COVID-19 - CORONAVIRUS - REQUEST FOR DEFERRAL

PLEASE FILL OUT ONE FORM FOR EACH PERSON ON THE LOAN WHO'S INCOME HAS BEEN AFFECTED

Required Fields

Date Phone Number Customer Name Account Number Payment Amount Payment Due Date

Explanation of Hardship

Employer Contact Person Contact Number E-mail Address Last Date of Work Tentative Date of Return

Layoff

Unemployment Started

Hours Reduced

From To Weekly Wages prior to Hardship Weekly Wages After Hardship

Are you still receiving regular pay from Employer

For How Long Message

By signing this form, I am attesting, under penalty of perjury, that my income has been negatively affected by the COVID-19 Coronavirus pandemic and I am requesting Monroe Savings Bank defer my payment(s) up to 90 days on the above loan(s). All other terms, collateral and conditions remain the same. Examples of income being affected negatively include but are not limited to: having the virus, being quarantined (self or mandatory), job has been eliminated or hours reduced (temporarily or permanently), or other unexpected burdens created by the virus.

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