3 Loan Supplement for Investment Providers The Annuity Life Insurance Company Variable (VALIC), Houston, Texas (For use with decentralized multi-investment plans 403 (b) (Jump this page if your plan has only one provider or if you are not in a plan 403 (b)). Borrowers: Your application for a loan from your account 403 (b) and the yes answer to the section 6 question also requires the submission of this supplementary form to your other investment providers to determine the credit distribution authorization from your employer`s plan. You should fill out box A (below) and provide each of the other investment providers with a copy of this form to complete Box B. After completing this form, the additional form can be filed with the credit application form. In addition, forward the page to each of the investment providers mentioned in section 6 in order to provide the necessary information: PARTICIPANT Information Name: SSN: Address: Daytime Phone: () Contract or Account: State: ZIP: BOX A: Name of the investment provider: Employer name: Employer name: Subscriber name: Participant`s address: The borrower authorizes VALIC to confirm the accuracy of the information provided with the listed suppliers and authorizes these suppliers to confirm the information contained in it, subject to the obligation that the information be used exclusively for the purpose of implementing the restrictions of the plan. The borrower understands that the application will not be processed until it has been confirmed. Signature Subscriber Investment Provider: The client has authorized VALIC to collect the following information. Complete the following table for each account 403 (b) on which contributions were made at any time. Do not include accounts that contain only amounts deferred before 25.09.2007.
Return to the client after graduation. BOX B: Account #1 account #2 number (s): Account balance (s): Balance (s) At 31.12.1988: Total outstanding credit balance: Total outstanding credit in the last 12 months: Describe the status of the loan: Assets, Defaulted, or Fully Repaid Signature of Investment Provider Printed name of Investment Provider Title of Investment Provider Page 3 of 3 AIG Retirement Services has a policy to apply quarterly payments made in an amount in that exceeds the payment due first to the current quarterly payment amount due and excess any to the following quarterly payment due.