Test Project - ECMC Loan Resolution Form

Debtor Loan Resolution & Settlement Request Form

Please complete this form to officially submit your request for student loan **Settlement**, **Consolidation**, or **Cancellation/Discharge**. All uploaded documents are handled confidentially through ECMC's secure resolution process.

1. Debtor Information

Full Legal Name *

Last 4 Digits of SSN *

For account verification purposes only.

2. Resolution Terms & Financials

Loan Agreement Request Type *

Total Current Loan Amount ($ USD) *

Proposed Amount to Pay for Settlement ($ USD) *

Leave blank or $0 if applying for Cancellation or Consolidation.

3. Means of Identification Upload

Upload a valid government-issued photo ID (Driver's License, State ID, or Passport).

ID Card - Front Image *

Click or Drag Front ID Here

PNG, JPG, or PDF (Max 5MB)

ID Card - Back Image *

Click or Drag Back ID Here

PNG, JPG, or PDF (Max 5MB)

Additional Notes / Comments

Data transmitted directly to ECMC Default Resolution Services.

Debtor Loan Resolution & Settlement Request Form

1. Debtor Information

2. Resolution Terms & Financials

3. Means of Identification Upload

Request Received