1 Thrift Savings Plan Form TSP-70 Request for Full Withdrawal January 2008
2 GENERAL INFORMATION AND INSTRUCTIONS Use this form to request an immediate withdrawal of your entire vested account balance, to be paid after your agency confirms your separation from Federal service. To request a partial withdrawal of your account, do not complete this form; instead, complete Form TSP-77, Request for Partial Withdrawal When Separated. Before making a withdrawal request, read the booklet Withdrawing Your TSP Account After Leaving Federal Service and the TSP tax notice Important Tax Information About Payments From Your TSP Account. Your former agency should have given you these materials when you separated from service. If you do not have these materials, download them from the TSP Web site ( or ask your former agency for a copy. Note: If, after reading the TSP tax notice, you decide to submit a Form W-4P, Withholding Certificate for Pension or Annuity Payments, attach a copy of the form to your withdrawal request when you mail it to the Thrift Savings Plan (TSP). If you request a mixed withdrawal, indicate on the top of Form W-4P the option to which the withholding applies. You should not complete Form TSP-70 if: Your vested account balance is less than $200. The TSP will automatically send you a check for the balance of your account after your agency reports that you have separated. You expect to be rehired after a break in service of less than 31 calendar days. You must be separated from Federal service for 31 or more days in order to be eligible for a post-employment withdrawal. If you expect to be rehired after a break in service of 31 or more full calendar days, see the withdrawal booklet for information about rehired participants and withdrawal restrictions. There are two ways to request a post-employment withdrawal: 1. Complete Form TSP-70 and mail it to the TSP; or 2. Use the TSP Web site ( to begin (and, in some cases, complete) your withdrawal request. If your request cannot be completed on the Web because additional signatures, information, or documentation is needed or because you want to receive your money via direct deposit, you may print out your partially completed withdrawal request form at the end of your on-line session. Review the form, complete any missing information, and provide any required signatures and documentation. Do not change or cross out any of the prefilled information resulting from your entries on the Web; the form may not be accepted for processing if you do. Note: Access to the Web site s post-separation withdrawal request area is not available to you until your agency reports your separation to the TSP. After completing your withdrawal request, make a copy for your records. Mail the original to: Thrift Savings Plan, P.O. Box , Birmingham, AL Or fax the completed form to: If you have questions, call the (toll-free) ThriftLine at 1-TSP-YOU-FRST ( ) or the TDD at 1-TSP-THRIFT5 ( ). Outside the U.S. and Canada, please call (not toll free). SECTION I. Complete Items 1 9. Your TSP account number is the 13-digit number that was issued to you. For security purposes, the TSP account number is used instead of your Social Security number to identify your account. The address you provide on this form will be used to update the address in your TSP account record. If you are married, provide your spouse s name. Only provide your spouse s Social Security number if you are a CSRS employee and you check Item 17 or are a FERS employee and you check Item 22. SECTIONS II and III. Spouses rights apply to accounts that are more than $3,500 at disbursement. If your account balance is $3,500 or less you do not need to complete Sections II or III. Spouses Rights for Full Withdrawals Classification Requirement Exceptions FERS CSRS Spouse is entitled to a survivor annuity unless he or she waives that right. Spouse is entitled to notification by TSP of participant s election. Whereabouts unknown or exceptional circumstances Whereabouts unknown If you are a married CSRS participant with an account balance of more than $3,500, you must complete Section II so that your spouse may be notified of your withdrawal. If you do not know your spouse s whereabouts, check Item 17, provide your spouse s Social Security number in Item 10, and submit Form TSP-16, Exception to Spousal Requirements, with the required documentation. If you are a married FERS participant and your account balance is more than $3,500, complete Section III. By law, your spouse is entitled to an annuity with a 50% survivor benefit, level payments, and no cash refund (i.e., TSP Annuity Option 3b). If you would like to use your entire vested account balance to purchase this annuity, check the box in Item 18 and skip to Section VIII. For any other withdrawal option, including a mixed withdrawal, your spouse must waive his or her right to that annuity by signing and dating Items 19 and 20. Your spouse s signature must be notarized (Item 21). If you cannot obtain your spouse s signature because his or her whereabouts are unknown or exceptional circumstances apply, check the box in Item 22, provide your spouse s Social Security number in Item 10, and submit Form TSP-16, Exception to Spousal Requirements, with the required documentation. SECTION IV. Withdrawal Method. You must complete Item 23.You may withdraw your entire account balance by choosing any one, a combination of any two, or all three, of the basic withdrawal methods (single payment, monthly payments, life annuity). On the line to the right of each withdrawal method, indicate the percentage of your account that you would like to