Fillable Printable Authorization for Release of Student Loan Information - North Dakota
Fillable Printable Authorization for Release of Student Loan Information - North Dakota
Authorization for Release of Student Loan Information - North Dakota
Student Loan S ervices
1200 Memorial Hwy | PO Box 550 9 | Bismarck, ND 58506-550 9 | 800.472.2166 | 701.328.5660 | TTY: 800.366.6888 | FAX: 701.328.5696 | de alstudentloan.nd.gov
AUTHORIZATION FOR RELEASE OF STUDENT LOAN INFORMATION
BANK OF NORTH DAKOTA
STUDENT LOAN SERVICES
SFN 60501 (10-2014)
A borrower must authorize the release of st udent loan inf ormation when requesting loans from
another student loan lender to be included in Bank of North Dak ota’s (BND) Consolidation Loan
Program.
This for m must be completed and will be sent to any Holder or Servicer you identify in your loan
application in order to gather the necessary data to confirm eligibility and receive pay-off amounts.
Secti on 326 of the USA PAT RIOT A ct
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requires us to ask for your Social Security Number. The principal purpose and routine uses of
this inform ation are to verif y your identity, provide for t he servicing of your account or loan, including communicat i ons wit h consumer
reporting agenc i es, and in the event it is necessary, to l ocat e you and collect on your loan(s). Providing any requested inform ation is
m andatory in order to receive the requested servic e. We may not be able to grant the service if the reques ted inform ation is not
provided.
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This notice also satisfies our obligations under the Privacy Act of 1974.
Borrower Name (pleas e pri nt)
Soci al Securi t y Number
Address
City
State
ZIP Code
I authorize BND Student Loan Services to contact my Holder(s) or Servicer( s) of the loan(s)
I have chosen to include in my Consolidation Loan Application.
I authorize the Holder or Servicer of my student loan(s) to release inf ormation to BND to
determine if my loan(s) are eligible for consolidation under North Dakota’s state-sponsored DEAL
Consolidation Loan Program.
In addition, I reques t the Holder or Servicer of my loan(s) provide the payoff amounts for any
Alternative Educational and/or Federal Student Loan(s) they hold, along with any other loan
information requested by BND within 14 days of receipt.
Borrower Signature
Date (mm/dd/ yyyy)
Borrower must return signed form by email, fax or mail to:
Email: bnd[email protected]
Fax: 701-328-5696
Ba nk of North Dakota
Student Loan Services
Attn: New Loans
PO Box 5509
Bismarck, ND 58506-5509
