Metlife Annuity Loan Application – Fill Out and Use This PDF

MetLife Insurance Company of Connecticut

Annuity Loan Application and Agreement

Loan Amount

(Please fill in the requested loan amount, OR mark the box to request the maximum loan amount available*.)

As provided by and subject to the terms of the contract(s) and this agreement, a loan check is requested for the amount of:

If a check for interest is not submitted with this application, the loan will be processed for the amount requested plus the first quarter’s interest.

*The maximum amount to be loaned may not exceed the lesser of (a) or (b), where:

(a) = (i) $50,000 less the aggregate of the highest loan balances, reduced by (ii) the aggregate loan balance on the date of the application.

(b) one half the contract account balance, or $10,000 if greater (for Non-ERISA plans only)

Loan Duration

(Complete A or B below. If neither is completed, B will apply.)

I (the Borrower) promise to repay this loan in quarterly installments of principal and interest over the period noted above. As an express condition of the loan, the contract owner and Borrower will grant MetLife a security interest in the contract cash value equal to the amount borrowed plus any unpaid interest due, including interest due after loan default.

Variable Annuity Loans Only

Loans may only be taken from the fixed account. It may be necessary to transfer cash value equal to the loan amount from one or more funding options to the fixed account.

(Complete A or B below. If neither is completed, B will apply.)

NOTE: Repayments of loan principal will automatically be applied to the current allocation.

Group Plans Only

(Check A or B below. If neither is completed, B will apply.)

Loan Request Information

List all outstanding loans from any retirement plan of the employer (or related employer) during the previous 12 months, including defaulted loans which have not been repaid or offset.* A loan will not be processed if the participant has an outstanding loan

under any retirement plan of the employer (or related employer) which has defaulted, but not been repaid or offset.

Acknowledgement and Signatures

I authorize the loan check and bills to be sent to this billing address:

I (the borrower) understand that federal income tax loan regulations will be enforced to the extent necessary to keep the annuity contract qualified under applicable Internal Revenue Code provisions and under other applicable tax and benefits plan laws and regulations. I understand that I may have only one loan at a time from this contract or certificate. I may not have another loan from this contract or certificate until the outstanding loan and interest are repaid in full.

I understand that a loan is not permitted if I have a loan from 1) any of my employer’s retirement plans or 2) from retirement plans of a related employer, that is in default and is still outstanding due to tax law restrictions on offset; and I certify that I do not have any such previously defaulted loans.

I understand that I am responsible for ensuring that I do not borrow an amount in excess of the loan amount permitted under section 72(p) of the Internal Revenue Code of 1986, as amended ( the “Code”); and that adverse tax consequences, including treatment of such excess amounts as deemed distributions, will result in such case.

I (borrower and/or contract owner) understand and accept the terms and conditions applicable to this loan, including the special terms and conditions described in the "Contract Loan Terms and Conditions" section of this agreement, and accept full responsibility for compliance with these requirements. I/we also understand that MetLife accepts no responsibility concerning adherence to these requirements and that contract values are assigned to MetLife as sole security of the loan.

I acknowledge that I have read and understood the terms and conditions of this loan agreement:

I certify this withdrawal is permissible under the terms of the Plan.

*A loan offset occurs when your accrued plan benefit is reduced (offset) in order to repay the loan (including the enforcement of our security interest in your accrued benefit).

Spousal Consent – ERISA Plans Only

I hereby consent to the loan request by the contract owner as set forth above. I understand that if I am married, I must obtain my spouse's consent to this loan. I understand that a spouse is guaranteed certain rights to assets in this retirement account by federal law and these rights include the right to a preretirement survivor's annuity and the right to a joint and survivor annuity and these rights could be diminished by an annuity loan which is not repaid. This consent cannot be revoked once given.

__ I certify that I am not married and therefore spousal consent to this loan is not required __ I am married and my spouse's consent to this loan is provided below

__ I am married and certify my spouse's consent cannot be obtained or is not required because: (Check only one box below) __ My spouse cannot be found

__ My spouse is legally incompetent to give consent (spouse's legal guardian may give consent)

__ I am legally separated from or have been abandoned by my spouse (within the meaning of local law) and have a court order to such effect and no qualified domestic relations order exists that requires spousal consent to this loan.

I certify that the above-named Spouse personally signed this document before me this______ day of ___________________20_____

SEE NEXT TWO PAGES FOR LOAN TERMS AND CONDITIONS

ERISA Loans:

The interest rate charged at the inception of the loan will remain in effect for one year from the loan effective date. The interest rate may change annually. Notification of any change in the interest rate charged will be made at least thirty (30) days prior to its taking effect. If the interest rate changes, required quarterly repayments will change.

Non-ERISA Loans:

The interest rate charged at the loan’s effective date will remain in effect for the duration of the loan.

Current loan interest rates can be obtained by contacting your MetLife representative directly or by calling our Annuity Customer Service Center.

Loan Default and Taxation

You may repay amounts after a loan default. Such repayments will prevent any additional interest from accruing on the repaid amounts and will reduce the amount of your outstanding loan balance for purposes of determining the amount of any additional loans you may have under retirement plans of your employer. However, such repayments after the administrative grace period will not reverse the default or the deemed distribution of the unpaid loan balance that is reportable for federal income tax purposes. (See below.)

If a quarterly repayment has not been received thirty-one (31) days after its due date, and if there is sufficient cash value attributable to the Borrower’s contributions that is not restricted by federal tax law or regulation, the billed amount or a portion of the billed amount (to the extent of the unrestricted amounts in the contract on such date) due will be surrendered from the unrestricted cash value. Any applicable deferred sales charges or surrender penalties will be deducted. The amount surrendered will be reported to the Internal Revenue Service (IRS) as a distribution.

If a repayment is not received within ninety (90) days of its due date and the billed amount has not been paid as described in the previous paragraph, the entire loan will be placed in default. A tax report will be produced for the calendar year the loan was placed in default, reporting to the IRS as a deemed distribution the outstanding loan amount. Interest will be charged on the defaulted loan amount until it is repaid. The defaulted loan can be repaid at any time to avoid the interest charge accrual. At the time the contract cash value becomes available for loan repayment under federal tax law or regulation, and to the extent permissible under applicable state regulations, the cash value will be reduced by the amount of the loan outstanding and any unpaid interest due. Any applicable deferred sales charges or surrender penalties will be taken. The loan will no longer be outstanding.

The loan plus any unpaid interest due must be repaid in full at the time of an allowable full surrender, including a direct rollover or transfer. Amounts available for partial surrender , including a direct rollover or transfer, will be limited to the cash surrender value of the contract minus the loan amount outstanding, including amounts in default, minus unpaid interest due.

In the event the Borrower files a bankruptcy petition while the loan remains in effect, an exemption will be elected for the annuity contract, including but not limited to its cash value, pursuant to Section 522 of Federal Bankruptcy Code or under a state law exemption at least as broad in scope as Section 522.

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