withdraw by that method. Be certain that the percentages in Items 23a, b, and c add up to 100%. Use whole percentages only. Note: You can use the calculators on the TSP Web site to project an annuity or a monthly payment. If you choose to withdraw your account as a TSP annuity, the minimum amount to purchase the annuity is $3,500. This means that if you are withdrawing only a portion of your account by means of an annuity (Item 23a), the percentage you choose must equal $3,500 or more of your vested account balance. You must also provide information needed for the annuity purchase on Page 3 of this form. If you are withdrawing any portion of your account by means of monthly payments (Item 23c), indicate either the dollar amount that you would like to receive each month or check the box to have the TSP compute your payments based on your life expectancy. If you choose a dollar amount, it must be at least $25. If you indicate a monthly dollar amount, you will receive that amount until you change it or until your entire balance has been paid. Note: You are allowed to change the dollar amount annually. If you choose to have the TSP compute your payments, they will be computed using the IRS Single Life Table, Treas. Reg (a)(9)-9, Q&A 1 (for participants who are under age 70 after June 30 of the calendar year when payments are calculated) or the Uniform Lifetime Table, Treas. Reg (a)(9)-9, Q&A 2 (for participants who turn age 70 before July 1 of that year). Transfer Option. If, in Item 23, you choose to withdraw any portion of your account as a single payment or monthly payments for a fixed dollar amount that results in payments that are expected to be completed in less than 120 months, you may be able to transfer all or any portion of the payment(s) to a traditional IRA, eligible employer plan, or Roth IRA. Not everyone is eligible to transfer funds to a Roth IRA. You are not eligible for a Roth transfer if either of the following conditions applies: (1) your modified adjusted gross income is over $100,000 or (2) you are married and file a separate return. Additionally, you must pay tax on the amount you transfer from the TSP to a Roth IRA; the tax liability is incurred for the year of the transfer. We strongly encourage you to consult with a tax advisor regarding your eligibility for, and the tax consequences of, making the transfer. Single or eligible monthly payments that are not transferred directly to an IRA or plan are subject to mandatory 20% Federal income tax withholding. Read the TSP tax notice Important Tax Information About Payments From Your TSP Account for detailed tax rules.
3 THRIFT SAVINGS PLAN REQUEST FOR FULL WITHDRAWAL TSP-70 I. INFORMATION 1. Name Last First Middle ABOUT YOU / / 4. ( ) TSP Account Number Date of Birth (mm/dd/yyyy) Daytime Phone (Area Code and Number) 5. Address Street address or box number 6. City State/Country Zip Code 9. Are you married, even if separated from your spouse? 10. Yes (Go to Item 10.) No (Skip to Section IV.) 11. Spouse s Name Spouse s Social Security Number (Required only if Item 17 or 22 is checked) Last First Middle II. 12. Is your spouse s address the same as above? Yes (Skip to Section IV.) No (Complete Items ) FOR MARRIED CSRS 13. Spouse s Address Street address or box number PARTICIPANTS ONLY 14. City Check here if you do not know your spouse s address. State/Country 16. Zip Code III. If your account balance is more than $3,500, your spouse is entitled to a survivor annuity with a 50% survivor FOR MARRIED benefit, level payments, and no cash refund. Check Item 18 to use your entire account balance to purchase that FERS annuity. If your spouse waives his or her right to that annuity (Items 19, 20, and 21), proceed to Section IV. PARTICIPANTS 18. Participant: Use my entire account to purchase the prescribed joint life annuity with 50% survivor benefit, ONLY level payments, and no cash refund (Option 3b in Section IX). (Skip to Section VIII and complete Page 3.) Your spouse s OR 19. Spouse: I give up my right to the prescribed joint life annuity (Annuity Option 3b) by signing below. signature must be notarized. 20. Spouse s Signature 21. Notary: On this day of,, the person who signed Item 19, Month Year who is known to or was identified by me, personally appeared and acknowledged to me that he or she signed this form. In witness thereof, I have signed below on this date. [seal] My commission expires: Notary Public s Signature Jurisdiction 22. Participant: Check here if you cannot obtain your spouse s signature. (See back of form) IV. WITHDRAWAL ELECTION Choose one or more methods. Indicate percentages in whole numbers. If choosing monthly payments, include the dollar amount of each payment or choose to have the TSP compute your payments based on your life expectancy. 23. a. Life Annuity.0% (Must equal $3,500 or more. Also complete Page 3.) b. Single Payment.0% c. Monthly Payments.0% $.00 per month OR Compute my payments TOTAL 100.0% Transfer Option If you want to transfer all or any portion of your single or monthly payments (for a dollar amount that results in payments expected to be completed in less than 120 months) to a traditional IRA, eligible employer plan, or Roth IRA (see back for rules and restrictions), complete Items 24 and/or 25 and Section V. 24. Transfer.0% of my single payment (Item 23b) to a traditional IRA, eligible employer plan, or Roth IRA. 25. Transfer.0% of each of my monthly payments (Item 23c) to a traditional IRA, eligible employer plan, or Roth IRA. (Note: You cannot transfer payments expected to last 120 months or more or those that are computed based on life expectancy.)
