Trs Qpp Loan Application Form – Fill Out and Use This PDF

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In฀Part฀A:฀ All information must be provided.

In฀Part฀B:

1)Please indicate the amount you want to borrow. You may specify a dollar amount or write “maximum” to borrow the maximum loan amount available to you. Please฀note฀that฀the฀maximum฀amount฀you฀may฀request฀for฀a฀QPP฀loan฀at฀retirement฀is฀ 75%฀of฀your฀accumulated฀contributions฀(including฀the฀balance฀in฀the฀employee฀portion฀of฀your฀Additional฀Member฀ Contributions฀(AMCs),฀if฀applicable);฀additional฀restrictions฀on฀loan฀amounts฀apply฀to฀loans฀for฀members฀who฀are฀ not฀retiring฀and฀members฀on฀a฀leave฀of฀absence.฀฀Please฀see฀the฀QPP Loans฀brochure฀for฀more฀information. In addition, if your requested loan amount exceeds your maximum QPP loan amount, you must elect whether to receive the maximum QPP loan amount available to you or have your application canceled.

Note:฀IRS regulations do not allow outstanding loan balances to be combined with new loans. Any new loan

requested would be treated as a separate loan, and each loan balance would be subject to the interest, applicable insurance charges, and repayment terms in effect when the loan is issued.

2)You must elect the repayment period for your QPP loan (unless you are filing for a QPP loan in conjunction with retirement).

3)You must elect how you would like your loan disbursed. (Please note that loan checks may no longer be placed on hold for pickup at TRS.) If you are paid on the City of New York payroll and receive your paychecks through direct deposit, you may be eligible to have your QPP loan forwarded via EFT to the account where your paychecks are deposited. If you cannot receive your QPP loan via EFT (e.g., you are not paid on the City of New York payroll, you do not receive paychecks through direct deposit, or TRS is unable to confirm the applicable bank account information on file), your loan check will be mailed to your home address.

Note:฀In order for a loan check to be mailed to your home address or forwarded via EFT on a given Wednesday, TRS must generally receive your loan application by the close of business on Wednesday of the preceding week; the funds would be available on Fridays. (If a holiday occurs during a given week, TRS must receive your loan application by the first business day of that week.) However, checks for loans taken in conjunction with retirement are normally issued the third Wednesday after your effective retirement date.

4)You must provide additional information if you are on a leave of absence without pay.

In฀Part฀C: You must complete this part ONLY if you are a Tier I or II member, and you have applied for an excess withdrawal. Please note that an excess withdrawal may affect the loan amount for which you are eligible.

In฀Part฀D: You must complete this part ONLY if you are filing this application for a QPP loan taken in conjunction with retirement.

Please be advised that TRS must receive this application no later than one business day before your effective retirement date, and that your loan taken in conjunction with retirement would be distributed after your effective retirement date. (If฀this฀application฀is฀not฀ preceded฀by฀or฀iled฀in฀conjunction฀with฀an฀application฀for฀retirement,฀your฀loan฀would฀be฀subject฀to฀the฀same฀restrictions฀ that฀apply฀to฀members฀who฀are฀not฀retiring.)

1)QPP loans at retirement are not repaid to TRS. Instead, they would be treated as taxable distributions (unless you receive a distribution of tax-free funds).

2)You must elect how your QPP loan at retirement will be distributed. Distribution methods include Direct Cash Payment (i.e., funds that TRS distributes directly to you by mail or via EFT) and Direct Rollover (i.e., funds that TRS pays directly to one or more eligible Individual Retirement Accounts (IRAs) or other successor program(s) that you designate).

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3)IRS฀regulations฀require฀TRS฀to฀withhold฀20%฀of฀any฀taxable฀loan฀amount฀that฀you฀do฀not฀directly฀roll฀over฀to฀an฀ eligible฀IRA฀or฀other฀successor฀program(s). The withheld amount would be sent to the IRS as a credit toward your federal income taxes for the year of distribution. If you receive a Direct Cash Payment, you may elect to roll over any taxable portion of the amount you receive, or roll over an amount equal to the entire taxable distribution, by replacing the amount withheld by TRS with funds from another source; however, this rollover must occur within 60 days of notification by TRS.

4)If you currently have an outstanding QPP loan balance, TRS is required to withhold an amount equaling 20% of the taxable portions of your existing loan balance and of your new loan amount that you do not instruct us to directly roll over to one or more eligible IRAs or other successor program(s). If you elect to receive your loan taken in conjunction with retirement as a Direct Cash Payment, the withholding from the prior outstanding loan must be taken, even if all or part of the new loan is tax-free; if the full withholding amount exceeds the amount of your new loan, TRS would issue you a check in the minimum amount of $10. If you are a Tier I or II member, any remaining deficit would be applied to any subsequent excess withdrawal you receive directly in the same tax year; this withholding would be in addition to any withholding that would ordinarily be applied to an excess withdrawal you receive directly.

