HESLB – SLF 1

HIGHER EDUCATION STUDENT’S LOANS

BOARD
P.O. Box 76068,Tel: (022) 2669036/2669037/2669038, Fax: (022) 2669039
DAR ES SALAAM
Website: www.msthe.go.tz E-mail: msthe@msthe.go.tz

FINANCIAL ASSESSMENT AND LOAN APPLICATION FORM

Serial No.
Student Registration No Applicant’s
Surname Passport size
First Names Colored
Other Names Photograph

A. Student Guiding Notes On Filling This Form

Before filling this Financial Assessment and Loan Application Form please read these guidelines
carefully.

1. This Financial Assessment and Loan Application Form is issued by the office of The
Executive Secretary to the Board upon payment of non refundable fee to be determined from
time to time and announced by the Board. Photocopies, scanned copies and similar
duplications are not acceptable.

2. You should return this Form to the address indicated at the top of this page.

3. Please fill this form in BLACK INK and use CAPITALS. If there are any check [√] boxes,
please tick those that apply. Items, which need coding, must be coded correctly including
inserting one letter or number in each of the provided boxes. Incomplete form and/or forms
without specified attachments shall not be considered for processing. Certified copies of birth
and/or death certificates and affidavits for self, parents and guardians must be attached.

4. Applicant for the loan must be a Tanzanian citizen admitted into an accredited institution of
higher learning (private or public) and is required to attach the following documents for
verification by the Board:

a. Applicant’s certified copy of birth certificate or affidavit or verification report on

applicant’s citizenship from ward secretary and
b. Certified copies of applicant’s and parents’ or guardian’s passports and place of
occupation or Certified copies of National Identity.
c. Admission notice to an accredited institution of higher learning and associated costs.

5. Applicant may apply for loan to cover part or all of the following:
a. Meals and accommodation costs
b. Books and stationery costs
c. Field practical work expenses
d. Tuition fees to be determined by the Board
e. Special Faculty Requirement at a rate to be determined by the Board and
f. Research/Dissertation expenses

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 6. Applicant for the loan shall not have any other financial assistance from any other source to
cover the item or items of cost for which the application is made.

7. Applicant for the loan is required under Section (18) of the Act and Regulation (6) to attach to
this application form evidence of ownership of the declared security, particulars and location
of the security. Where the owner of the security is other than the applicant, a letter from the
owner indicating his consent to use the property as security for the loan shall be attached.
Property deemed as security under the Act includes but not exclusive to:
a. Immovable properties such as farm, plot or buildings with title deeds and/or appraisal
report
b. Certified salary slips for in-service students
c. Life insurance policy
d. Certified bank statements with income verification report
e. Proof of guarantee from private company, NGO or Community Based Organization
(CBO) or
f. Verification of applicant’s residence, affiliation and income from ward verification
committee, local council or congregation of belief.

8. Any student or person who is filling a Financial Assessment and Loan Application Form and
knowingly or recklessly supplies false information relating to any matter affecting the request
for a loan shall be guilty of an offence and shall under Section 23 (1) (b) of the Act, be liable
to a fine not exceeding Tanzanian shillings one million five hundred thousand
(TAS.1,500,000.00) or to imprisonment for a term not exceeding six (6) months or both.
Forgery is a criminal offence and any applicant who commits such an offence or offences
shall be charged in a court of law.

9. For any future correspondence with the Board you must quote this form’s serial number and
later Student Loan Number, when you are in receipt of the loan.

10. The information that you give on this form will be used for the purpose of processing your
student loan application. The Higher Education Student’s Loans Board is under duty to protect
public funds, as well as funds provided by other stakeholders. It may use the information
provided on this form to follow up on loan repayment and to detect and prevent fraud. It may
also share this information with other organizations for the same purposes,.

B. Student Personal Details .

1. Surname
2. First Name Middle Name

3. Gender : MALE FEMALE

4. Date of birth [dd/mm/yy] :
5. Place of Birth- Village: Ward:
District: Region:
6. Are you employed? Yes No
7. If yes, give name of Employer and contact details:
8. Employer’s name
Physical address
………………………………………………………………………………………………………………………………………………………………………
Town/City
………………………………………………………………………………………………………………………………………………………………………
Telephone
9. Are you handicapped? Yes No If yes tick the appropriate Box below:
Visual Physical Hearing Mental Other

