Request For A Loan Voucher
To determine your ability to take a loan from this 403(b) plan, please complete the following information. The amount of the loan you are eligible for is based on existing loans you already have under this 403(b) plan and any other retirement plan of your employer and the largest outstanding loan balance in the past 365 days. If you are eligible for a loan, you will be issued a voucher. However, some vendors may not allow loans. For those vendors that offer loans, they may require that you provide additional information. Please be aware that vendors may impose additional processing restrictions or requirements in order to receive a loan from a specific contract or account. Therefore, completion of this request does not ensure approval of the loan. The Loan Voucher will be valid 30 days from date of issue.
Section A: Participant Information Plan Name: St. Joseph School District -- In order to expedite the process, a voucher can be automatically sent to you by e-mail. Would you like the voucher e- mailed to you?
If yes, please provide a valid e-mail address:
Section B: Other Retirement Plans
In order to properly calculate the loan amount available all loan balances from retirement plans other than your 403(b) plan need to be included in the calculations. If you have any outstanding loans in other retirement plans sponsored by your employer, provide the following information. Do not include any amounts listed in another employer’s plan or any amounts listed with the approved vendors.
Status of Outstanding Outstanding Outstanding Loan Active Contract/Account Name of Retirement Plan or Defaulted Balance in (payments the past 365 being made) Section C: Loan Request Amount and Terms
Indicate that you would like the Maximum Loan Amount
If the term of the loan is greater than 5 years, are the proceeds being used for the purchase of a principal residence? Yes
*If you are requesting a loan with a term greater than 5 years, you will need to provide the vendor(s) with proof of principal residence purchase.
Section D: Select a Vendor(s)
Indicate the vendor(s) from which you intend to take the loan you are requesting by indicating the Amount of Loan you intend to borrow. The total amount you input cannot exceed the total amount of the loan you requested above.
Vendor Name Account Number Total Account Balance Amount of Loan Please Note: Your vendors may impose additional restrictions in order to receive a loan from a specific contact or account. Some vendors may not allow participant loans. For those vendors that offer loans, they may require that you provide additional information. Therefore, completion of this request and receipt of a voucher does not ensure you can borrow the amount requested from a specified vendor. Participant Certification
I certify that the information provided in this request is true and correct to the best of my knowledge. I understand that the voucher will expire in 30 days from the date it is issued. If the voucher is not used with the 30 days, it will become invalid and it will be necessary to request a new voucher. Printed Name Signature
Please send this request to the provided information:
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