Checklist for Completing Your Loan Application

 Make sure the loan terms on this agreement are the terms that you
requested.

 If you are a married FERS employee or a member of the uniformed

services, make sure your spouse signs and dates your form.

 If you want direct deposit of your loan, be sure to provide the re-
quired information about your financial institution and your ac-
count.

 Make sure you sign and date the form.

 If you are married and cannot fulfill the TSP’s spouses’ rights require-
ments, submit Form TSP-16 (TSP-U-16 for uniformed services),
Exception to Spousal Requirements, along with the required docu-
mentation.

 Make copies for your records and mail your completed form(s) to:
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238

OR fax to: 1-866-817-5023

 THRIFT SAVINGS PLAN TSP-21-R
loan agreement
Review the terms of the loan in this Loan Agreement. If you accept the loan terms, you must complete Section III Loan Number:
(if applicable) and Section IV. A $50 fee will be deducted from your loan. Do not alter any preprinted informa- 0228003R
tion. If this Form TSP-21-R and Form TSP-21-DOC and associated documentation are not received before the
Expiration Date:
Expiration Date, your loan request will be cancelled automatically. Also, if you want to change or cancel this
loan, see the information in the “Loan Cancellation” section below. 05/02/2011

I. Name: DAVILA, SHIRALEE Unless you complete Section V below, your check will
INFORMATION be mailed to the following address:
ABOUT YOU TSP Account Number: 8007771620827 HC 4 BOX 45881
Payroll Office: 97381600 CAGUAS, PR 007279002

II. Annual Percentage Rate Amount Financed (This Interest (The interest you will Total Amount of Payments (The
(The cost of your loan as a yearly amount includes the $50 fee.) have paid when you have made amount you will have paid when you
TERMS interest rate) all scheduled payments) have made all scheduled payments)
OF LOAN
2.875% % $ $1,000.00 $ $18.39 $ $1,018.39

Amount of Each Payment Frequency of Payments Total Number of Payments Repayment Period

$ $39.17 26
Per Year 26 1 Years Months
If, at disbursement, the maximum loan amount is less than the amount financed but at least $1,000, your loan will be issued in the
maximum loan amount. In this case, the annual percentage rate will not change and your loan payment may be reduced. Once
your loan is issued, under certain conditions (such as return from nonpay status), the amount of your loan payment may be in-
creased automatically to ensure that this loan is repaid in full by the required deadline.

Iii. If you are covered by the Federal Employees’ Retirement System and you are married (even if separated from your
spouse), your spouse must consent to your loan. If you are not able to get your spouse’s signature, you may be
SPOUSE’S able to obtain an exception by submitting Form TSP-16, Exception to Spousal Requirements. (If you are covered by
CONSENT the Civil Serv­ice Retirement System, your spouse’s consent is not required.)
To be completed Spouse’s Consent: By signing below, I consent to this loan from my spouse’s Thrift Savings Plan account. (Spouse’s
by spouse of Social Security number is only required if the letter E appears beside “Married:”.)
FERS employee
– –
Married: Typed or Printed Name of Participant’s Spouse Spouse’s Social Security Number

No
Signature of Participant’s Spouse Date Signed

Iv. I agree to the terms and conditions described above and I promise to repay the entire amount of this loan, plus
PROMISE interest. I authorize the Amount of Each Payment shown above to be deducted from my pay each pay period to
TO PAY and repay my TSP loan. I agree that I will not cancel these deductions. I certify that all information submitted in conjunc-
tion with my loan request is true and complete to the best of my knowledge. I understand that any intentional false
certification
statement or willful misrepresentation is a violation of law that is punishable by a fine of as much as $10,000 or im-
prisonment for as long as 5 years, or both (18 U.S.C. § 1001).

Participant’s Signature Date Signed

V. Deposit my loan directly into my account at the financial institution below. (Note: Confirm with your financial institu-
Request tion that the account information you provide is correct.)
for Direct
Deposit
Name of Financial Institution Routing Number (must be 9 digits)

Type of Account: Checking Savings

Checking or Savings Account Number

VI. If you want a TSP loan under different terms than indicated in this Loan Agreement or you want to cancel your loan
LOAN request altogether, do not send in this Loan Agreement. To change the terms of a loan, you must begin your loan
CANCELLATION again by completing a Loan Application. Once you submit a Loan Agreement, you will only be able to cancel it on
the TSP Web site (www.tsp.gov) or through the ThriftLine at 1-877-968-3778 after it is received by the TSP. (Outside
the U.S. and Canada, call 404-233-4400.)