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10. Marital Status, tick as appropriate Single Married Divorced
Separated Widowed Other
11. If married, provide details of your spouse:
Name of spouse
……………………………………………………………………………………………… ………… … …… …………………… ………………………
Physical address
………………………………………………………………………………………………………………………………………………………………………
Town/City
………………………………………………………………………………
Telephone
………………………………………………………………………………………………………………………………………………………………………
E-Mail:
12. Information on dependent children:
Fist Names and Gender Date of Birth Place of Birth Name of School, if
Surname (DD/MM/YY) Hospital and School going
District

13. Are you a Single Parent? YES NO

14. Present contact and mailing address
.
Street name
………………………………………………………………………………………………………………………………………………………………………
Post Box Number
............................................................................................................................................................................................................................................................
Suburb or Neighborhood
………………………………………………………………………………………………………………………………………………………………………
Town/City
………………………………………………………………………………………………………………………………………………………………………

Telephone
……………………………………………………………………………………………………………………………………………………………………
E-Mail:
………………………………………………………………………………………………………………………………………………………………………
House No./Plot No.
………………………………………………………………………………………………………………………………………………………………………
15. Permanent contact address
.
Street name

………………………………………………………………………………………………………………………………………………………………
Post Box Number
…..………………………………………………………………………………………………………………………………………………
Ward
………………………………………………………………………………………………………………………………………………………………………
Suburb or Neighbourhood
…………….……………………………………………………………………………………………………………………………
Street. Plot No.
………………………………………………………………………………………………………………………………………………………………………
Town/City
…………………………...…………………………………………………………………………………………………………………………………
Telephone……………………………………………………………………………………………………………………………………………………

16 Bank Details .
………………………………………………………………………………………………………………
Banker’s Name:
……………………………………………………………………………………………………………………………………………………

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 Branch Name: …………………………………… Branch Code: …………………………………

Account Number:
..................................................................................................................................................................................................................................
Suburb or Neighbourhood
…………………………………………………………………………………………………………………………………………
Town/City
……………………………………………………………………………………………………………………………………………………………
Telephone
……………………………………………………………………………………………………………………………………………………………

17. Information on parents:

.
………………………………………………………………………………………………………………………………………………………………………

Father Mother
Surname Surname
................................................................................................................................................................................................................................................................................................
First Name First Name
………………………………………………………………………………………………………………………………………………………………………………………………
Address: Address:
……………………………………………………………………………………………………………………………………………………………………………………………..
Street name/Village Street name/ Village
………………………………………………………………………………………………………………………………………………………………………………………………
Post Box Number Post Box Number
………………………………………………………………………………………………………………………………………………………………………………………………
Ward Ward
………………………………………………………………………………………………………………………………………………………………………………………………
Suburb Suburb
……………………………………………………………………………………………………………………………………………………………………………………………..
Town/City Town/City
……………………………………………………………………………………………………………………………………………………………………………………………..
Telephone Telephone
……………………………………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………………………………….
Is your Father alive YES , NO Is your Mother alive YES , NO
………………………………………………………………………………………………………………………………………………………………………………………………
If yes, give his age: years If yes, give his age: years
………………………………………………………………………………………………………………………………………………………………………………………………
If no, give date of death: If no, give date of death:
……………………………………………………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………………………………………..
Father’s occupation Mother’s occupation
………………………………………………………………………………………………………………………………………………………………………………………………
Education level Education level
……………………………………………………………………………………………………………………………………………………………………………………………..
Father’s employer’s name and address: Mother’s employer’s name and address:
…………………………………………………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………………………………………………..

Are your parents: (tick one box only)

Married? Divorced? Living as partners? Separated?
Widowed? Single? All dead? Other?

If your parents live apart who do you normally have most contact with? [tick as appropriate]
Father , Mother

18. If both parents are not alive, who has been paying for your education?
……………………………………………………………………………………………………………………………………………………………………………..............
Guardian Sponsor Trustee or Estate Administrator
………………………………………………………………………………………………………………………………………………………………………………………

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19. Information on Guardian/Sponsor or Trustee:
____________________________________________________________________________________________________________________________________
Guardian/ Sponsor/ Trustee
Surname
………………………………………………………………………………………………………………………………………………………………………………………
Fist Name
………………………………………………………………………………………………………………………………………………………………………………………
Address:
Street name/ Village
………………………………………………………………………………………………………………………………………………………………………………………
Post Box Number
………………………………………………………………………………………………………………………………………………………………………………………
Ward
………………………………………………………………………………………………………………………………………………………………………………………
Suburb
………………………………………………………………………………………………………………………………………………………………………………………
Town/ City
………………………………………………………………………………………………………………………………………………………………………………………
Telephone
………………………………………………………………………………………………………………………………………………………………………………………
E-Mail:
………………………………………………………………………………………………………………………………………………………………………………………