4 GENERAL INFORMATION AND INSTRUCTIONS SECTION V. If you chose to transfer any portion of your single or monthly payments by completing Item 24 and/or Item 25, complete this section. Your traditional IRA, eligible employer plan, or Roth IRA can use this information to identify you when completing Section VI. SECTION VI. If you chose to transfer your single payment or eligible monthly payments to a traditional IRA, eligible employer plan, or Roth IRA, your financial institution or plan administrator must complete this section before you submit this form to the TSP. (The traditional IRA, eligible employer plan, and Roth IRA are described in the TSP tax notice Important Tax Information About Payments From Your TSP Account. ) Do not submit transfer forms of financial institutions or plans; the TSP cannot accept them. Note: You can transfer to only one traditional IRA, eligible employer plan, or Roth IRA; therefore, if you chose a mixed withdrawal with both single and monthly payments (that are eligible to be transferred), all payments you chose to transfer will be sent to the financial institution/ plan and account designated in this section. The institution or plan to which your withdrawal is to be transferred must be a trust established inside the United States (i.e., the 50 States and the District of Columbia). The financial institution or plan should retain a copy of this page to identify the account to which the check should be deposited when it is received. If the transfer is to a traditional IRA or Roth IRA, the institution accepting the transfer should submit IRS Form 5498, IRA Contribution Information, to the IRS. The TSP will report all payments and transfers to you and to the IRS on Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Type of Account and Account Number. In Item 33, indicate whether the transfer is to a traditional IRA, eligible employer plan, or Roth IRA. In Item 34, enter the account number, if available, of the IRA or plan to which the money is to be transferred. If the transfer is to an eligible employer plan, you must provide the plan name (Item 35). Make check payable to. Provide the name of the IRA trustee or plan administrator (Item 36) as it should appear on the check. The check will be made payable to the name you provide on this line. Mail to. If the check is to be mailed to someone other than the payee of the check, provide the name and address (Items 37 38) of the institution and/or person to whom the check should be sent. The certifying representative must provide the requested information in Items If we need to contact the financial institution or plan for more information, the individual named here will be used as the contact person. SECTION VII. Complete this section only if you want the TSP to send your single payment or monthly payments directly to your checking or savings account by means of a direct deposit (electronic funds transfer (EFT)). Provide all of the requested information. If you do not know the 9-digit Routing Number, contact your financial institution for this information. Note: Only payments that are not being transferred to a traditional IRA, eligible employer plan, or Roth IRA can be paid by EFT. EFTs will be made only to a financial institution in the United States. EFT is a safer method of payment than mailing a check to you. SECTION VIII. Read the certification; then sign and date it. By signing the certification, you are certifying that the information you have provided is true and complete to the best of your knowledge. You are also certifying that you are separated from Federal service and that your separation will last for 31 days or more. In addition, you are certifying that, if you chose to transfer your withdrawal to a Roth IRA, you are eligible to make the transfer and that you understand that you must pay tax on the amount transferred for the year of the transfer.
