Office of Admissions

and Scholarships

STUDENT LOAN PROGRAM

Promissory Note

Date

For value received, I/we promise to pay De La Salle University or its order the sum of

________________________________________________________________ ( P ________________ ) on or before

____________________________.

I/We understand and accept that the applicant will not be allowed to enroll for the succeeding term or to graduate (as

applicable) for failure to pay the amount of loan due for the trimester. Default in payment will also serve as a basis for

disapproval of student loan application for the succeeding term/s. A 1% interest per month will be imposed on the

outstanding balance after the deadline of payment.

I/We certify that the information given on this Student Loan Program Application Form and Promissory Note are correct and

complete. Falsification or withholding of information on this form will automatically nullify the application and/or subject the

applicant to dismissal from the University.

Signature over Printed Name Signature over Printed Name

APPLICANT PARENT ON-RECORD (if applicable)

Approved by:

Ms. Maria Paz Isabel G. Trinidad

Director
Office of Admissions and Scholarships

Note: Please accomplish in two (2) original copies.

ALL RIGHTS RESERVED. Parts of this material may be reproduced provided (1) the material is not altered; (2) the use is non-commercial; (3) De La
Salle University is acknowledged as source; and (4) DLSU is notified through academic_services@dlsu.edu.ph.