EXHIBIT 4.9(a) The Northern Trust Company THRIFT-INCENTIVE PLAN Loan Request Form This form is for use by participants who, due to hearing or language limitations are unable to use the Benefits Express telephone system. Name: ___________________________________ ____________________________________ (Print) Last First Initial Signature _______________________ _________________ _______________ ___________________ Social Security # Date Location Extension I understand my loan check will be mailed approximately five weeks after the month in which I applied. - -------------------------------------------------------------------------------- AMOUNT OF LOAN $____________________________________ Note: The minimum loan is $1,000, with additional increments of $500. The reverse side of your most current TIP statement indicates your maximum loanable amount. For a more recent loanable amount call the TIP area. - -------------------------------------------------------------------------------- TERM OF LOAN ______________________(months) Note: Repayment must be made within 60 months except purchase of primary residence loans which must be repaid within 180 months. If this is a primary residence loan, please enclose a copy of the purchase contract. TIP primary residence loans are not mortgages, and are not eligible for the tax treatment that is available for mortgage loans. Note: YOU MAY HAVE 2 TIP LOANS OUTSTANDING. TIP LOAN REPAYMENTS ARE TAKEN OUT OF EACH PAY CHECK (twice a month). Request Requirements: Forms are due at 5:00 p.m. (close of business) by the 5th business day before the end of the month to the TIP Administrator, M-8. Any questions concerning TIP loans can be directed to extension 7613 or 4416.