5 TSP-70 Name: TSP Account Number: Page 2 V. To transfer all or a portion of your withdrawal directly to your traditional IRA, eligible employer plan, or Roth IRA, INFORMATION complete this section. Then take or send this page to your IRA or plan. Your financial institution or plan administrator must complete Section VI. You must submit the completed package in order for it to be processed. FOR YOUR TRANSFER 26. Name Must match Last First Middle Section I 27. Social Security No. 28. ( ) Daytime Phone (Area Code and Number) 29. Address Street address or box number 30. City State/Country Zip Code VI. INFORMATION FROM THE IRA OR ELIGIBLE EMPLOYER PLAN To be completed by financial institution/plan administrator Complete this section and return this form to the participant identified in Section V. The financial institution or plan administrator must ensure that the account described here is a traditional IRA, eligible employer plan, or Roth IRA as defined by the Internal Revenue Service. Do not submit transfer forms of financial institutions or plans. Traditional Eligible Roth 33. Type of Account 34. IRA Employer Plan IRA IRA or Plan Account Number 35. Plan Name Only if eligible employer plan 36. Make check payable to IRA Trustee or Plan Administrator (Limit response to 30 characters.) 37. Mail to Name of institution or person, if different from Item Address City State Zip Code I confirm the accuracy of the information in this section and the identity of the individual named in Section V. As a representative of the financial institution or plan to which the funds are being transferred, I certify that the financial institution or plan agrees to accept the funds directly from the Thrift Savings Plan and deposit them in the traditional IRA, eligible employer plan, or Roth IRA identified above ( ) Typed or printed name of Certifying Representative Phone (Area Code and Number) Signature of Certifying Representative VII. REQUEST FOR DIRECT DEPOSIT Single or monthly payments not being transferred can be paid by direct deposit to a checking or savings account at a financial institution. 43. Pay my single payment monthly payments or both types of payments by direct deposit Name of Financial Institution Routing Number (Must be 9 digits) 46. Type of Account Checking Savings 47. Checking or Savings Account Number VIII. CERTIFICATION I certify that the information I have provided in Sections I VII is true and complete to the best of my knowledge. I certify that I am separated from Federal service and I do not expect to be rehired by the Federal Government within 31 days after my separation. Also, if I chose to transfer my withdrawal to a Roth IRA, I certify that I am eligible to make this transfer and I understand that I must pay taxes on the transferred amount for the year in which it is transferred. Warning: Any intentional false statement in this application or willful misrepresentation concerning it is a violation of law that is punishable by a fine of as much as $10,000 or imprisonment for as long as 5 years, or both (18 U.S.C. 1001) Participant s Signature
6 GENERAL INFORMATION AND INSTRUCTIONS Complete Page 3 (Sections IX XII) only if you would like to purchase an annuity and have indicated this by checking the box in Item 18 or by entering a percentage in Item 23a. Before completing this page, read the annuity information contained in the booklet Withdrawing Your TSP Account After Leaving Federal Service. Note: You cannot change your annuity option or cancel your annuity once your annuity has been purchased. SECTION IX. Provide your gender, then choose the annuity option you want by checking the appropriate box. Note: If you are a married FERS participant and you checked Item 18 on Page 1, you must select Annuity Option 3b; otherwise, your form cannot be accepted. An asterisk (*) before an annuity option number indicates that there is a cash refund or 10-year certain feature associated with that annuity. If you choose one of these annuities, you must complete Section XI and name beneficiaries for your annuity. If you are choosing among the joint life annuities, consider both the monthly payments you will receive while you and your joint annuitant are both alive and the payments that will be made to the survivor if one of you dies. If you choose a joint life annuity with a 50 percent survivor benefit, the monthly annuity payment to the survivor whether the survivor is you or your joint annuitant will be reduced by half (that is, 50 percent) of the annuity payment made while you and your joint annuitant are alive. If you choose an annuity with a 100 percent survivor benefit, the monthly annuity payment to the survivor will not be reduced when one of you dies. However, with the 100 percent survivor benefit, the monthly payment that you will receive while you and your joint annuitant are both alive will be less than if you select the 50 percent survivor benefit. The booklet Withdrawing Your TSP Account After Leaving Federal Service provides detailed information. SECTION X. If you chose a joint life annuity, you must provide the requested information about your joint annuitant. You must