Elevator Constructors Union Local No. 1 Annuity & 401(k) Fund 2185 Lemoine Avenue, Fort Lee, N.J (201) (212) N O T I C E

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1 Elevator Constructors Union Local No. 1 Annuity & 401(k) Fund 2185 Lemoine Avenue, Fort Lee, N.J (201) (212) UNION TRUSTEES Leonard Legotte Michael Riegger Robert Stork EMPLOYER TRUSTEES Vincent Schiavone Michael Shields E. James Walker Jr. N O T I C E Please note the following loan application fees are applicable: Medical or Funeral Loan $ Purchase of Primary Residence $ Education Loan $100.00* Purchase of a Motor Vehicle as $ Transportation to and from Work Home Improvements or Repairs $ of Primary Place of Residence *One-time charge per student Please include a check or money order with your application for the amount(s) listed above. The check should be made payable to: Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund

2 ELEVATOR CONSTRUCTORS UNION LOCAL NO. 1 ANNUITY AND 401(k) FUND 2185 Lemoine Avenue, Fort Lee, N.J (201) (212) APPLICATION FOR LOAN (other than Disability or Unemployment) Section 6.2 of the Rules and Regulations of the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund provides that the falsity of any statement material to an application or the furnishing of fraudulent information or proof shall be sufficient reason for the denial, suspension or discontinuance of all benefits under the Plan, and in any such case, the Trustees shall have the right to recover any payments made in reliance thereon. Complete Parts I, II, and III. If you are married, complete Part IV. If you are not married, complete Part V. The completed form and supporting documentation should be returned to the following address: Elevator Constructors Union Local 1 Annuity and 401(k) Fund, 2185 Lemoine Avenue, Fort Lee, New Jersey PART I Biographical Information Name: Last First Middle Initial Social Security No.: Telephone No.: Address: Number Street City State Zip Code Name of Current Employer: Check one or more of the following types of loans: PART II Purpose of Loan (1) Medical Expenses: Out-of-pocket expenses for sickness or injury of a Participant or of a member of the Participant s immediate family which have not been reimbursed by benefits from the National Elevator Industry Health Benefit Plan or any other welfare program, of at least $100 for one period of illness. (Attach proof of expenses, such as itemized doctors bills, hospital bills, pharmacists receipts, etc. and a copy of the explanation of benefits from the National Elevator Industry Health Benefit Fund.) (2) Funeral Expenses: Funeral expenses incurred as a result of the death of a spouse, dependent child, parent, parent-in-law, brother or sister. A loan for funeral expenses is limited to expenses incurred within 6 months prior to the date of the loan application. (Attach itemized bills from funeral director, church, etc.) Name of Deceased: Relationship to Participant:

3 (3) Educational Expenses: Expenses incurred for payment of tuition, room and board and/or books for secondary or post-secondary education for the Participant or the Participant s spouse or dependent children or grandchildren. A loan for a grandchild s expenses can be obtained only if the Participant has legal custody of the grandchild, the grandchild lives with the Participant and the Participant is financially responsible for the grandchild. (Attach itemized bills from school, bookstore, etc. If the expenses are for a grandchild, attach proof of legal custody, that the grandchild lives with the Participant and that the Participant is financially responsible for the grandchild.) Check appropriate box(es): Tuition Room and Board Books Name and Address of Educational Institution: Name of Student: Student s of Birth: Relationship to Participant: (4) Purchase of Primary Residence: Down payment, title and/or mortgage fee expenses to purchase a home or a cooperative or condominium apartment for use as the Participant s primary place of residence. A Participant may have only one outstanding loan at any time for the purchase of a primary residence. (Attach proof of expense, such as contract of sale, mortgage application, settlement sheet, etc.) I hereby affirm that the dwelling for which this loan is made will be my primary place of residence. Participant s Signature (5) Purchase of Automobile: Expenses related to the purchase of an automobile or motorcycle needed for the Participant s transportation to and from work. A loan for the purchase of an automobile or motorcycle can include a purchase made within 6 months prior to the date of the loan application. (Attach proof of expense, such as bill of sale.) Name and address of Employer: How have you been previously commuting to work? Why do you now need a new automobile to commute to work? (6) Household Improvement or Repairs: Major household improvements or repairs to be made to the Participant s primary place of residence. A loan for major household improvements or repairs can include improvements or repairs incurred within 6 months prior to the date of the loan application. (Attach proof of expense, such as contractor s estimates or invoices.)