....................................................................................................................................................................................................................................................................................
Guardian’s occupation
………………………………………………………………………………………………………………………………………………………………………………………
Highest education level
………………………………………………………………………………………………………………………………………………………………………………………
Guardian’s employer’s details [where appropriate]:
………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………

20. The information provided in here must be certified by either Imam of the local mosque, Pastor or Priest
in the community the Applicant hails from.

I know the Applicant and certify the information given in Financial Assessment and Loan Application
Form is true and correct to the best of my knowledge.

Name: Title :
---------------------------------------------------------------- -------------------------------------------------------------------------

----------------------------------------------------------------
Signature/Stamp

C. University / College Details .

………………………………………………………………………………………………………………………………………………………………………………………
1. Name of University/ College
………………………………………………………………………………………………………………………………………………………………………
2. Campus Name
………………………………………………………………………………………………………………………………………………………………………
3. Faculty
………………………………………………………………………………………………………………………………………………………………………
4. Program of study [ e.g. BA Economics]
………………………………………………………………………………………………………………………………………………………………………
5. Year of study for which you are applying for loan
………………………………………………………………………………………………………………………………………………………………………
1 2 3 4 5 6 7
Tick [√] as appropriate
………………………………………………………………………………………………………………………………………………………………………
6. Year of admission to the University
7. Are you repeating the year indicated in Part 5 above? YES NO

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8. Certification By The University/ College/ Institution Dean Of Students

Title of the Course

Degree Post Graduate Degree
Advance Diploma Post Graduate Diploma

Name of Dean of Students Signature/ Official Stamp

9. Any relevant comments

D. Educational Background Of Applicant

.
1. College Education:
………………………………………………………………………………………………………………………………………………………………………
Name of College
………………………………………………………………………………………………………………………………………………………………………
Program of study
………………………………………………………………………………………………………………………………………………………………………
Year of graduation
………………………………………………………………………………………………………………………………………………………………………
College Contact details:
………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………
Full College Index No.
………………………………………………………………………………………………………………………………………………………………………

2..Secondary Education [Advanced Level]: .

………………………………………………………………………………………………………………………………………………………………………
Name of School
………………………………………………………………………………………………………………………………………………………………………
Program of study [Combination]
………………………………………………………………………………………………………………………………………………………………………
Year of graduation
………………………………………………………………………………………………………………………………………………………………………
School Contact details:
………………………………………………………………………………………………………………………………………………………………………
Full NECTA Index No.
………………………………………………………………………………………………………………………………………………………………………

3. Secondary Education [Ordinary Level]:

.
………………………………………………………………………………………………………………………………………………………………………
Name of School
………………………………………………………………………………………………………………………………………………………………………
Program of study [Stream]
………………………………………………………………………………………………………………………………………………………………………
Year of graduation
………………………………………………………………………………………………………………………………………………………………………
School Contact details:
………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………

Full NECTA Index No.

………………………………………………………………………………………………………………………………………………………………………

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E. Information About Your Financial Arrangements .
NOTE: The Higher Education Student’s Loan Board can give a loan of up to TAS. 31/2 million per year but the amount may
not be guaranteed and you are advise to arrange to partly cost share for your higher education.

Please indicate in the following section the amount of loan being applied for and items involved by amount:

Loan amount applied for:

1. ……………………………………………………………………………………………………………………………………………………………………………………
Amount in TAS (numerals):
……………………………………………………………………………………………………………………………………………………………………………………
Amount in words:
……………………………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………………………

Amount by Item:
Item Loan Request (Tick [√] as appropriate) Amount per year
a. Meals and accommodation costs YES NO
………………………………………………………………………………………………………………………………………
b. Books and stationery costs YES NO
………………………………………………………………………………………………………………………………………
c. Field practical work expenses YES NO
………………………………………………………………………………………………………………………………………
d. Tuition fees YES NO
………………………………………………………………………………………………………………………………………
e. Special Faculty Requirement YES NO
……………………………………………………………………………………………………………………………………
f. Research/Dissertation expenses YES NO
………………………………………………………………………………………………………………………………………

Indicate below the amount you expect to raise from your own family/parental sources including Community
contributions and Donors/Sponsors/Foundations/Charities for your University Education this academic year.