5)The minimum amount that TRS will directly roll over to a successor program is $200. (This฀amount฀may฀be฀greater,฀ depending฀on฀the฀successor฀program’s฀minimum฀requirements;฀any฀designated฀Direct฀Rollover฀amount฀that฀does฀ not฀meet฀the฀successor฀program’s฀minimum฀requirements฀will฀be฀sent฀directly฀to฀you฀as฀a฀Direct฀Cash฀Payment,฀ less฀any฀required฀withholding.) Any payment less than $200 will be sent directly to you and will not be subject to the 20% withholding.

6)Any amount that is distributed through a Direct Rollover is not taxable until it is received as income and is not subject to any withholding.

7)If you are eligible to receive tax-free funds as part of your loan taken in conjunction with retirement, you would not be subject to the 20% withholding on these funds; you would also not be eligible to roll over these tax-free funds.

In฀Part฀E: You must sign and date this application in the presence of a notary public, who must then complete Part F.

In฀Part฀F: You must have this application notarized.

This฀page฀intentionally฀left฀blank.

QPP LOAN APPLICATION

FOR LOANS FROM YOUR

QUALIFIED PENSION PLAN (QPP) ACCOUNT

Please฀read฀the฀instructions฀before฀completing฀this฀application.

(NOTE:฀Please฀print฀in฀black฀or฀blue฀ink,฀and฀initial฀any฀changes฀that฀you฀make฀on฀this฀application.)

PART฀A:฀ All information must be provided.

Please keep your personal information with TRS up to date. We will update our records based on the information you provide above, so do not enter a temporary address; instead, TRS suggests that you consult the U.S. Postal Service about having your mail forwarded on a temporary basis. To register any changes to your permanent address (and/or phone number), please access our website or file a “Member’s Change of Address Form” (code DM13) with TRS.

If you are providing new information above, please indicate the effective date:

PART฀B:฀฀Please provide all applicable information below.

Please indicate the QPP loan amount you are requesting to borrow, or write “maximum” to request the maximum QPP loan amount available to you:

$

If you specified a dollar amount (rather than writing “maximum”), please write the requested amount on the line below. For example, if you want to borrow $1,000, please write “One Thousand Dollars.”

___________________________________________________

Please choose ONE of the following options and write your initials in the space provided.

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If you are a Tier I or II member, your repayment period may not exceed 48 months. If you are a Tier III, IV, or VI member, your repayment period may not exceed 60 months.

Please select how you would like to receive your QPP loan. In order to elect EFT, you must receive your paychecks through direct deposit:

If you are on a leave of absence, when did your leave of absence begin? (M/D/Y)

If you are on a leave of absence, you would automatically receive a 12-month grace period when loan payments need not be made; however, interest and applicable insurance charges would continue to accrue.

If you would prefer to begin making payments immediately, please check this box:

PART C: Please complete the following ONLY if you are a Tier I or II member.

If you checked “Yes,” please indicate the date that you filed for an excess withdrawal: (M/D/Y)

PART฀D: Please complete the following ONLY if you are filing this application for a QPP loan in conjunction with retirement. TRS฀must฀ receive฀this฀application฀no฀later฀than฀one฀business฀day฀before฀your฀effective฀retirement฀date.

Please note that, under IRS regulations, your tax-free funds must first be applied to any total outstanding QPP loan balance that you have at retirement. Any remaining tax-free funds would then be distributed as part of your new loan.

Please indicate your effective retirement date: (M/D/Y)

Please choose ONE of the following options and write your initials in the space provided.

loan distribution, and I have therefore attached a “QPP Loan Direct Rollover Election Form” (code LO57) to this application. I understand that any portion of this loan to be paid directly to me would be distributed according to my election indicated in Part B.

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PART฀E: Please read the following statement and sign and date below in the presence of a notary.

I confirm that I have read the QPP Loans brochure and that I understand the terms and conditions of this loan. I certify that all of the information presented on this application is accurate, that I am in active service or on a leave of absence, and that I am not precluded by any court from borrowing against my QPP accumulations. I am aware that any loan balance I may have from a City of New York DCP account during the previous 12-month period may affect the loan amount available from my QPP account. I also understand that all payments representing the proceeds of this loan are final and cannot be returned to TRS for cancellation.

MEMBER’S SIGNATURE __________________________________________________ DATE (M/D/Y) ________________

PART฀F:฀฀TO BE COMPLETED BY A NOTARY (NOTE: Attestation made outside the U.S. must be executed before an American consul.)

State of ____________________________ )

)s.s.:

County of __________________________ )

On the _______________ day of __________________________, __________, before me personally appeared the person

known to me to be ____________________________________________________________________________________,

the individual who executed the foregoing instrument and acknowledged to me that (s)he executed the same. Signature: _______________________________________________________

Official Title: ______________________________________________________

Expiration Date of Commission: ______________________________________