Fill and Sign the Loan Request Form Aba Retirement

GENERAL CONSENT FORM — QJSA Note: If you sign this agreement, you agree that your spouse can choose the form of payments that he/she will receive from the plan and his/her beneficiary without telling you and without getting your agreement. Your spouse does not need to tell you or get your agreement to any future changes in the form of payments or the beneficiary.You may limit your agreement to a particular payment form and a particular beneficiary. If you want to allow your spouse to select only a particular payment form, do not sign this form. In that case, contact the plan administrator for more information and to get a new agreement that lets you state the particular payment form and the particular beneficiary that you will allow your spouse to select.I, [Name of Participant’s Spouse], am the spouse of [Name of Participant]. I understand that I have the right to have [Name of Plan] pay my spouse’s retirement benefits in the special QJSA payment form, and I agree to give up that right. I understand that by signing this agreement, I may receive less money than I would have received under the special QJSA payment form and I may receive nothing after my spouse dies, depending on the payment form or beneficiary that my spouse chooses.I understand that by signing this agreement, my spouse can choose any retirement benefit form and any beneficiary that is allowed by the plan without telling me and without getting my agreement. I also understand that my spouse can change the retirement benefit form selected or the name of a beneficiary at any time before retirement benefits begin without telling me and without getting my agreement.I understand that I can limit my spouse’s choice to a particular retirement benefit form and a particular beneficiary who will receive payments from the plan after the death of my spouse and that I am giving up that right.I understand that I do not have to sign this agreement. I am signing this agreement voluntarily.I understand that if I do not sign this agreement, then my spouse and I will receive payments from the plan in the special QJSA payment form. Plan Administrator: Witness: Spouse: Date: