Fillable Request For Loan printable pdf download

Normal Processing

RUSH Processing (Additional $60 Fee Required)

REQUEST FOR LOAN

Note: Time sensitive material. Please complete this form carefully. Missing information will delay processing. The Request

for Loan Instructions should be reviewed prior to completing this form.

Plan/Company Name: _______________________________________________________________________________

Participant Name: _______________________________________________________________________________

Print or Type Complete Legal Name – First, MI, Last

Social Security #: _______________________ Date of Birth: ________________ Date of Hire: ________________

Address: _______________________________________________________________________________________

City: ________________________________ State: ____________ Zip: ____________ Phone: _________________

Participant Spouse: _____________________________________ Social Security #: _________________________

Print or Type Complete Legal Name – First, MI, Last

My benefits are subject to a court order dividing benefits as a result of a dissolution of marriage. Yes

or No

SECTION 1: AMOUNT AND TERM OF LOAN

Completed by PARTICIPANT for ALL loan requests

Loan Amount Requested $ _____________

Reason for Loan________________________________________

Note: If the dollar amount you are requesting exceeds the amount available for a loan from your account, TRA will

process for the maximum amount available.

The appropriate processing fee must be included with the loan request*:

A cashier’s check or money order made payable to The Retirement Advantage, Inc. is enclosed.

I wish to have the processing fee deducted from my account (if allowed – check with the Plan Administrator

before making this election).

*The Plan’s investment manager may also apply a fee, reducing the participant’s interest under the Plan or adding the

fee to the loan amount.

Term of Loan: (may not exceed 5 years, unless the loan is for the purchase of a principal residence)

1 Year

2 Years

3 Years

4 Years

5 Years

_____ Years for purchase of principal residence (maximum of 20 years)

The loan will be amortized and repaid through after-tax payroll deductions in accordance with the payroll schedule provided

below.

SECTION 2: PAYROLL SCHEDULE AND VESTING

Completed by PLAN ADMINISTRATOR for ALL loan requests

PAYROLL SCHEDULE:

This participant is paid:

Weekly

Bi-Weekly

Semi-Monthly

Monthly

The next two payroll dates at least 28 days away are _____/_____/_____ and _____/_____/_____. The minimum number

of days prior to any payroll deduction date that the Plan Administrator needs to be notified is __________________.

PARTICIPANT VESTING:

Number of hours worked from their original date of hire to the end of that FIRST PLAN YEAR: __________________

Number of hours they worked during the CURRENT PLAN YEAR (first day of Plan Year through current date): _____________

Other than the first and current years of employment, did they work LESS than 1000 hours in any PLAN YEAR?

Yes

If “Yes”, please specify the Plan Years in which the participant worked less than 1,000 hours:

___________________________________________________________________________________________

If participant ever terminated prior and was rehired please provide those dates and hours work in those years:

__________________________________________________________________________________________________

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Request for Loan Form

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Request For Loan

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