LOAN PAYMENT FORM

Name of Participant

LOAN PAYMENT FORM

Social Security Number

Telephone Number of Participant

Employer Name

Plan Name

Plan Account Number

Total Loan Payment Amount (Include detail below) $ -Interest Payment $ -Principal Payment $

Loan Number

FORM OF PAYMENT:

Please send a Certified Bank Check or Money Order payable to Banco Popular de PR as trustee for NAME OF PLAN. NO personal checks will be accepted.

MAIL CHECK AND FORM TO:

Banco Popular de Puerto Rico Popular Fiduciary Services Division (725) Recordkeeping Group PO Box 362708 San Juan, P.R. 00936-2708

HOW TO OBTAIN ADDITIONAL INFORMATION ABOUT YOUR LOAN:

To obtain information regarding your loan including the outstanding balance and payment amounts, you may visit us at 401K or, call our Customer Service Center at (787) 724-3657, press option 2, twice.

PLEASE CHECK THAT YOU HAVE COMPLETED THE FOLLOWING PRIOR TO SENDING THE PAYMENT:

You have completed and signed the LOAN PAYOFF FORM. The check is signed. The check has been made payable to Banco Popular de PR as trustee for NAME OF PLAN. The written dollar amount on the check matches the numerical amount.

Signature

Date

PLEASE PROVIDE A COPY OF THIS FORM TO YOUR PAYROLL/HUMAN RESOURCE DEPARTMENT

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