BORROWER ACKNOWLEDGEMENT FORM

BORROWER ACKNOWLEDGEMENT FORM

You must sign and return this form to the address listed in order to participate in the loan rehabilitation program. Failure to agree to the capitalization of collection costs renders you ineligible for participation in this program.

By signing below, I understand and agree that the lender may capitalize collection costs of 18.5% of the outstanding principal and accrued interest upon rehabilitation of my loan(s). I also understand and agree that the lender may capitalize any outstanding accrued interest at the time of Rehabilitation.

Signature: Date:

Printed Name:

Signed Name:

Social Security Number:

Telephone Number:

Regional Adjustment Bureau, Inc. 1900 Charles Bryan Rd Suite 110 Memphis TN 38016-4942 [email protected]

This is an attempt to collect a debt and any information obtained will be used for that purpose. This communication is from a debt collector.

This collection agency is licensed by the Tennessee Collection Service Board of the Department of Commerce and Insurance. 381927091-0301/302/335 183399616

AMBER L STIERLEY 12055 S Sherman Lake Dr Augusta MI 49012-9251

Si usted prefiere un representante español, llame al (877) 270-3049

Account Number:

Client: Michigan Guaranty Agency (MGA)

LOAN REHABILITATION PROGRAM TERMS FORM

Congratulations! You are eligible to participate in the Loan Rehabilitation Program. You can receive many benefits from this program, which are outlined for you below.

This form is the first step to enter into Loan Rehabilitation and confirms our agreement to accept reasonable and affordable monthly payments of $ in conjunction with your request to participate.

We encourage you to participate in the program and take advantage of this opportunity, and we are providing you with the following terms and conditions.

• Nine (9) qualifying payments within a ten (10) month period of $ , with a due date of , must be received timely. To be considered timely, each payment must be received no earlier than 20 days before your due date and no later than 20 days after your due date. According to federal law, a loan may be considered for rehabilitation only after you have made voluntary reasonable and affordable full payments for each of the 9 qualifying payments within a 10 month period. If a payment is received too late, too early, or for less than the agreed amount, this offer becomes null and void and the series of payments must start over again.

• After you have made the voluntary reasonable and affordable payments, the loan(s) maybe considered for purchase by an eligible lender to complete the Loan Rehabilitation. You must continue to make your monthly payments, as agreed upon, until you are notified that your loan(s) have been rehabilitated.

• Once your loan(s) is rehabilitated and is no longer in default, the national credit bureaus will be notified to delete the derogatory credit rating previously reported by the guarantor in reference to the loan(s).

• Once rehabilitation is complete, collection costs that have been added will be reduced to 18.5% of the unpaid principal and accrued interest outstanding at the time of Loan Rehabilitation. Collection costs may be capitalized at the time of the Loan Rehabilitation by your new lender, ALONG WITH OUTSTANDING ACCRUED INTEREST, to form one new principal amount.

• Once your loan(s) are rehabilitated, you can apply for additional financial aid if you return to school. You also regain remaining deferment and forbearance eligibility on the rehabilitated loan(s).

• You may object to the rehabilitation terms outlined in this form by contacting Regional Adjustment Bureau, Inc. at 1-800-829-7204

To participate in the Loan Rehabilitation program and take advantage of the benefits above we MUST RECEIVE THE ATTACHED ACKNOWLEDGEMENT FORM BACK, WITH YOUR SIGNED APPROVAL. Once we receive the form with your signature, and you have made your monthly payments, your loan(s) will be considered for Loan Rehabilitation. If the loan(s) is rehabilitated, we will notify you once the Loan Rehabilitation is complete. The lender will establish a new repayment schedule after rehabilitation and your monthly payments may increase or decrease according to the new schedule.

This is an attempt to collect a debt and any information obtained will be used for that purpose. This communication is from a debt collector.

RONRABI02335

Regional Adjustment Bureau, Inc. _•1900 Charles Bryan Rd, Suite 110 _•PO Box 34111 _•Memphis TN 38016 (866) 896-2080 • ( 9 0 1 ) 3 8 2 - 0 2 5 0

O f f i c e H o u r s : 8 : 0 0 A M - 9 : 0 0 P M M o n d a y - T h u r s d a y , 8 : 0 0 A M - 6 : 0 0 P M F r i d a y Vermont Student Assistance Corp.