Form TSP-21-R (10/2007)

INSTRUCTIONS Before completing this agreement, read the booklet TSP Loans. The booklet contains information about the cost
of TSP loans, as well as borrowing restrictions and repayment requirements. The booklet is available from your
agency personnel office or the TSP Web site at www.tsp.gov.
Make a copy of this completed form for your records and mail the original form to:
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238

Or fax the completed form to our toll-free fax number:

1-866-817-5023
If you are applying for a residential loan, return this Loan Agreement and your completed Form TSP-21-DOC, Resi-
dential Loan Documentation, and its associated documentation together.
When your loan is disbursed, the TSP will send your loan payment information to the payroll office listed in your TSP
account record at that time. If the payroll office shown in Section I is not your current payroll office, ask your current
payroll office to update your TSP records. After your loan is disbursed, check your earnings and leave statements
to make sure your loan payments are being deducted.

TERMS OF The terms of this loan are set forth in Section II on the front of this form. The Annual Percentage Rate is the interest
LOAN rate for the Government Securities Investment (G) Fund in effect on the date your Loan Application was processed;
this rate remains in effect for the life of the loan. A loan fee of $50 is included in the Amount Financed.

REPAYMENT By signing Section IV of the Loan Agreement:

• You are agreeing that you will pay principal and interest on this loan in substantially equal installments through au-
tomatic payroll deductions, or, if your agency fails to deduct payments, by submitting payments directly to the TSP.
• You are authorizing these deductions and agreeing that you will not cancel them.
• You are certifying that all information you submitted, including spouse information, is true and complete.
If your deduction does not start in the first full pay period after you receive your loan, notify your agency.
You may request that your loan be reamortized to change the payment amount or repayment period or frequency
of your payments (if, for example, you transfer to another agency and your pay frequency changes). However,
there are limits on the length of the repayment period, which are described below.
You can make additional loan payments or repay your loan in full at any time without a prepayment penalty. To
make a payment, follow the instructions on the Loan Payment Coupon, which is available from the TSP Web site.
You can obtain a prepayment amount by accessing your account on the TSP Web site or the ThriftLine.

taxable The TSP may declare a taxable distribution of the outstanding balance of your loan, plus accrued interest, if:
distribution • Your loan was identified as being in default and you did not submit the required amount by the deadline;
• Your general purpose loan is not paid in full by the 5th anniversary of the loan issue date or your residential loan
is not paid in full by the 15th anniversary of the loan issue date;*
• You separate from Federal service and do not repay your loan in full;
• You are found to have provided false information; or
• You die before your loan is repaid in full.
If the TSP declares a taxable distribution of your loan, this amount is subject to Federal income tax (and, in some
jurisdictions, to state and local tax) and may also be subject to an early withdrawal penalty tax in the year in which
the taxable distribution is declared.
* These term limits may be extended if TSP records show that loan payments were missed because you entered
nonpay status in order to perform military service.

PRIVACY ACT NOTICE. We are authorized to request the information you pro­
vide on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System.
We will use this information to identify your TSP account and to process your
transaction. In addition, this information may be shared with other Federal agencies
for statistical, auditing, or archiving purposes. We may share the information with law
enforcement agencies investigating a violation of civil or criminal law, or agencies
implementing a statute, rule, or order. It may be shared with congressional offices,
private sector audit firms, spouses, former spouses, and beneficiaries, and their
attorneys. We may disclose relevant portions of the information to appropriate parties
engaged in litigation and for other routine uses as specified in the Federal Register.
You are not required by law to provide this information, but if you do not provide it, we
will not be able to process your request.

Form TSP-21-R (10/2007)

 THRIFT SAVINGS PLAN TSP-21-DOC
RESIDENTIAL LOAN DOCUMENTATION
Complete this form and make a copy for your records. Attach copies of the required documentation Loan Number:
and return this form with Form TSP-21-R, Loan Agreement, to the TSP address on the agreement. 0228003R
Return your loan forms together; they must be received before the Expiration Date shown at the right.
Expiration Date:
05/02/2011

I.
INFORMATION Name: TSP Account Number:
ABOUT YOU
DAVILA, SHIRALEE 8007771620827

II. Read the booklet TSP Loans and the detailed instructions for this form before completing this section.
DOCUMENTATION You must attach documentation (for example, copies of contracts, bills, or receipts) supporting the
OF EXPENSES purpose and the amount of your residential loan. Do not send originals; your documents will not be
returned to you.
The TSP may contact other parties to verify the documentation you provide.
1. Address of Residence Being Purchased or Built (A post office box number is not acceptable. The address
of this residence must match the address on your supporting documentation.)

