XXX county, Laibin city, Guangxi province

Students' Basic Information Student's Name * Sex * Female Date of Birth 199 1 year 1 month.

Id number *45223 1 19973202

Nationality * Zhuang nationality's hukou nature * □ town □ agriculture

Graduating middle school * XXX middle school

Pre-school household registration *

Contact phone number e-mail address

Mobile phone instant messaging

Mailing address (postal code:)

* * * Name of borrower * Telephone number of father or mother * Relationship with students *

ID number * mobile phone health status * □ healthy □ sick

Home address * address on ID card (zip code:)

Name of Information University *

Department Name * Specialty Name *

Year of admission * Year of graduation *

Education * □ Master □ Undergraduate □ College Number

Professional Category * □ Philosophy □ Economics □ Law □ Education □ Literature □ History □ Science □ Engineering □ Agriculture □ Medicine □ Management □ Military Science □ Unknown

Application information Application school year * 20 10 to 20 1 1 school year * loan amount *

Reasons for applying for loan * □ Difficulties due to illness □ Difficulties due to disasters □ Less labor force, no stable income □ Others.

Agent account name

Account number of settlement institution

Signature Borrower's signature for confirmation:

I guarantee that the above information is true. Student's signature: _ _ _ _ _ _ _ _ _ _ _ _

Qualification examination examines the certificate issued by the loan unit:

The borrower and the borrower are true and agree to recommend.

(with official seal)

_ _ _ _ _ _ _ _ _ _ _

Contact: _ _ _ Tel: _ _ _

County (city, district) funding center review comments:

(with official seal)

_ _ _ _ _ _ _ _ _ _ _

Instructions for completing the form:

1. This form is an application review form for eligible freshmen and college students with financial difficulties. Before entering the school, apply to the National Development Bank for a student loan in the county (city, district) where the household registration is located. Students who apply for loan cancellation must truthfully fill in all kinds of information listed in the form.

2. The domicile of the borrower's student should be the county (city, district): the borrower must be a student who is officially admitted to an ordinary university or higher vocational school recognized by the national education authorities at all levels and has obtained a true, legal and effective admission notice; Borrowing students' families are indeed families with financial difficulties. Borrowing students should be honest and trustworthy, law-abiding, and have no record of violation of laws and regulations.

3.* * * The same borrower mainly refers to the borrower's parents, such as the borrower is an orphan, the same borrower is another legal guardian, or a natural person with full civil capacity who voluntarily shares the repayment responsibility with the borrower.

4. Borrowing students should choose the time limit for applying for loans according to the academic system and major of the admitted institutions. The upper limit of the loan term is "remaining years of study+10 year", and the longest is not more than 14 year.

5. The loan amount applied for is not less than 1 1,000 yuan and not more than 6,000 yuan, and it must be an integer.

6. Units that issue loan certificates are: village committees (neighborhood committees), township (street) civil affairs departments and middle schools, and the audit opinions need to be stamped with official seals.

7, this form in duplicate, the county (city, district) funding center unified distribution management.

8. Items marked with "*" are required.