APPLICATON FOR REASONABLE AND AFFORDABLE PAYMENTS

NOTE: BEFORE YOU COMPLETE THIS FORM, PLEASE REVIEW THE ATTACHED INSTRUCTIONS CAREFULLY. PRINT

OR TYPE NEATLY. I AN ITEM DOES NOT APPLY TO YOU WHEN YOU ARE COMPLETING THIS

FORM,

(1) NAME: (LAST, FIRST, MIDDLE) (2) SOCIAL SECURITY NUMBER:

(3) PERMANENT STREET ADDRESS: (3) CITY: (3) STATE: (3) ZIP:

(4) HOME TELEPHONE: (5) WORK TELEPHONE: (6) DATE OF BIRTH: (7) DRIVERS LICENSE NUMBER: State #

(8) DO YOU RENT OR OWN YOUR RESIDENCE: RENT OWN

(8) LANDLORD/MORTGAGE COMPANY: (8) HOW LONG HAVE YOU LIVED HERE: (9) VEHICLES: (ATTACH LIST IF NECESSARY)

YR. MAKE MODEL YR. MAKE MODEL (10) MARITAL STATUS: (11) LIST DEPENDENTS AND AGES:

EMPLOYMENT INFORMATION

(12) EMPLOYER NAME: (13) JOB DESCRIPTION:

(14) STREET ADDRESS: (14) CITY (14) STATE: (14) ZIP:

(15) DATE OF EMPLOYMENT: / /

(16) GROSS MONTHLY INCOME: $

(17) NET MONTHLY INCOME: $

(18) DID YOU FILE A TAX RETURN LAST YEAR? YES NO

OTHER INCOME

CHILD SUPPORT: $ ALIMONY: $ INTEREST INCOME: $ PENSIONS: $ DISABILITY: $ SOCIAL SECURITY: $

AFDC OR ADC: $ WORKMAN’S COMP: $ OTHER: $

ASSETS

OTHER REAL ESTATE: $ CHECKING: $ SAVINGS: $ STOCKS/BONDS: $ INHERITANCE: $ PERSONAL PROPERTY: $ OTHER: $

DEBTS BALANCE MONTHLY

FINANCIAL INFORMATION

MORTGAGE/RENT $ $

CHECKING ACCOUNT INFORMATION:

NAME:

CHILD SUPPORT $ $

ADDRESS: STATE: ZIP:

ALIMONY $ $

ACCOUNT NUMBER: BALANCE:

$

CREDIT CARDS $ $

SAVINGS ACCOUNT INFORMATION:

NAME:

OTHER STUDENT LOANS $ $

ADDRESS: STATE: ZIP:

UTILITIES $ $

ACCOUNT NUMBER: BALANCE:

$

PHONE $ $

PLEASE PROVIDE OTHER INFORMATION THAT MAY BE PERTINENT WITH ANY DOCUMENTATION THAT YOU BELIEVE IS NECESSARY.

CAR PAYMENT $ $

CABLE TELEVISION $ $

INSURANCE $ $

HEALTH $ $

LIFE $ $

AUTOMOBILE $ $

GROCERIES $ $

PUBLIC TRANSPORTATION $ $

CAR FUEL $ $

MEDICAL COSTS $ $

DEPENDENT CARE $ $

OTHER $ $

TOTAL _{$ $} SIGNATURE DATE

FOR INTERNAL USE ONLY Documentation Checklist

Written Request: Proof of Income

Reason for NGS recommendation:

Recommendation YES NO

INSTRUCTIONS FOR COMPLETING

APPLICATION FOR REASONABLE AND AFFORDABLE PAYMENTS Item 1: Enter your last name, then your first name and middle name

Item 2: Enter your nine-digit Social Security Number.

Item 3: Enter your permanent home address, apartment number, city, state and zip code. Item 4: Enter your area code and telephone number for the address listed in Item 3. Item 5: Enter the telephone number of the place where you are employed.

Item 6: Enter the month, day and year of your birth. (Use numbers only. Be careful not to enter the current year) Item 7: Enter your driver’s license number. (List the state that issued the license followed by the number)

Item 8: Check next to the appropriate selection. Enter the name of your landlord or mortgage company. Enter thenumber of years in which you have lived at the address listed in Item 3. (If you have lived there less than a year, list the number of months)

Item 9: Enter the year, make, model, and tag number of the vehicles that you own. (If you own more than two vehicles,_{attach a separate list describing these vehicles)} Item 10: Enter your marital status.

Item 11: Enter the names of your dependents and their ages. (Attach a separate list for additional dependents) EMPLOYMENT INFORMATION (Attach Separate List If Necessary)

Item 12: Enter the name of the business that employs you. Item 13: Enter your job title or description of your duties. Item 14: Enter your work address.

Item 15: Enter the month, day and year of your employment at the business entered in Item 12.

Item 16: Enter your monthly income before required deductions have been made. (Documentation required)

Item 17: Enter your monthly income before required deductions have been made. (The amount deducted for insurance_{should be included in the section entitled DEBTS.)} Item 18: Check the appropriate box. (Attached documentation of your federal and state tax returns if you filed a tax_{return last year)} OTHER INCOME: Enter the monthly amount of any other income that you receive. (Documentation required)

ASSETS: Enter the value of any assets that you may have. Items that must be include in personal property include televisions, video equipment, stereos, and other items.

