 Applicant's Current. Region * District ounty* ‘SubCounty* Patsh [Ward™ = : = Emergency Contact Person Relationship “Telephone of Contact Person2020/21 Aslan’ Marta Status ese atch donut vee plete) Co sde F] mar (are lS ame pe, Cone Hal Mambo) Soon tame Spou'sTeephane No. spouesnaonatiettyna, | .Z Applicants Disability (Pease attach picture and Doctors report), Do youhaveanydsabitty? [| ves[__] No (WES Please inst which ofthe folowing debe andthe extent ofthe dblty) Tine of tity vel of daa 1 communiatne | stent Moderate sever Hearing — slight) Moderate [—} severe [] mrememberog — ) |] sient 5] Moderate E] severe O] IV. Seeing G]} se 5 Moderate E sever wo sic = |] sie Moderate sere O (une ahrs VL Walking CO]] ste ca Moderate severe OJ wi otherstnecty |] signe Moderate F severe O] cant’ Entry Mode lucation institution * [over ode trom eve |] inact Mode (ertteat/Dploms Halder or Meare ae ery) rine er mode, here pple, prove ute hematin blo) Name of Employer Employer Addeess Employer'sContact Gross SalayinUshs __-URATIN NSSF Number Police Force 7 Personal Supplier PDF Service Number PPS Number See a i petite cere2020721 licant’s Education. Informs ane aoe Le anes eR eri eee eet Goad Cn Bell ices ela sonar Iain evidence) Universities Atended a “Tertiary Institutions Attended * (shouldbe filed Appear’ Eaton Enty Mode Other) “X tevel Schools Attended * (shouldbe filed f Applicant's Education Entry Mode is Drea) Level Schools Attended * Primary Shoo! Attended * low was your education financed?) (Tick appropriately and capture A Level / School Fs Tertiary fees in accordance wth Hes Teacher recommendeton) Ferent Guardar! Government Scholarship set Fees perterm Sponsor! (tach copy of Pays Sing coe al ial Oo oc om O O O O OC a) i O oc !¥fees wes pid by Guardian / Sponsor sing / Scholarship please Indice and attach evidence.2020/21 2. PARENTS’ DETAILS OF THE APPLICANT (Complete all sections in Capital / Block Letters) 2.4 FATHER (ware seoyed lease atch fabs lest paap and I elamplyed stich prot d income e.g, Franc Sseenibanksnirent ed eecesed prove dash catteate (61 Chsparcns ones) 2.4.1 Father's Blo - Data Sumame* Fist Name * (ther Namets | Nation 1 No MN) EMieeo (2.1.2 1s your father alive? * [vss [10 yma ocho eth crt / ete contig sath ten got secon 2.2 Fathers Current Contact infor Soanecas eee ee pee = = = ‘Sub-County * Parish / Ward * ] Village / Cell * a J] 2.1.4 Father's Disability (Please attach a picture and Doctor's report) Sewer terre day [_] yes [] no, MMe he ih oot ne corps \eveLoroisasury Communiating oll sO Moderte seen verne Ol} sexe wedente B see 5 fememtetng Bl) se G wodeate foxes] sen Ol} se O Modeate swe sete Ol) see medeste F] some (Ulta) vioing Off sm O Wodeate soe ters ee see 5 wederte F see 5 2.45 Fathers Highest evel of Eaton * (ease ick spropriately) re eC cerete Diora] seteersSorme —] ponte tite] ereenee Decorate2020/21 .S Father's Profession/Curre ation/Job Title — 2.1.7 Father's Employment Informatir Isyourtatheremployec? [J ve [] NO. eves rate provide he town eta) Employer Name __, Neture of Employers’ Business 2.4.8 Father’ Income information (month) * (Specify as applicable) {come from Employment Income from Business/ Income from Crop/ Income from Other Source Rentals ‘Animal husbandry 2.2. MOTHER Sarre erploed es atach motors kat paytp and f slerployed atach prot of cone €6. Fanc tserentbarkstaament wii docensod rove dat cata Lot Chaperone exe 2.2.4 Mothers Bio Data ‘Sumame * Fst Name * ‘ther Name(s) Coco | 2.22 Is vour Mother's ave? *[_]¥es[Nownansn te seteafer/ct tse es pein 2.2.4 Mother's Current Contact information .0. Box Number Email Address Mobile Phone Number Cae IE, = Sub-County Patch / Ward 2.2.4 Mother's Disability (Please atch picture and Doctor's epot) Doesteurmoter