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UCSB BW-2
Biweekly Transition Assistance Program
Personal Loan Promissory Note
Valid ID #_______________________________ HR Staff Initial: __________________
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Name:_______________________________________!Employee!ID#:!_____________!
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Department:____________________________________________________________!
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Campus!Phone!#:!_____________________!Home!Phone!#:!____________________!
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Mailing!Address:!________________________________________________________!
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__________________________________!Email!Addre ss:!___ ____________________!
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For value received, I promise to pay The Regents of the University of California in lawful
money of the United States the sum of: $ ______________________ and 00/100 dollars
commencing shortly after disbursement, to be repaid over 12 biweekly installment payments of
$ ____________________each. I understand that pre-payment may be made without penalty by
sending a personal check payable to UC Regents and mailed or delivered to UC Santa Barbara
Human Resources. I also herewith authorize a payroll deduction of the following amount:
$_____________ per biweekly payment, commencing with the March 13, 2013 biweekly
paycheck. Deductions will continue every two weeks thereafter until paid in full. In the event that I
take an unpaid leave of absence from the University, I agree to make my scheduled payments by
personal check payable to UC Regents, and mailed directly to Human Resources, 3101 SAASB,
University of California, Santa Barbara, CA 93106-3106.
The final payment of principal, if not paid sooner, shall be due and payable no later August 28,
2013. If any portion of the loan is not repaid in accordance with the above schedule, I authorize
the University to deduct the unpaid balance from any and all sums due to me from the University,
without notice. On my failure to pay any sum due under this Note when it becomes due and
payable, or any breach of any other promise or obligation in this Note (“Default”), this Note shall
automatically become due and payable regardless of the maturity date, and I waive notice of the
exercise of this option.
In the event that I separate from University employment, the University will declare the
outstanding balance of the loan immediately due and payable and the University may deduct any
and all sums due and payable on the loan from my final earnings. If the net amount of my final
earnings is insufficient to repay the loan, I will repay the remaining balance by personal check
payable to UC Regents, and mailed directly to Human Resources at the address listed above no
later than 10 calendar days following date of separation from employment.
If this Note is not paid in full when due according to the terms above, whether on the maturity
date or on acceleration, I understand that the University will pursue collection via the State
Franchise Tax Board or other lawful means of collection. I further promise to pay all collection
costs, including, but not limited to, attorneys’ fees and court costs, whether or not suit is filed on
this Note.
This provision shall control every other provision of all agreements between the University and
me. This Note shall be governed by California law.
I attest, under penalty of perjury, that I am a citizen or national of the United States or otherwise
qualified to receive public benefits under the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (P.L. 104-193: 110 STAT. 2105, 2268 2269).
BORROWER!SIGNATURE:!_______________________________!!DATE:!_________!
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HUMAN!RESOURCES!DIRECTOR:!_________________________!DATE:!!________!
Loan Promissory Note Template
source: bfs.ucsb.edu
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