Retirement Plan Loan Request Form
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Complete Retirement Plan Loan Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1RETIREMENT PLAN
LOAN REQUEST FORM
YOUR EMPLOYER: _____________________________________________________________________________________________________
YOUR NAME: _________________________________________________________________________________________________________
Last
First
M.I.
ADDRESS: ____________________________________________________________________________________________________________
Street
City
State
Zip Code
SOCIAL SECURITY #: ___________________________ BIRTH DATE: _____________________ PHONE #: __________________________
EMAIL ADDRESS: ______________________________________________________________________________________________________
LOAN INFORMATION:
Amount of Loan:
$_____________________ (you may write “maximum”)
The maximum is 50% of your vested balance up to $50,000.
Number of Years:
_______ (If over 5 years you must provide proof of purchase of primary residence)
Interest Rate:
1% above Prime Rate (Interest is paid to your account. Loan interest is not tax-deductible.)
Payroll Cycle:
[ ] weekly
[ ] bi-weekly
[ ] twice a month
[ ] monthly
Notes:
A promissory note and amortization schedule will be mailed to your human resources department.
Some plans require spousal consent on the promissory note (such as all 403b Plans)
Your check will be mailed to your human resources department to ensure the promissory note is signed before you receive the check.
Funds will be sold pro-rata, source of money by hierarchy (rollover, deferral, match, other)
Loan payments are made only through payroll deduction on an after-tax basis.
Applicable loan fees, $100 to $200 based on the length of the loan, will either be deducted from your account or the loan check.
OPTIONAL DELIVERY SERVICE:
Optional Service ($25.00):
[
] Overnight the check to my company’s human resources department (see above)
This optional service will only save time as compared to US Mail and will not speed the processing of your loan.
SIGNATURES:
________________________________________________________________________________
_____________________________
Participant Signature
Date
________________________________________________________________________________
_____________________________
Trustee/Authorized Signature
Date
HAVE THIS FORM SIGNED BY A TRUSTEE OR AUTHORIZED REPRESENTATIVE AND THEN HAVE IT FAXED
TO RETIREMENT PLANNERS AT 703-893-7325 OR SCAN TO
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