# LENDER'S APPLICATION FOR PAYMENT OF INSURANCE CLAIMS

## ED FORM 1207

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control
number for this information collection is 1840-0517. The time required
to complete this information collection is estimated to average .27
minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and review the
information collection. **If you have any comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form,
please write to:** U.S. Department of Education, Washington, D.C.
20202-4544. **If you have comments or concerns regarding the status of
your individual submission of this form, write directly to:** U.S.
Department of Education, Accounting Division, 830 First St., NE
Washington, DC 20002

## 

## I. BORROWER SECTION

**1. Social Security Number**: Enter the social security number exactly
as it appears on the student application for programs identified under
III CLAIM SECTION item #11.

**2. Name of Borrower**: Enter the borrower's last name, first name, and
middle initial. If the borrower's name has changed since the student
application was submitted, enter the previous name in the space provided
with parentheses, e.g., Jones, Mary A. (Smith).

**3. Telephone Number**: Enter the last telephone number of record, even
if that number is known to be invalid.

**4. Last Known Address**: Enter the last address of record, even if
that address is known to be invalid.

## II. LENDER SECTION

**5. Lender ID Number**: Enter the lender's six digit identification
number that was assigned by ED.

**6. Lender's Name**: Enter the lender's full name.

**7. Lender Telephone Number**: Enter the contact person's telephone
number, including the area code.

**8. Lender's Address**: Enter the lender's full mailing address.

**9. Contact Person**: Enter the individual who would be able to respond
to any inquiries regarding this claim submission.

## III. CLAIM SECTION

**10. Claim Reason**: Enter an "X" in the appropriate box. Please insure
that documentation supporting the claim reason is attached to the claim.

**11. Loan Type**: Enter an "X" in the appropriate box. Please insure
that documentation supporting the loan type is attached to the claim.

**12. Date Student Ceased at Least Half-time Study**: Enter the month,
day and year. This item may not be left blank. If the borrower is still
in school insert the words "INSCHOOL" in the space provided for the
date. (It is possible to have bankruptcy and default claims for
nonpayment of interest on nonsubsidized loans during the in-school or
grace period).

**13. Date Grace Period Ends**: Enter the date the borrower's grace
period ended.

**14. Date First Payment Due**: Enter the exact date that the first
payment was due in the six digit MMDDYY format (i.e., March 25, 1994 -
032594).

**15. Due Date of Most Delinquent Payment**: Enter the due date of the
most delinquent payment.

**16. Last Date Interest was Paid or Capitalized**: Enter the date, if
any, through which interest was paid by the borrower, capitalized, or
subsidized by the Federal Government. This field can be left blank if no
activity has occurred since the account was converted into repayment
status.

**17. Guarantor's Name and Address**: enter the name and full address of
the last Guarantee Agency.

**18. Telephone Number**: enter the guarantor's telephone number, if
available.

## IV. LOAN INFORMATION

**19. Date of Disbursement**: Enter the actual date the loan or any
portion of the loan was disbursed, not the date on the promissory note.
IF there was more than one disbursement, list all disbursements.

**20. Amount of Disbursement**: enter the gross amount of each
disbursement that corresponds to each date listed in #19 above. The
amount reported must be the amount listed on the promissory note, prior
to any deductions for insurance premiums and origination fees. The total
amount disbursed must not exceed the sum of the commitment amount
reflected on the student application.

**21. Annual Interest Rate**: Enter the amount shown on the promissory
note. The rate is not affected by any administrative cost allowance or
special allowance that may have been paid to the lender.

**22. Amount of Capitalized Interest**: Enter the total amount of
interest that has been capitalized under program regulations.
Capitalized interest is that interest which has been accrued and then
added to the previously unpaid principal balance.

**23. Unpaid Principal Balance**: Enter the unpaid principal balance.
Note: This balance is net of any interest, except capitalized interest.

## V. COSIGNER/ENDORSER INFORMATION

**24. Name of Cosigner**: Enter the cosigner/endorser's last name, first
name, and middle initial. If the cosigner/endorser's last name has
changed, enter the previous name in the space provided.

**25. Telephone Number**: Enter the last telephone number of record even
if that number is known to be invalid.

**26. Address**: Enter the last address of record, even if that number
is known to be invalid.

**27.** Please use the description from #24.

**28.** Please use the description from #25.

**29.** Please use the description from #26.

**30. Signature of the Officer**: The signature of the individual
submitting the claim for payment.

**31. Typed Name & Title**: Enter the name and title of the individual
submitting the claim for payment.

32. **Date of Application for Insurance Claim**: Enter the date the
    claim is submitted for payment.

**The completed application should be mailed to:**

**U.S. Department of Education**

**P.O. Box 4135**

**Greenville, TX 75403-4135**