DEBTS, BALANCE AND MONTHLY PAYMENT: Enter the balance owed and the monthly payment on each debt listed. If you have other debts that are not listed, enter the source of debt, the balance of the debt and the monthly payment.

FINANCIAL INFORMATION: Enter the name and address of the financial institution(s) where you checking and/or savings accounts are located. Include the account number and current balance. Attach a separate list of other institutions if necessary.

OTHER INFORMATION: A space has been provided for you to enter information that you believe is pertinent regarding your situation.

SIGNATURE AND DATE: This form must be signed and dated. You signature certifies that the information that you have provided is true and accurate.

RAB Account Number Printed Full Name Address City, State, Zip Telephone Number

Financial Institution's Name Financial Institution's City & State Checking

Routing Number Bank Account Number

Credit Card Visa Mastercard Credit Card #

Cardholder Name

Experation Date CVV

(3 digit # on back of card) Payment Amount

How often should this amount be withdrawn? Weekly Bi weekly Monthly (Same date each Month)

Start Date Due Date

Comments:

Bank Account Holder Signature  Bank Account Holder Signature 

(If joint accounts, both must sign) Date

Return Authorization Form & Voided Check to:

This is an attempt by a debt collector to collect a debt. Any information obtained will be used for that purpose.   Fax: 901‐435‐4854

Regional Adjustment Bureau, Inc. 1900 Charles Bryan Rd Suite 110

Memphis, TN 38016‐4942 1‐800‐829‐7204 [email protected]

I (we) authorize Regional Adjustment Bureau (RAB) to initiate charges to my checking or shard draft account  described above. This authorization will remain in effect until RAB has received a written notification to terminate  the agreement within a reasonable time frame to act on it. I will contact RAB if there are any changes to my bank  account information. 

By list any cellular telephone number I authorize Regional Adjustment Bureau (RAB) to contact me regarding my account  at the cellular telephone number provided by using a predictive or automated telephone dialing system and/or artificial or  pre‐recorded voice messages. 

Automated Withdrawal Authorization

Thank you for your interest in participating in our Automatic payment system. 

The following information may pertain for your state of residence:   

This collection agency is licensed by the Tennessee Collection Service Board of the Department of Commerce and  Insurance. 

California 

As required by law you are hereby notified that a negative credit report reflecting on your credit record may be  submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations. 

The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act require that,  except under unusual circumstances, collectors may not contact you before 8 a.m. or after 9 p.m. They may not  harass you by using threats of violence or arrest or by using obscene language.  Collectors may not use false or  misleading statements or call you at work if they know or have reason to know that you may not receive personal  calls at work.  For the most part, collectors may not tell another person, other than your attorney or spouse, about  your debt. Collectors may contact another person to confirm your location or enforce a judgment. For more  information about debt collection activities, you may contact the Federal Trade Commission at 1‐877‐FTC‐HELP or  www.ftc.gov. Nonprofit credit counseling services may be available in the area. 

Colorado 

A consumer has the right to request in writing that a debt collector or collection agency cease further communication  with the consumer. A written request to cease communication will not prohibit the debt collector or collection agency  from taking any other action authorized by law to collect the debt.  FOR INFORMATION ABOUT THE COLORADO FAIR  DEBT COLLECTION PRACTICES ACT, SEE WWW.COLORADOATTORNEYGENERAL.GOV/CA. Our local office address is  3025 S. Parker Rd., #711, Aurora, CO 80014.  Our local phone number is 303‐309‐3839. 

Massachusetts 

NOTICE OF IMPORTANT RIGHTS 

YOU HAVE THE RIGHT TO MAKE A WRITTEN OR ORAL REQUEST THAT TELEPHONE CALLS REGARDING YOUR DEBT NOT  BE MADE TO YOU AT YOUR PLACE OF EMPLOYMENT.  ANY SUCH ORAL REQUEST WILL BE VALID FOR ONLY TEN DAYS  UNLESS YOU PROVIDE WRITTEN CONFIRMATION OF THE REQUEST POSTMARKED OR DELIVERED WITHIN SEVEN DAYS  OF SUCH REQUEST.  YOU MAY TERMINATE THIS REQUEST BY WRITING TO THE DEBT COLLECTOR. 

Minnesota 

This collection agency is licensed by the Minnesota Department of Commerce.   North Carolina 

North Carolina Department of Insurance permit number 101465.  New York 

New York City Dept of Consumer Affairs Permit No. 0988585.  Wisconsin 

This collection agency is licensed by the Office of the Administrator of the Division of Banking, P.O. Box 7876,  Madison, Wisconsin 53707. 

Washington 

This collection agency is licensed in the State of Washington at the following address: 1900 Charles Bryan, Suite 110  Memphis, TN 38016. 

Utah 

As required by Utah law you are hereby notified that a negative credit report reflecting on your credit record may be  submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.