have anyday? [_] Es | no an net whofe tines vilage cil * l nd the xen of he by) OF DISABILITY EVEL OF DISABILITY Communising O][ sie Moderate C] severe O Hearing OY) sie O Moderate E] sere Remenbering D]] sie B a seere F] Seeing GO} swe 5 seere setcare O]] sie a seve C) (Unabietolook ter hers Wating DB] sem Moderate severe C] Others (Sect) OG} sie G Moderate F] sewre2020/21 2.2.5 Mother's Highest Level of Education * (Please tick appropriately) None] Priarytewving — )otevey tere!) Veeatonacerttete 5] censeste Dirleme — [[]eachele'sdearee[] rostcraduateipoma []Mastersdearee 5] poeomte 2.26 Mothers Profession/Cutrent Occupation/Jb Title ee ee 2.2.7 Mother nt Information Isyeurmotiremptoves?—[_]v88 [] No. ops rete prove te toning se Employer Name Taueo! flyer Busnes 2.2.8 Mother's Income information (monthly) *(Speciy as applicable) Imeonerméngomett ince em une eae omen? eon om or souce ro tonsa C C L | i] 2. etl of ings ooo ng wwe sl agenda fay beg ch Where the space provide snot adequate compete and tach nadine.) Name Institution / Schoo! ove of Study Term Fees 2.4 Family Social Economic Situation 2.4.1 Blok ils Total number of school going children from “Total number of school going chiren rom Dolla father biological mether Acyoursorenssayatestst? [}yes |] no #80, whom doyoustay?[] rathar[ —] Mather] ots eee spec) 2.4.3 What is the total of people in your household[ 24a ily resider Elie Feet Fhe ee, 2.45 Tye of hows Co rermnet anton [J eae tathes [Joes iene ety Sintec stonsitetenrteue [] What isthe estimated m of hold in Us bee 2 [| So ees] 4 Uses ee eeeeeemerneeeeres Cn | eee eee] weeewoos Se ee | ia es een] Tee Monty Howe pnd fmot.2, Sang) 2:48 Medical Care * (Where does your family go for medial trestient? Pease Wk appropritey) [comnts ratty |] rtp] Maa ntl ote ety 2 sm ca tatment? * (please ek peop [reson [Jan [J seathinrneemsors tin |] er eure spc 2.4.20 Data ot endants (rove intormaton of dependants whose silsudyigsndin cat of any eal epenants cy. Where the sac rodent adequate complete nd tach on atona chet fe Name Inston / choot Level ot Study ‘Annes2020/21 3._ADMISSION AND LOAN DETAILS (Complete all sections in Capital / Block Letters) Site opal /locktetters) 1 Details of Institution To Which You Are Adm iter ae " Tay So claps" erat dition * ‘asiion Number ™ ‘Course Ada ‘Course Duration * (in Years: Please tick) ‘Current Year of Study * fin Years: Please tick) an] We svar avai] loan Amount Required for One adem earn Shs [Sense | gst —Fae — 1 a ees 1) Rac es Far GT Schou maser spe TAs nd pnts he Baad (ren Sc Sac a pane Ha ter fy be anes] 2.3 Borrowing Motivation (Pease Give Reason Why You Must Sorrow From Government To Finance Your ‘Higher Eveation) 3.4 Early Payments (.e. lan repoyments during the pated of rudy, end these loan repayments ae not charged Interest). This therefore to encourage you to find sponsors to compete the tbe below 20 tet you benef om he reduced interest burden) [ee poman eoe le ‘Sponsor 2 Name Profession ‘occupation Contact Proposed Amount Frequency voy 5) save veo Clewenty ] rsenty seatip DECLARATION AND RECOMMENDATIONS (Complete all sections in Capital / lock Letters) 4.1 Parent / Guardian {declare that have read this form or this form hasbeen read tome and hereby confirmthat the information {ven herein is true to thebestof my knowledge, Telephone contact — Mobile Number * SE Residential Physical address * Employer (Appeal): nee Employers Pyseal adress . —— . lationship with Appian . a Sienaure® Ce a oate* ——$—— rn | 4.2.Terms and Conditions 2 they dere tht the above partes an formation aed above ite othe bs of knowlege andthe ame ‘ufo he is of ry aangevnt fr ey Sant’ Lah, ad ay ote produc the and mene dress toe 3 The loan sab repaid with nes as maybe tried