Amount to be raised from personal sources:

2. ……………………………………………………………………………………………………………………………………………………………………………………
Amount in TAS [numerals]
……………………………………………………………………………………………………………………………………………………………………………………
Amount in words
……………………………………………………………………………………………………………………………………………………………………………………

F. Financial Standing

1.0 Gross Income In The Year Ending Last 31st August

Self Spouse Father Mother Total

1.1 Income from Employment(Salary or
Pension) Attach latest copy of pay slip
Certified by Employer.
1.2 Business Income e.g. Shop, Rent, Hotel,
Grocery, etc
1.3 Income from property, lettings, rent, etc.
1.4 Income from farming (crops, livestock

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 Products) or fishing etc
1.5 Income from other sources; sale of
Shares, dividends or interest, etc.
1.6 Income from community contributions
and donations
1.7 Maintenance payments
1.8 Other incomes [list as needed]:
TOTAL.

2.0 What Assets Do You, Your Spouse, Parents, Guardian, Own? Indicate by filling in the following table:

Property: Size [Area] Precise District, Current use Estimated

Location Region value
2.1. Land

2.2 Buildings:
Bungalows

2.3 Mansions

2.4 Flats

2.5 Others

3.0 Which Specific Geographic Area Do Your Parents Live?

3.1 Street name

3.2 House No. Owned Rented

3.3 Block
3.4 Ward
3.5 Suburb or
Village
3.6 Town/City

4.0 What Type Of Structure Is The Main House Of Your Parents? Tick [√] as appropriate

4.1 Permanent stone/brick-walled

4.2 Mud-walled & grass thatched
4.3 Other

5.0 What Other Assets Do You, Your Spouse, Your Parents Or Your Guardians Own?

Type of asset No of units Year of acquisition Monthly Income [TAS]

5.1 Saloon Car
5.2 Pick-up truck
5.3 Commuter bus/Coach
5.4 Heavy Goods Truck
5.5 Tractor
5.6 Grain milling machine
5.7 Artisan workshop
5.8 Other [list]

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6.0 Applicant’s Children In School
Child’s Name Name of Institution Year of Education Level (Pre- Educational
Study/Class school, Primary, ‘O’ Expenditure for last 12
Level, ‘A’ Level or Pro- months ending
Secondary School. 31 August (TAS)
6.1
6.2
6.3
6.4
GRAND TOTAL
. .
Please enclose documentary evidence such as school fees structure, previous receipts/invoices etc.

7.0
Your Parent’s Children (Excluding The Applicant) In Higher Learning Institution From 1st
September This Year.

Full name Date of birth University, School Course of If they are in receipt of
[dd/mm/yy] or College study Loan indicated
Student Loan Number
7.1
7.2
7.3
7.4
GRAND TOTAL
.
Please enclose documentary evidence such as school fees structure, receipts/invoices etc.

8.0 Other Family Expenditure In The Last 12 Months Ending 31 August In Tas

Expenditure item Self and family TAS Parents TAS Total TAS
8.1 Food
8.2 Medical (attach evidence
8.3 Clothing
8.4 Rent (attach evidence)
8.6 Commuting and fuel.
8.7 Income and other taxes.
(attach evidence)
8.8 Mortgage and loans
repayments (attach evidence)
TOTAL

G. Declarations
This part should be filled before a Commissioner of Oaths, District Officer or Magistrate

1. Applicant’s Declaration
………………………………………………………………………………………………………………………………………………………………………………………
…
I declare that the information given herein is true to the best of my knowledge. I also understand that this is a
loan that must be repaid according to the agreement and subject to the provisions of the Act.

………………………………………………………….
……………………………………………………
Applicant’s full name Signature

Date: This …………………………..Day of

……………………….Year…………………………………

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 2. Guarantor’s Declaration
……………………………………………………………………………………………………………………………………………………………………………………
I declare that I have read this form/this form has been read to me and I hereby confirm that the information given
herein is true to the best of my knowledge.

................................................................................................................................... ..........................................................................................................
Guarantor’s full name Signature or Thumb print

Date: This …………………………..Day of .........................Year…………………………………

3. Commissioner of Oaths/ Magistrate

The above named applicant and his/her guarantor appeared before me and made the solemn declaration that the
information given herein is correct
................................................................................................................... ………….................................................................................................................
Commissioner of Oaths Signature and Official Stamp

Date: This …………………………..Day of ………………….Year…………………………………

4. Village Secretary
………………………………………………………………………………………………………………………………………………………………………………………
……..
I certify that the applicant is a resident of my Village and that I have checked the information given herein and
confirm to be true to the best of my knowledge.

