Loan Payoff Form - Benefits OnLine

[Pages:2]1. Participant Identification

Please Print

Loan Payoff Form

Brotherhood of Locomotive Engineers/CSX 401(k) Savings Plan #200585

Social Security Number ( required )

Name: ____________________________________________________________________________________________________________

Last

First

MI.

Street Address: _________________________________________________________________________________

City: _______________________________________________________ State: _______________ Zip: ________________________ E Mail Address: : ____________________________________ Date ________________ _________________________________

2. Loan Details

The amount you enter in the Loan Payoff field must equal your total loan payoff amount. You must also provide the Loan Number that you are paying off, and the type of Loan ( General Purpose or Principal Residence ). The answers to these questions can be found on the Merrill Lynch Benefits OnlineTM Website at benefits., under loans, then select loan inquiry.

$

Residential Loan

Loan Payoff or Repayment Amount

Loan Number

General Purpose Loan

Check One box above for your

Please note that this payoff amount will be applied to principal only and that any amount that exceeds the required amount to satisfy this loan will be returned to you at the above address. If the amount does not satisfy the required loan payoff amount, this payment will be returned to you at the above address.

3. Check Preparation and Form Completion Instructions

Personal Checks WILL NOT be accepted as form of payment. Please submit a certified bank check, or money order only. ? Merrill Lynch & Co., Inc and it's subsidiaries, may not accept money orders in excess of an aggregate of $5,000 per participant.

Please note, this is a lifetime limit. ? Make your certified bank check or money order payable to: "The Trustee of Brotherhood of Locomotive

Engineers/CSX 401(k) Savings Plan #200585". ? Enter your Social Security Number ( all 9 digits ) in the memo section of your check or money order.

4. Mailing Instructions

? Make a copy of this signed form, and your certified bank check or money order before you place it in the envelope. ? Mail the signed certified bank check or money order and completed form to:

Retirement & Benefit Plan Services 1400 Merrill Lynch Drive

Mail-Stop NJ2-140-03-50 Pennington, NJ 08534

? If you have any questions with completing this form, please contact the Merrill Lynch Retirement Service Center at 1-800228-4015.

5. Participant Signature

I acknowledge that this deposit is being made in accordance with the provisions of the plan. I further acknowledge that I have read the prospectuses for the mutual funds and that this deposit will be invested in accordance with the terms and conditions specified therein.

Participant's Signature _____________________________________________________Date_______________________________

Office Use Only

Date Received by Merrill Lynch ___________________________________________

Merrill Lynch Wealth Management makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of Bank of America Corporation. MLPF&S is a registered broker-dealer, Member SIPC and a wholly owned subsidiary of Bank of America Corporation.

Investment Products:

Are Not FDIC Insured

Are Not Bank Guaranteed

May Lose Value

MLPF&S makes available investment products sponsored, managed, distributed or provided by companies that are affiliates of Bank of America Corporation or In which Bank of America Corporation has a substantial economic interest, including Columbia Management.

?2015 Bank of America Corporation. All rights reserved.

200585lpf 01/20/2015aj

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