Do you need a loan payoff request form? This hypothetical example is used for illustrative purposes only.Actual results will vary. This is an example of a payoff letter used in a syndicated loan transaction. This payoff letter (including the defined terms such as Lenders,. 504. Payoff of first mortgage loan. 103. Settlement charges to borrower (line 1400). 403. 108. Assessments. 408. It includes a detailed breakdown of the principal balance, accrued interest, fees, and any other outstanding charges. Your account number is at the top of your monthly statement and on the payment coupon at the bottom of the statement. Online.