the oad om neo tine 5. The oa eta the right to evant loan appatons ond determine he numba of ena (h aplation ‘Inthe event hat the loan ener dont tues a whichever reson bef ldhrsement sade Board ‘ant dibura the remaining allocation ad sal real the ona advanced inal ih ihe nacre 5. Theloan sal be reps n ean montana pe shade determined by Baad ‘8 precio by scion 2 ofthe Higher Edcaton tent tng ct 2014 undertake eal ety payene hen un alo a sal 50 manner tat shal be approve bythe Bure ean beefy fut n repayment when th ane, th whale amount shall become ds and pale and the lea bane salbe Bound to py ther cares tht maya at resto the gefeuk ncnng Bee cc The dome fh opal cert te reading understanding ed gn arent ith eter and cents 9. Woloan stab ered une the loan agreement fem ged 10 1am aware that he Soars my a5, wil protect funds the Sent Lon ag any sud ik sch smunes i he Boar has proved rd shred me. nthe et tay San’ enn erat sessed try Indenture200/21 134 1 undrake to ntty the Board or Hs sucssrs oF Rept inte of any change wich mater Changes any representation rt stove mensond | the Aspcant hereby consent to you, the Cele Pov: Rech, coming snd ttaing any conenta rest Information about me fo purposes fait you perform our sity stestment of my edna: ding woather fo rant eto me ond fi) montrig my eed profi shld you pont meee ng my comune ane tines cred iformaton wth any ter ret rove and Computcan a repatered Cre rene uresend whe Sens in tems ofthe Fen nts Crt Reference Buren reqston ef 208 Sty ny conte wet ‘norman with ny ace oen or Coleco Comgany he evan defen my cet repeynet elgaion toro ua erty const the re Reference arau Provide you wha cet pre wich you may rly tats my creertines sn to base your decsion wheter to want cet ta me; Aceptngthe ing of my conser ct information om ay east poe cny "port any pron who request fr purpose. Senate ert spies my consent as sloresi nd my agreement to eld yu ad rc bureu and three ‘rode to whom you may vide my consumer cet foaton nes of my afrsi ama hess nat en ‘a aby, ss, a, demand, cost fet and epenses an ring otf ram on cotton why soresod ‘4.3 Recommendations (lease ensure that alathoritis below complete the frm accoringy) Recommendation / (ffl (Please nsere Name & Sgature)_| Recommendation / Offical stamp Toes Council =1* Tiead Teacher af previoutSchool/ Institution attended Please indicate the termlyfes and stamp against it )* ‘Sub County Chet Town Gark™2020721 leant’ Check ist Cross Check wheter al equired information is atache. TckApproprae) 13 paspor sie photos * 2. Copy of applicants National iO 3. Copy institution's admission eter * 4 Copy of fees structure * 5: Copy of Parent's / Guardian's Nationa 1D * 6 2 8 ° ‘Copy er Copies of death certificates) orphaned or LC Chairperson’ Confirmation Copy oF UCE, UACE and Certifcate/iploma result slip * Copies of fathers/Mether’s payline (Where applicable) ‘Copy of Financial Card (Where applicable) [| 4 10. sketch map to applicants Curent Adres / Residencet 31. copy of Beh Cerfeate * [aa 12, Copy ofbsabilty Report from Specials (Where applicable) 3 33. Applicant to sign each and every page ofthis document * [| * 34, Loan Procesing fee Bank payment receipt ® = 15, Recommendation (page 10 of 13) * a ee a farationsB nt {hereby decar thatthe above Information i true, and that Iam aware that making fale statements on this {Erm an offence punishable bylaw. urther declare that | leary understand that this iss Loom whe she be reps, Name* — Sienature* ee Date* a Telephone Contact * : —— Email NOTE: Please pay Ushs 53,000 as Loan Processing Fee to HESFS a/e No: 3740300006 at ‘any Centenary Bank Branch, then submit your fully filled application form together with the evidence of payment to any Centenary Bank Branch near you,