also provide a copy of your joint annuitant s birth certificate. If your joint annuitant s birth certificate is unavailable, one of the following three items may be used if the date of birth is shown: baptismal certificate, family bible record, or marriage certificate. If a birth certificate or the above items are not available, submit two of the following types of evidence: school or college record, church record, birth certificate of children (if parent s age is shown), family record of genealogies, driver s license, military identification, military discharge papers, passport, life insurance papers, hospital records, census records, or voting records. Do not send original documents; they will not be returned to you. If the name on a document is not the same as the current name of the joint annuitant, you may be requested to submit a statement from the joint annuitant indicating that he or she is the person named in the document. If you choose an annuity that provides for a joint annuitant other than your spouse, the joint annuitant must be either a former spouse or someone with an insurable interest in you. This means that the person is financially dependent on you and could reasonably expect to derive financial benefit from your continued life. Blood relatives or adopted relatives (but not relatives by marriage) who are closer than first cousins are presumed to have an insurable interest in you. If you name such a joint annuitant (i.e., a former spouse or someone with an insurable interest) who is more than 10 years younger than you, you must choose a joint life annuity with the 50 percent survivor benefit.the only exception is for a former spouse to whom all or a portion of your TSP account is payable pursuant to a retirement benefits court order. If the person you named as your joint annuitant is not presumed to have an insurable interest in you, you must submit an affidavit (i.e., a certification signed before a notary public) from someone with personal knowledge that the named person has an insurable interest in you. The certifier must know the relationship between you and the joint annuitant and must state why he or she believes that the named joint annuitant might reasonably expect to benefit financially from your continued life. SECTION XI. If you chose an annuity option with a cash refund or 10 year certain feature, you must designate a beneficiary or beneficiaries to receive benefits from the annuity after your death, under the conditions outlined in that feature. The beneficiary designation on this form applies to the portion of your account used for the annuity purchase. After your annuity is purchased, changes in your beneficiary designation must be made directly with the annuity provider. The share of any beneficiary who dies before you die will be distributed among the surviving beneficiaries in proportion to the shares you indicate, or entirely to the surviving beneficiary. You may name any person, corporation, trust, legal entity, or your estate as your beneficiary. If you need additional space, use a blank sheet of paper with your name, TSP account number, and date of birth on it. If you use additional pages, number, sign, and date each page. Use the same date on each page. Indicate a percentage or fractional share for each beneficiary. Do not mix percentages and fractions. Percentages must add up to 100 percent; fractions must add up to 1. If your beneficiary is a person, enter for each beneficiary the last name, first name, and middle name; Social Security number (SSN); and relationship to you. If your beneficiary is a firm, corporation, or other legal entity, enter the name of the legal representative. Enter the Employer Identification Number (EIN) and enter firm and the name of the firm on the relationship line. If the beneficiary is a trust, enter the name of the trustee. Enter the EIN, if available, and enter trustee, the name of the trust, and the date the trust was established on the relationship line. If the beneficiary is an estate, enter the name of the executor. Enter the EIN, if available. Enter executor and the name of the estate on the relationship line. SECTION XII. Sign and date the form. PRIVACY ACT NOTICE. We are authorized to request the information you provide on this form under 5 U.S.C. chapter 84, Federal Employees Retirement System. We will use this information to identify your TSP account and to process your transaction. In addition, this information may be shared with other Federal agencies for statistical, auditing, or archiving purposes. We may share the information with law enforcement agencies investigating a violation of civil or criminal law, or agencies implementing a statute, rule, or order. It may be shared with congressional offices, private sector audit firms, spouses, former spouses, and beneficiaries, and their attorneys. We may disclose relevant portions of the information to appropriate parties engaged in litigation and for other routine uses as specified in the Federal Register. You are not required by law to provide this information, but if you do not provide it, we will not be able to process your request.
7 Name: IX. ANNUITY ELECTION TSP Account Number: Complete this page only if you are requesting an annuity. TSP-70 Page 3 Provide your gender in Item 50, then continue to Item 51 and check the annuity option you want. Also complete Section XI if you choose an annuity marked by an asterisk (*). (Note: If you are a married FERS participant and you checked Item 18 on page 1, you must select annuity option 3b.) 50. Your Gender Male Female 51. Single Life Level Payments: Single Life Increasing Payments: 1a No additional features 2a No additional features *1b Cash refund *2b Cash refund *1c 10-year certain *2c 10-year certain Joint Life With Spouse Level Payments: 3a 100% to survivor, no additional features 3b 50% to survivor, no additional features Joint Life With Spouse Increasing Payments: 4a 100% to survivor, no additional features 4b 50% to survivor, no additional features *3c 100% to survivor, cash refund *4c 100% to survivor, cash refund *3d 50% to survivor, cash refund *4d 50% to survivor, cash refund Joint Life With Joint Annuitant Other Than Spouse Level Payments: 5a 100% to survivor, no additional features *5c 100% to survivor, cash refund 5b 50% to survivor, no additional features *5d 50% to survivor, cash refund X. Complete this section if you chose a joint life annuity, and provide documentation of the joint annuitant s date of INFORMATION birth. If you chose a joint life annuity with a joint annuitant other than your spouse, you may be required to submit ABOUT an affidavit. SPOUSE OR OTHER 52. Name 53. / / Last First Middle Date of Birth (mm/dd/yyyy) JOINT ANNUITANT Gender Male Female 56. Joint Annuitant s Social Security No. XI. BENEFICIARY DESIGNATION FOR YOUR TSP ANNUITY If you chose an annuity with a cash refund or 10-year certain feature (annuity options in Section IX marked by an asterisk (*), make a beneficiary designation(s) and indicate the share for each. Use whole percentages or fractions. (Percentages must total 100%; fractions must total 1.) 57. Beneficiary Name Last First Middle Social Security Number/EIN Share: 58. Beneficiary Name Last First Middle Social Security Number/EIN Share: 59. Beneficiary Name Last First Middle XII. CERTIFICATION Social Security Number/EIN Check here if additional pages are used. How many additional pages? Share: I certify that the information I have provided in Sections IX XI is true and complete to the best of my knowledge. (See warning in Section VIII.) 60. Participant s Signature 61.
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GOLD CROSS SERVICES, INC. 401(K) RETIREMENT SAVINGS PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS INTRODUCTION TO YOUR PLAN What kind of Plan is this?... 1 What information does this Summary provide?...
A not-for-profit ministry of Church of the Brethren Benefit Trust Inc. 1505 Dundee Avenue Elgin, IL 60120-1619 800-746-1505 847-695-0200 Fax 847-622-3399 www.brethrenbenefittrust.org firstname.lastname@example.org
#10486 (3/2004) QP/401(k) Separation From Service Distribution Request Form This form may be used if you have separated from service due to termination, disability or attainment of normal retirement age
Distribution Request Form READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF YOUR PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50% CONTINGENT SURVIVOR ANNUITY FORM OF
ANNUITY DEATH CLAIM We want to ensure you receive your benefit payment promptly, so please complete the applicable sections and be sure to enclose the documentation requested. Each named beneficiary will
Distribution Request Form READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF YOUR PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50% CONTINGENT SURVIVOR ANNUITY FORM OF
Required Distribution Election Form For IRA and 403(b) Contracts Participant Name Contract Number Daytime Phone Number Date of Birth Plan Type Protective Life Insurance Company (PLICO/"the Company") Protective
#1303-PS (5/14/2008) Governmental 457(b) Application For Distribution GENERAL INFORMATION Name of Plan Name of Employer Address City State Zip Name of Participant Date of Birth Complete the following section
FORMS Applying for Retirement under the Portable Benefit Package S U R S STATE UNIVERSITIES RETIREMENT SYSTEM State Universities Retirement System of Illinois If you choose an optional form of annuity,
Death Benefit Distribution Claim Form Non-Spousal Beneficiary READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF THE PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50%
Bricklayers & Trowel Trades International Pension Fund 620 F Street, Suite 700, NW; Washington, DC 20004 Phone: 202/638-1996 Fax: 202/347-7339 http://www.ipfweb.org IPF PENSION APPLICATION 1. IMPORTANT
Contact Information There are numerous sources of information about the Thrift Savings Plan (TSP). The most up-to-date information is on the TSP website. You can also obtain basic plan information from
Base Plan Account Withdrawal Purpose of the Form Use this form to choose how you want PERSI to handle the withdrawal of your PERSI Base Plan contributions and interest when you terminate employment with
AFPlanServ 403(b) Plan Exchange Authorization Form Participant Instructions The AFPlanServ 403(b) Plan Exchange Authorization Form must be submitted to AFPlanServ to approve an exchange of assets within
annuity options. Master Retirement Plan Your Master Retirement Plan Handbook... Key points in understanding this generous benefit: Remember, if you re married, you can select any of the payment options.
Establish a Beneficiary Account in the Decedent s Fidelity Plan 2A. Establish a Beneficiary Account and Move Funds to This Account Only Fidelity Investments Beneficiary Distribution Form General Instructions:
FMPTF 401(a) Defined Contribution and 457(b) Deferred Compensation BENEFICIARY DISTRIBUTION REQUEST If you have any questions, please contact the Florida Municipal Pension Trust Fund (FMPTF) by calling
Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security
G First Name Address City DIRECT ROLLOVER OR TRANSFER BOARD OF EDUCATION RETIREMENT SYSTEM OF THE CITY OF NEW YORK 65 COURT STREET BROOKLYN, NEW YORK 11201-4965 If you wish to directly rollover any taxable
REQUIRED MINIMUM DISTRIBUTION FORM PLAN NAME: PLAN NUMBER: Use this form to request a required minimum distribution following attainment of age 70½, unless you are still employed and are not a 5% owner.