....................................................................................................................... .................................................................................................................
Village Secretary Signature and Official Stamp
Address:
.........................................................................................................................................
Date: This …………………………..Day of ……………………….Year………………………………

5. Ward Secretary

....................................................................................................................................................................................................................................................................................
I wish to confirm that the applicant appeared before me and I interviewed him/her and hereby state that the
information given is true to the best of my knowledge.

............................................................................................................................................... ..................................................................................................................
Ward Secretary Signature and Official Stamp
Address:
Date: This …………………………..Day of ……………………….Year………………………………

H. Decision On Application

Acknowledgement

Date received

Initials:

Data entry

Initials: .

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 HESLB – SLF 2
HIGHER EDUCATION STUDENT’S LOANS
BOARD
P.O. Box 76068,Tel: (022) 2669036/2669037/2669038, Fax: (022) 2669039
DAR ES SALAAM
Website: www.msthe.go.tz E-mail: msthe@msthe.go.tz

STUDENT’S LOAN AGREEMENT FORM

1.0 Applicant’s Particulars:

1.1 Serial No. Applicants
1.2 Student’s Loan Number (SLN) Passport size
1.3 Institution of Study Colored
1.4 Student Registration No Photograph
1.5 Surname
1.6 First Name
1.7 Other Names

1.0 Terms And Conditions.

1.1 No interest shall be imposed on repayment of the loan except where the interest is levied by
way of penalty for default of repayment of the loaned money in accordance with the
provisions of any written law or with the order of a court of competent jurisdiction.

1.2 In the event that I discontinue or I am discontinued from studies for whichever reason before
full disbursement is made, the Board shall not disburse the remaining allocation and shall
recall the loan so far advanced for immediate start for repayment.

1.3 Subject to the provisions of the Act and sub provisions in the Regulations the loan shall be
repaid by equal monthly instalments or by any other convenient mode of repayment as shall
be directed by the Board.

1.4 If I default in repayment when the loan is due, the whole amount shall become due and
payable and I shall be bound to pay all other charges that may arise as a result of the default
including but not limited to the Advocates fees and penalties.

1.5 Approved SDC loans shall be credited into individual applicant’s bank account as indicated in
this form and which shall not be changed without the consent of the Board on application.

2.6 Loan money for fees, special faculty requirement and other institutional costs shall be paid
directly to the respective bank account of the institution of study.

2.7 The Board shall engage agent (banks and similar institutions) who shall be responsible for the
disbursement or recovery of due loans as shall be advised by the Board from time to time.

2.8 The loan shall be mandatory due for repayment one year after completion of the course of
study or within such a period as the Board may decide to recall the loan whichever is the
earlier.

2.9 The Board shall send to me and other loan recipients annual statements indicating the amount
disbursed per each academic year. The sums of the amount indicated in the statements shall

1
 form the principal loan to be recovered from me. The contents of the statements shall be
deemed to be correct unless a written complaint to the contrary is received by the Board
within three (3) months from the date of the statement whereupon the Board shall either
confirm the complaint or advise otherwise as the case my be.

2.10 Where it is discovered that the loan was granted due to false information furnished by me, the
Board shall withhold release of the amount yet to be disbursed if any, and may prosecute me
in the court of law.

2.11 I commit to inform the Board immediately my circumstances change in a way that might
affect the loan entitlement or/and repayments. I further agree to supply further information
that the Board may request.

2.12 My signature shall certify the reading, understanding and being in agreement with the terms
and conditions herein.

2.13 No loan shall be disbursed unless this agreement form is approved by the Board.

I (name of loaner) with Student Reg. No./Admission No.

of (name of Institution)
in the
Faculty of Course Course Duration
years

Certify as follows:

I understand that this is A LOAN WHICH MUST BE REPAID and do hereby bind myself to repay
to the order of the Board all sums disbursed to me (hereinafter called “the loan”) together with any
other charges that may become due and payable under terms and conditions set herein. I understand
that acceptance of any disbursement issued to me at any time will signify obligation to repay the loan
and I shall abide by all the obligations as bestowed upon me by the Board and it’s successors and
assigns.

Signature of loan recipient :

Signed this day of year
Name of Witness:
Witness signature:
Date: