Insurance Claim Form

Lender's Application for Payment of Insurance Claim, ED Form 1207

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Lender Application for Payment of Insurance Claim

OMB: 1845-0042

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LENDER'S APPLICATION FOR PAYMENT OF INSURANCE CLAIM





OMB NO. 1845-0042







EXPIRATION:
1. BORROWER SECTION






1. SOCIAL SECURITY NUMBER
2. NAME OF BORROWER (LAST, FIRST, MI, MAIDEN)


3. TELEPHONE NUMBER








4. LAST KNOWN STREET ADDRESS CITY STATE ZIP CODE














II. LENDER SECTION






5. LENDER ID
6. LENDER NAME


7. LENDER TELEPHONE NUMBER








8. LENDER ADDRESS CITY STATE ZIP CODE




9. CONTACT PERSON
















III. CLAIM SECTION






10. CHECK THE REASON FOR CLAIM



11. CHECK TYPE OF LOAN

_____ (0) CLOSED SCHOOL



____ A. FEDERALLY INSURED STUDENT LOAN

_____ (1) DEFAULT - IS THERE A "CURE"? YES ___



____ B. STAFFORD (FFEL)

_____ (2) BANKRUPTCY WITH 7 YRS IN REPAYMENT (CH 7 & 11)



____ C. UNSUBSIDIZED STAFFORD

_____ (3) DEATH



____ D. SLS

_____ (4) PERMANENT AND TOTAL DISABILITY



____ E. CONSOLIDATION

_____ (5) BANKRUPTCY LESS THAN 7 YRS IN REPAYMENT (CH 7 & 11)



____ F. PLUS

_____ (6) FALSE CERTIFICATION



____ G. OTHER

_____ (7) BANKRUPTCY CHAPTER 13






_____ (8) BANKRUPTCY CHAPTER 12














12. DATE STUDENT CEASED AT

13. LAST DAY OF

14. DATE FIRST
LEAST HALF-TIME STUDY ________________

GRACE PERIOD _____________

PAYMENT DUE ____________

MM/DD/YY

MM/DD/YY

MM/DD/YY
15. DUE DATE OF MOST


16. LAST DATE INTEREST


DELINQUENT PAYMENT_______________


WAS PAID OR CAPITALIZED _________________



MM/DD/YY


MM/DD/YY








17. GUARANTOR'S NAME
ADDRESS CITY STATE ZIP CODE


18. GUARANTOR'S TELEPHONE NUMBER








IV. LOAN INFORMATION (For each loan, list the first actual disbursement date and unpaid principal balance)






19. Date of Disbursement 20. Amount of Disbursement 21. Annual Interest Rate 22. Amount of Capitalized Interest 23. Unpaid Principal Balance
Department of Education Use Only

$ % $ $



$ % $ $



$ % $ $



$ % $ $



$ % $ $



$ % $ $



$ % $ $



$ % $ $


Totals $
$ $










V. COSIGNER/ENDORSER INFORMATION (If applicable)






24. LAST NAME FIRST NAME MI MAIDEN NAME




25. TELEPHONE NUMBER








26. ADDRESS CITY STATE ZIP CODE














27. LAST NAME FIRST NAME MI MAIDEN NAME




28. TELEPHONE NUMBER








29. ADDRESS CITY STATE ZIP CODE














I certify that all the information provided in connection with this claim is true and correct and that this claim fully complies with the provisions of Title IV, Part B of the Higher Education Act of 1965, as amended (the Act)






and all statues and regulations applicable to the Federal Family Education Loan Program. I also certify that the loan satisfies all the requirements for payment under the Act and regulations and that (1) if I am filing a






default claim, the borrower is not eligible for a deferment: and (2) the loan has been serviced in compliance with the Department of Education's regulations for due diligence in 34 C.F.R. Part 682. If I receive any






payments related to this claim after I have submitted this form, I agree to send the money received to the Department of Education after the Department has paid the claim.






30. SIGNATURE OF OFFICER
31. TYPED NAME AND TITLE

32. DATE OF APPLICATION FOR INSURANCE CLAIM











DO NOT WRITE BELOW THIS LINE (FOR ED use only)




DATE OF DEFAULT
SLIP DATE
APPROVED BY
DATE APPROVED








ED FORM 1207






File Typeapplication/vnd.ms-excel
File TitleFISL FORM
AuthorDepartment of Education
Last Modified BySheila.Carey
File Modified2007-12-14
File Created2000-03-10

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