Street Address

City State/Country Zip Code

2. Expenses Amount
A. Full Purchase Price $
B. Additional Expenses
(Required only if the amount of your loan request is more than the amount in Item 2A.)

Total this page

3. Check here if additional Total from continuation sheet

expenses are listed on a
continuation sheet. GRAND TOTAL $

III. 4. If you are purchasing or building this residence with someone other than your spouse, enter either a
NON-SPOUSE dollar amount or a percentage representing your share.
CO-OWNER
$ or % will be paid by me.

Form TSP-21-DOC (10/2007)

INSTRUCTIONS
I. Your name and TSP account number are printed from your TSP account records. If your name is incorrect,
INFORMATION contact your agency personnel office immediately. If your account number is incorrect, contact the TSP
ABOUT YOU immediately.

II. Write the Loan Number from the front of this form on each document that you attach. Do not send your original
DOCUMENTATION contracts and receipts — attach copies.
OF EXPENSES Your primary residence may be a house, condominium, town­house, unit in a cooperative housing corporation,
boat, mobile home, or RV (recreational vehicle), but it must be used as your principal residence. For real es-
tate, the documents must clearly show the full address of the residence, its cost, and that you are the purchaser.
You may use a TSP residential loan for constructing a new residence, but you may not use it to refinance an ex-
isting mortgage, for renovations, or for an addition to an existing residence. Your documentation must:
• Be from a third party (that is, someone who is selling the home to you or building the home for you —
for example, a building contractor, a real estate firm, or a mortgage company).
• Show you as the purchaser or builder.
• Show the purchase price or construction price.
• Show the address of the residence.
• Be dated no more than 24 months before the Expiration Date shown on the front of this document.
Examples of Acceptable Documentation:
• Copy of the purchase contract showing the sales price. For a cooperative, the documents must clearly
show that you own shares in the housing corporation. A lease-to-buy option is not eligible unless you
are exercising the option to buy.
• Copy of the final settlement sheet. Do not send an estimated settlement sheet. Only the contract
price and those additional expenses that can be added to the cost basis of the residence for Federal
income tax purposes are eligible for a TSP loan. For examples of items that can be added to the cost
basis, see the booklet TSP Loans.
• Copy of the construction contract showing the building cost.
• If you are building a residence, a copy of the building permit and the construction contract with costs,
which show that an entire house is being constructed. If you are building the house with your own
labor, you must provide documentation of actual purchases of materials and a blueprint or other docu-
mentation to show that you are building an entire house.
Note: If you are purchasing a boat, mobile home, or RV, see the TSP Web site (www.tsp.gov) for the documenta-
tion requirements.

Item 1: Address of Residence. The address of the residence must match the address on your supporting
documentation. For a residence being purchased, include the full address of the residence (including street
address and unit or apartment number, if applicable), as well as the city, state, and zip code. For a residence
being built, if a street address is not available, include a plat description of the construction site, as well as the
city, state, and zip code.
Item 2: Expenses. Enter the documented purchase price on Line A. If the Amount Financed shown on your
Loan Agreement is greater than the documented purchase price, list the additional expenses you have docu-
mented on Line(s) B. As noted above, any additional expenses must be those that are eligible to be added to
the cost basis of the residence for Federal income tax purposes.
Item 3: Continuation Sheet. Each continuation sheet must have your name, TSP account number, and the
Loan Number.

III. Your residence must be purchased (in whole or in part) by you. If it is being purchased with a person other than
non-spouse your spouse, you must indicate the portion of the total cost that represents your share of the purchase. If you will
CO-OWNER be the sole owner of the residence, or if the co-owner is your spouse, skip this section.

PRIVACY ACT NOTICE. We are authorized to request the information you pro­vide
on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System. We
will use this information to identify your TSP account and to process your transaction.
In addition, this information may be shared with other Federal agencies for statistical,
auditing, or archiving purposes. We may share the information with law enforcement
agencies investigating a violation of civil or criminal law, or agencies implementing a
statute, rule, or order. It may be shared with congressional offices, private sector audit
firms, spouses, former spouses, and beneficiaries, and their attorneys. We may dis-
close relevant portions of the information to appropriate parties engaged in litigation
and for other routine uses as specified in the Federal Register. You are not required
by law to provide this information, but if you do not provide it, we will not be able to
process your request.

Form TSP-21-DOC (10/2007)