4 Address of dwelling: Number Street City State Zip Code Nature of repairs: I hereby affirm that the dwelling for which this loan is made is my primary place of residence. Participant s Signature PART III I hereby apply for a loan in the amount of $, under the Rules and Regulations of the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund ( the Fund ). I understand that the loan (together with any other outstanding loans) may not exceed the lesser of (1) 50% of the value of my Individual Annuity Account or (2) $50,000. I understand that in order to receive the loan, I must execute a promissory note to the order of the Trustees of the Fund and that the repayment of the loan is subject to the terms of such promissory note, including but not limited to the loan being subject to simple interest at the rate of % per year. Where the loan is made for the purpose set forth in Part II (1), (2), (3), (5) or (6), the loan and accrued interest are to be repaid entirely within a maximum of five (5) years from the date of making the loan, in quarterly installments of not less than 5% of the initial sum of the loan plus the accrued interest. Where the loan is made for the purpose set forth in Part II (4), the loan and accrued interest are to be repaid entirely within a maximum of ten (10) years from the date of making the loan, in quarterly installments of not less than 2½% of the initial sum of the loan plus accrued interest. I understand that my failure to repay the loan in accordance with the terms of the promissory note will, in addition to the terms of the note, further result in refusal on the part of the Trustees to grant any further loans pursuant to the terms of Section 3.6 (B) of the Fund Rules and Regulations, until such time as proper repayment has been made. Participant s Signature

5 PART IV Spouse s Consent to a Loan by Participant* SPOUSE'S SIGNATURE MUST BE NOTARIZED State of ) ) ss.: County of ), being duly sworn, deposes and says: Name of Spouse My name is: Last First Middle Initial My address is : Number Street City State Zip Code I am married to:. We were married on Name of Participant at. Place I understand that my spouse is a Participant in the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund. I have been informed that my spouse s Individual Annuity Account under the Fund is now approximately $. I understand that my spouse has applied for a amount Loan in the amount of $ in order to pay expenses in connection with amount. I understand that if this loan is granted, the loan will be a state reason for loan** lien against my spouse s Individual Annuity Account until the loan is paid in full, with all accrued interest. I understand under federal law and the rules of the Fund, when my spouse begins to receive benefits from the Fund, that unless I consent to another form of payment, my spouse s benefits will be paid as a monthly annuity for my spouse s life and, if my spouse dies before I do, with payments equal to 50% of the payments my spouse was receiving being paid to me for the rest of my life. (This is called a Joint and 50% Survivor Annuity.) The amounts of these annuity payments depend upon the amount in my spouse s accounts in the Fund, less the amount of any loans (including accrued interest) which are a lien against my spouse s Individual Annuity Account. I understand that this means that if my spouse takes a loan against the Individual Annuity Account and does not repay the loan in full with all interest, then the amount of the monthly annuity which would otherwise be payable to my spouse and/or me will be reduced or even entirely eliminated. I also understand that any such lien will also reduce or eliminate the amount payable to me or, if I consent to the designation of a beneficiary for all or part of my spouse s benefits under the Fund other than me, to such beneficiary, in the event that my spouse dies before beginning to receive benefits from the Fund. I understand that the amount of the reduction may be substantial, depending upon the amount of the loan, the accrued interest upon the loan, and whether it is repaid in full prior to my spouse beginning to receive benefits or my spouse s death. * ** The spouse of a Participant who requests a loan must complete and sign this Consent. Reasons for a loan are listed at the end of this Consent.

6 I understand that under federal law and the rules of the Fund, I have at least 30 days from the date I receive this Consent to decide whether to consent to my spouse s loan. I HEREBY WAIVE my right to take the full 30 days to make my decision, and I HEREBY CONSENT to the loan before the end of the 30 days. I understand that I may revoke my waiver and consent at any time during the 7 day period which began when I received this notice. I HEREBY AGREE that the Fund may make the loan to my spouse. I realize that by signing this Consent, I am waiving my statutory right under the Internal Revenue Code of 1986, as amended, to have my spouse receive benefits under the Fund as a Joint and 50% Survivor Annuity, and my statutory right, if my spouse dies before I do, to receive a death benefit of 100% of my spouse s benefits under the Fund, and that as a result I may be entitled to a lesser amount as an annuity or other payment from the Fund. Signature of Spouse This Consent was signed by the spouse of the Participant at the offices of the Fund, in the presence of the Administrator for the Fund whose signature appears below. d Administrator OR On the day of, 20, before me personally appeared, personally known to me, or proved to me on the basis of satisfactory evidence, to be the person who executed the foregoing Consent as the spouse of, who acknowledged to me that s/he executed same, and being duly sworn by me, made oath that the statements in the foregoing Consent are true to the best of her/his knowledge and belief. NOTARY PUBLIC State of ) ) ss.: County of ) Participant s Verification PARTICIPANT'S SIGNATURE MUST BE NOTARIZED I,, am a Participant in the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund. I understand that under federal law and the rules of the Fund, the spouse of a Participant in the Fund has certain rights and that I may not make a loan against my Individual Annuity Account without my spouse s written consent. I hereby certify that the signature which appears upon this Consent is the signature of, who is my true and lawful spouse. I agree to reimburse the Fund for any loss the Fund may suffer in the event that this verification is inaccurate in any respect.

