Fillable Tax-Sheltered Annuity Loan Repayment - The Standard

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Agreement for 403(b) Tax-Sheltered Annuity Loan Repayment Standard Insurance Company Individual Annuities 800.247.6888 Tel 800.378.4570 Fax 1100 SW Sixth Avenue Portland OR 97204-1093 www.standard.com 1 Participant PLAN OR POLICY NUMBER NAME 2 Repayment Agreement I own the above tax sheltered annuity Contract, purchased under the provisions of 403(b) of the Internal Revenue Code (IRC). I have requested a Loan on...
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