The 3121 Premier Plan Eligible Full-Time, Part-Time, Seasonal, and Temporary Employees Social Security Alternative Retirement Plan Employer (please print or type): Distribution Request Form Name of Participant:
Member Companies: Great American Life Insurance Company Annuity Investors Life Insurance Company Administrator for Life Insurance and Annuities: Loyal American Life Insurance Company United Teacher Associates
MONTGOMERY COUNTY RETIREMENT SAVINGS PLAN (RSP) Plan #65674 Direct Rollover/Distribution Election Form Please note: if your vested account balance is $5,000 or more and you are interested in purchasing
State of California Savings Plus Program Part-time, Seasonal, and Temporary Employees Retirement Program Benefit Payment BOOKLET All information contained in this booklet was current as of the printing
QUALIFIED DOMESTIC RELATIONS ORDER (QDRO) PAYOUT REQUEST FORM Social Security Number Plan Number: 47130 Plan Name: TTT West Coast, Inc. 401(k) Retirement Savings Plan Alternate Payee Information Alternate
Teachers Retirement Plan Participants (All CSO and WTU Employees Only) If you are enrolled in the Teachers Retirement Plan, you must complete the following steps to secure your refund: Obtain a copy of
QUALIFIED RETIREMENT PLAN AND 403(b)(7) DISTRIBUTION REQUEST FORM The Employee Retirement Income Security Act of 1974 (ERISA) requires that you receive the information contained in this form prior to your
DISTRIBUTION REQUEST FORM FICA ALTERNATIVE PLAN FOR FLORIDA STATE UNIVERSITY INSTRUCTIONS: Complete items one through four and send this form to the employer at the address printed at the bottom of the
Member Companies: Great American Life Insurance Company Administrator for Loyal American Life Insurance Company Annuity Investors Life Insurance Company Administrator for United Teacher Associates Insurance
First Western Advisors PARTICIPANT TERMINATION/ROLLOVER NOTIFICATION Submission of this form initiates the processing of distributions from a qualified plan. All items on the form must be completed for
AFPlanServ 403(b) Hardship Distribution Authorization Form Participant Instructions If your Plan allows loans, you must apply for a loan first. If you are not eligible for a loan from your provider, your
Mailing Instructions: A. Plan/Trust Information Plan/Trust Name: LSW Annuities - Life Insurance Company of the Southwest NL Annuities - National Life Insurance Company PO Box 569080, Dallas, TX 75356 Service:
TO OUR EMPLOYEES: We wish to announce that the Mission Health System Employee Retirement Plan ( Plan ) has been amended, effective June 1, 2015, to change the automatic form of benefit. Therefore, in order
Application Instructions 1. Print and fill out entire (PHSA) Application. 2. Write a $20.00 check payable to New York Community Bank for your PHSA set up fee. 3. Mail application and check to: NYCB Plaza
1. CLIENT INFORMATION Name: Daytime Phone: ( ) Date of Birth: SSN or Tax ID: 2. DISTRIBUTION REQUEST Please select either OPTION A or OPTION B below. Selecting both options will delay processing your distribution
Distribution Request Form READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF YOUR PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50% CONTINGENT SURVIVOR ANNUITY FORM OF
CHECK LIST FOR REFUND REQUESTS FROM PUBLIC SAFETY (1) Please Complete and Submit a Form P6 Application For A Separation Refund Or Deferred Retirement: Complete the top portion of the P6 form Initial under
TO: APPLICANTS FOR TERMINATION BENEFITS, 401K FUND 1. YOU ARE ENTITLED TO WITHDRAW 25%, 50% OR 100% OF YOUR ACCOUNT BALANCE IF YOU HAVE NOT WORKED FOR A SIGNATORY EMPLOYER THAT MAKES CONTRIBUTIONS TO THE
Prudential 30 Scranton Office Park Scranton, PA 18507-1789 Please print using blue or black ink. Keep a copy for your records and send the original form to the address above or fax it to 1-866- 439-8602.