Loan Request Form

The following documents must be submitted in order to process your loan request. If documents are incomplete upon submission, all documents will need to be re-submitted.

This form, completed and signed
If loan amount is to be sent to you electronically (via ACH), provide a voided check or letter from your bank on bank letterhead with your name, routing number, account number, and account type (checking or savings)
If a Residential or Hardship Loan, supporting documents are required
A valid photo ID, such as Driver's License or Passport

Employer / Plan Name *

Employer / Plan Name

Name *

First Name Last Name

Name

First Name Last Name

Name

First Name Last Name

Social Security Number

Primary Contact Number *

Please enter a valid phone number.

Alternative Contact Number

Please enter a valid phone number.

Text Message Notifications: Please initial here if your primary contact number is a mobile number capable of receiving text message notifications. With your initials, you acknowledge that message and data rates may be charged to you by your carrier.

Email Address *

example@example.com

Mailing Address *

Street Address

Street Address Line 2

City State / Territory

Postal / Zip Code

1. This is a request to borrow a loan of the amount indicated below from my Retirement Plan (minimum of $1,000). *

If your Plan does not allow you to take a loan for the full amount requested, the maximum amount available will be processed. The plan may have additional limitations on loans available to you.

2. The purpose of this loan request is a (please choose one option below that is allowed under your Plan's Loan Policy) *

PRIMARY RESIDENCE LOAN to acquire my primary residence (IRS maximum term: 30 years or 360 months; your plan maximum term may differ) HARDSHIP LOAN is subject to approval for a Financial Hardship reason (IRS maximum term: 5 years and supporting documentation is required) PERSONAL LOAN, if allowed under the Plan's Loan Policy, is for Non-Financial Hardship situations (IRS maximum term: 5 years; your plan maximum term may differ)

Please select one of the options below to describe your financial hardship need. *

Payment to prevent the loss of employee's primary residence through eviction or foreclosure Payment of tuition for post-secondary education for employee, employee's spouse or dependents Payment of non-reimbursable medical expenses for employee, employee's spouse or dependents Payment of funeral expenses for employee's spouse or dependents Repairs to your primary residence due to catastrophic disaster

A Loan Hardship Supporting Document must be attached to this request. *

3. I am applying for *

New Loan New Loan with Loan Payoff Loan Refinance

New Loan with Loan Payoff (Condition)

New Loan with Loan Payoff

I would like to repay the loan in equal installments over a term of ex: 12* months.

I would like to to repay the loan in equal installments over a term of ex: 12* months.

Loan Payoff amount: *

I would like to *

Keep the original Final Payment Due Date. Set up for the following number of payments:

My payroll frequency is *

Weekly Bi-Weekly Semi-Monthly Monthly Other:

I agree to a one-time loan setup fee of $100.00 and a quarterly loan maintenance fee of $15.00. Fees will be charged prorata to available investments in my retirement account.

Promissory Note

Loan terms. I promise to pay ASC Trust LLC, as Trustee of the Plan, the principal amount plus interest. The interest on the outstanding principal balance will be based on the loan policy. I will repay my loan according to the Amortization Schedule. Please refer to the Amortization Schedule for the breakdown of the principal and interest per pay period and over the full term of the loan. My account investments will be sold as needed to fund my loan. The interest portion on my loan payments will be credited to my account. I agree to the conditions in this Promissory Note.

Late charges. There are no late charges

Prepayment. There is no penalty for paying off your loan early.

Call provision. Unless otherwise stipulated in the loan policy, the total unpaid balance will become due immediately if your employment with the Company ends or the Plan is terminated. If you do not repay the balance, it will be treated as a Plan distribution, subject to taxes and penalties as described below.

Security. The funds in your Plan account will act as security for your loan (I hereby grant a security interest in my account for that purpose If you do not repay the loan, the loan principal and any interest you still owe will be subtracted from your account total.

Payment authorization. Each payment will be taken from my wages or salary through payroll deductions collected by my employer and sent to ASC Trust LLC. Payments will be applied first toward interest due. The rest of each payment will lower the remaining principal balance. Any unpaid interest and principal will become due on the "final payment due date" shownin the payment schedule above. Also, I understand that a quarterly loan maintenance fee will be charged to my account.

Tax consequences of defaulting. If I fail to repay the loan under the terms of the Note, the Trustee may report the unpaid balance to the proper tax authority as a taxable distribution. If I am under age 59-1/2 at the time the loan becomes a taxable distribution, a 10% early withdrawal penalty may apply.

Prevailing authority of the Plan. The Promissory Note has been drafted in accordance with the Plan's loan provisions, which are hereby incorporated as part of the Note by reference. This includes the requirement that, if the loan is scheduled to be repaid over a period exceeding 60 months, the borrower certifies that the proceeds will be used to acquire his or her primary residence. If this Note and any provision of the Plan are found to be inconsistent, the Plan shall prevail.

I elect for the loan to be paid to me in the form of a *

Check issued to me. Direct Deposit (ACH) to my bank account. I have attached a voided check or bank statement that contains the valid routing number and bank account number. I have also provided my physical address as required by the bank.

Bank Name *

Type of Account *

Savings Checking

Bank Account # *

Savings

ABA Routing # *

Savings

Bank Account # *

Checking

ABA Routing # *

Checking

Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Attach VOIDED Check or Original Bank Statement Below *

By electing a Direct Deposit (ACH) and by signing below, I hereby authorize ASC TRUST LLC (ASC) to 1) initiate credit entries to the depository financial institution named above; and 2) to initiate debit entries to adjust for processing errors. I understand that a $30.00 fee will be charged to my payout for any ACH payments rejected due to closed bank account or erroneous bank account info provided to ASC. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

FOR LOAN VALUE RECEIVED, I agree to 1) the full terms and conditions of the Promissory Note and 2) the Amortization Schedule showing the principal amount, interest rate, finance charge, payment amount, start date, and maturity date.

By signing this form, I authorize implementation of the above instructions. I understand that the loan will be funded through withdrawals from my eligible retirement account, divided proportionately among my investment funds unless I provide other instructions to ASC Trust LLC. I further understand that my loan payments will be reinvested according to my fund selection at the time the payment is received. If the purpose of the loan is for a hardship, I certify that the reason indicated in Section A of this form is true and that the amount requested in Section A of this form does not exceed the amount of the hardship.

A valid photo ID must be attached to this request. *

Signature of Participant *

Clear

Date *

Signature of Spouse

Clear

Date

The following documents must be submitted in order to process your loan request. If documents are incomplete upon submission, all documents will need to be re-submitted.

This form, completed and signed If loan amount is to be sent to you electronically (via ACH), provide a voided check or letter from your bank on bank letterhead with your name, routing number, account number, and account type (checking or savings) If a Residential or Hardship Loan, supporting documents are required A valid photo ID, such as Driver's License or Passport

Loan Request Form

General Information

A. Loan Details

B. Payment Details

C. Participant Signature