LOAN RATE MODIFICATION APPLICATION C2 1am applying for individual credit. CD We are applying for joint credit. Please initial below. Bee B a nl ell Applicant Co-Applicant 208 Elm St. New Canaan, CT 06840 203) 972-3838 APPLICANT CO-APPLICANT Middle Initial Last Name First Name Middle Initial Last Name City/Town State City/Town State Former Address if less than 2 years af current address: Former Address if less than 2 years at current address APPLICANT OCCUPATION Former Employer if in current position less than 2 years Former Employer i in current position less than 2 years How Long INCOME INCOME List sources of income below. Income from alimony or child support payments List sources of income below. Income from alimony or child support payments need not be revealed if you do not wish to have it considered as a basis for repaying | need not be revealed if you do not wish to have it considered as a basis for repaying this loan. this loan. Gross Monthly Salary Gross Monthly Salary Commissions and Overtime Commissions and Overtime Dividend and Interest Dividend and Interest EQUAL HOUSING MEMBER LENDER FDIC EFTA00307537

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TOTAL TOTAL ACCT NUMBER TYPE OR my ORIGINAL CURRENT MONTHLY NAME(S) ON ACCOUNT DEBT BALANCE PAYMENTS, 0 Mortgage CREDITOR O Rent TOTAL DEBTS APPLICANT CO-APPLICANT EXPLANATION (Please use a separate sheet if necessary.) O Yes (No O Yes No O Yes (I) No OyYes O No Have you ever been declared bankrupt? Are you party to a lawsuit? O Yes (No O Yes No O Yes (No O Yes No Have you ever had credit in another name? Are you obligated to pay alimony, child support or separate maintenance? O Yes OD No O Yes D)No Are you a co-maker, guarantor or endorser on a note? APPLICANT SIGNATURE (S) I/We hereby apply for the loan or credit described in this application. I/We certify that I/we make no misrepresentations in this loan application or in any related documents, that all information is true and complete, and I/we did not omit any important information. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by Lender for that purpose. Lender may disclose to any other interested party information as to Lender's experiences or transactions with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan is granted. I/We agree to be bound by the terms and conditions in the Credit Agreement and Disclosure, a copy of which will be provided to me/us if the Lender approves this application. APPLICANT: x a Applicant Date Co-Applicant Date Date Received by Bank Originator’s Signature EQUAL HOUSING MEMBER LENDER FDIC EFTA00307538