Loan Application Form cial.com
Loan Application Form
___________________________________________________________________ Name of the plan ("the Plan")
Use this form to request a loan from your Plan. Complete the following paperwork to obtain a loan: Loan Application, Loan Calculator, Spousal Consent, Promissory Note with Pledge & Assignment, and Amortization Schedule.
Part I. Employee Information:
___________________________________________ Employee Name
___________________________________________ Street Address
Account or Plan Number: _____________
XXX ? XX ? _________ Social Security Number
________________ D.O.B.
_______________________ ____ __________
City
State Zip
Marital Status: Single Married
Part II. Type of Loan General Purpose Loan for $______________
Residential Loan for $______________
Part III. Terms: I hereby request a Loan with the following term.
Maximum Repayment Period: ______ Years or _____ Months.
Repayment Frequency: Scheduled installment in equal and fixed payments, either quarterly or monthly as noted in the Loan
Application.
Part IV. Modification: Refinance my existing Loan. I understand that the maximum repayment deadline is 5 years from
original loan date.
Modify Repayment Amount
Part V. Loan Request: I hereby apply for a loan from the Plan. I acknowledge that my loan will be subject to the terms and
conditions of the Loan Policy and confirm that I understand the terms of the Loan and my obligation to make payments in scheduled installments.
_______________________________ Applicant's Signature
______________ Date
Part VI. Plan Administrator's Approval: I certify that all Participant and distribution information is accurate.
Participant Loan approved
Participant Loan denied
_______________________________ Administrator Signature
______________ Date
Page 1
Loan Calculator
____________________________________________________________________________ Name of the plan
A. Statutory Loan Maximum
B. Highest Outstanding Loan Balance during the past 12 months
$__________.___
$ 50,000.00 (Minimum $1,000)
C. Current Loan Balance
$__________.___
D. Enter the Difference between B and C (Subtract C from B)
$__________.___
E. Reduced Statutory Limit ? Subtract D from A
$__________.___
F. Vested Account Balance on ___/___/______
$__________.___*
(* Note: The amount entered should include the Current Outstanding Loan Balance)
G 50% of Vested Account Balance
Multiply by 50%
H. Adjusted Vested Account Balance
$__________.___
I. Amount Available for a Loan - Enter Lesser of E or H J. Current Outstanding Loan Balance K. Adjusted Amount Available for a NEW Loan (Subtract J from I)
$__________.___ $__________.________ $__________.___
Type of Loan: General Residence Modify Schedule Installments Refinancing
Amount of Loan Approved: Interest Rate (prime +1%): Loan Date: Maturity Date: Scheduled Installment: (principal + interest)
$__________.___ _______% ____________ ____________ $__________.___
Repayment Method: Payroll Deduction Self Pay* (*personal check, cashier's check, etc)
Frequency: Payroll Period
Weekly
bi-Weekly Monthly
bi-Monthly Quarterly
Please attach loan amortization schedule
_______________________________ Administrator Signature
______________ Date
Page 2
Spousal Consent
I ___________________________ the spouse of __________________________,
Spouse's Name
Employee Name
do consent to the attached application for a participant loan requested by my
spouse from the ________________________________________ in the sum
Name of the Plan
of $ _______________________.
Loan amount
I understand that this loan cannot be established unless I give my consent and I
understand that my consent is irrevocable.
I understand that by consenting to this loan I may be giving up certain retirement
benefits that otherwise I may receive at my spouse's death, disability or separation
from service with the company.
______________________________________ Spouse's Signature
______________ Date
Witnessed By:
______________________________________ Signature
______________________________________ Name
______________ Date
Page 3
Loan Promissory Note
____________________________________________________________________________ Name of the plan
Note: In consideration for the loan I received on _______________________, I the undersigned promise to pay to the Trustee(s) of the Plan the principal amount of ($_______) _____________________________________________DOLLARS plus ______% interest each year, to satisfy the outstanding balance of this loan.
Form of Payment: Loan repayments shall begin on _________________, and shall continue until the loan is paid in full on _________________.
I agree to make loan repayments in scheduled installments in equal and fixed payments, either quarterly or monthly as noted in the Loan Application.
Terms of Repayment: I further agree to pay any cost associated with the processing or maintenance of the loan, including any fees for the redemption, transfer or exchange of the investment involved in the processing of this loan.
I promise to pay this amount in equal installments as outlined on the amortization schedule that I have received. Each installment payment shall include a portion of the principal plus the accrued interest.
Pledge and Assignment: The loan, in this Note, shall be secured by my irrevocable pledge and assignment of a fifty percent (50%) interest in my vested account balance in the Plan. The amount of the security shall be determined as of the date of this Note. I authorize the Plan to hold this amount as collateral and security for this loan.
I understand that my loan is due and payable in full on or before ________________ (Years/Months). If I fail to repay this loan by this due date or fail to make any scheduled installment payments, I understand that this Loan will be in default by the last day of the calendar quarter following the calendar quarter in which the last scheduled installment payment was due. I also understand that my loan will be placed in default if I violate the terms of this Note or the Plan's Loan Policy. I understand this Note requires immediate repayment of the remaining principal and interest if I am no longer employed by the Employer sponsoring the Plan.
I acknowledge and assign to the Plan the right to foreclose on the security interest if I violate the terms of this Note or the Plan's Loan Policy. I understand that interest will continue to accrue on this loan until the loan is repaid in-full or the Note is extinguished.
Borrower's Signature:
______________________ Signature
__________ Date
Page 4
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