7 I understand that under federal law and the rules of the Plan, the loan cannot be made before the end of the 30 day period which began when this Consent was provided to my spouse and me unless both my spouse and I consent to the loan being made earlier and the loan is not made until at least 7 days after this Consent was provided. I hereby consent to the loan being made before the end of the 30 day period. Signature of Participant This Participant s Verification was signed by the Participant at the offices of the Fund in the presence of the Administrator for the Fund whose signature appears below. Administrator OR On the day of, 20, before me personally appeared, personally known to me to be, or proved to me on the basis of satisfactory evidence to be, the person who executed the foregoing Participant s Verification as a Participant in the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund, who acknowledged that s/he executed same, and being duly sworn by me, made oath that the statements in the foregoing Participant s Verification are true to the best of his/her knowledge and belief. NOTARY PUBLIC Reasons for a Loan (1) Medical Expenses not covered by National Elevator Industry Health Benefit Plan or any other welfare program. (2) Funeral Expenses for spouse, dependent child, parent, parent-in-law, brother or sister. (3) Educational Expenses for participant, participant s spouse or dependent children or grandchildren for high school level and beyond. (4) Purchase of Primary Residence. (5) Purchase of automobile or motorcycle needed for the participant s transportation to and from work. (6) Major Household Improvements or Repairs to primary place of residence.

8 PART V Certification of Marital Status*** PARTICIPANT'S SIGNATURE MUST BE NOTARIZED State of ) ) ss.: County of ), being duly sworn, deposes and says: Name of Participant My name is: Last First Middle Initial My address is: Number Street City State Zip Code I understand that under federal law and the rules of the Fund, a spouse of a Participant in the Fund has certain rights and that a Participant may not, without his or her spouse s written consent, make a loan against the Participant s account. I understand that the Fund will rely upon the accuracy of this Certification concerning my marital status. I agree that, if any of the information set forth in this Certification concerning my marital status is inaccurate, I shall reimburse the Fund for any loss the Fund may suffer by acting in reliance upon such inaccurate information. I hereby swear that I am not now married to any living person. I hereby swear that: Check Applicable Box (A or B) A. I was never married. B. I was married. (once, twice, three times, etc) The details of these marriages are: Signature of Participant (If married more than once, make photocopies of the Certification Regarding Other Marriages on the next page, and complete a copy of the Certification for each additional marriage.) Certification Regarding Marriage Number 1 I was married to:. We were married on Name of Spouse (use maiden name for wife) of Marriage at. This marriage ended by: Place of Marriage *** To be completed by a Participant who states that he (or she) is not married.

9 Death of my spouse on. (Attach copy of Death Certificate) Divorce Decree on. (Attach copy of Divorce Decree including any property settlement) Stopped living together as Husband and Wife on. No Divorce Decree has ever been issued by any court. My spouse now resides at. Address State of ) ) ss.: County of ) On the day of, 20, before me personally appeared, personally known to me to be, or proved to me on the basis of satisfactory evidence to be, the person who executed the foregoing Certification of Martial Status as a Participant in the Elevator Constructors Union Local No. 1 Annuity and 401(k) Fund, who acknowledged that s/he executed same, and being duly sworn by me, made oath that the statements in the foregoing Certification of Martial Status are true to the best of his/her knowledge and belief. NOTARY PUBLIC Complete a photocopy of the following Certification for each additional marriage. Certification Regarding Other Marriages I was married to:. We were married on Name of Spouse (use maiden name for wife) of Marriage at. This marriage ended by: Place of Marriage Death of my spouse on. Divorce Decree on. (Attach copy of Divorce Decree including any property settlement) Stopped living together as Husband and Wife on. No Divorce Decree has ever been issued by any court. My spouse now resides at. Address

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