Request Step 1 of 3 0% We can get started with your distribution request right away. Please provide information to help us get started. Your progress is presented above. A few easy steps and we can get you on your way.Thank you for using our automated distribution request. This easy-to-complete request will start the process and enable us to complete your request quickly.You can request a distribution from your plan for the reasons listed below. Employment hasbeen terminated A loan isbeing requested A hardship distribution is being requested An in-service distribution isbeing requested (Not all plans allow all of these types of distributions. If you’re unsure, please check your plan summary or contact your plan administrator).Plan Name or Company Name* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Social Security Number* Your SS# is encrypted and saved securely. Type of distribution being requested* Distribution due to termination of employment Loan Hardship Distribution In-Service Distribution Please identify if you are:* The Employee/Plan Participant The Employer/Plan Sponsor HiddenDistribution Due to Termination of EmploymentYou have requested a Distribution Due to Termination of Employment from your retirement plan. Please continue by completing the questions below.Reason employment terminated:* Left employment Disability We will prepare the forms necessary to process this distribution and send them to you. How would you like to receive them?* Email to you Mail to provided address After the last date of employment, did the participant work more than 1,000 hours in the current Plan Year?* Yes No Last day employed?* MM slash DD slash YYYY HiddenLoanYou have requested a loan from your retirement plan. By law, you are permitted to borrow up to 50% of your vested account balance not to exceed $50,000. Loans must be repaid by regularly scheduled payments. Failure to make payments may result in the balance of the loan becoming taxable. Please continue by completing the questions below.Do you want the maximum available?* Yes No Please specify dollar amount.Purpose of Loan General 1 Year 2 Years 3 Years 4 Years 5 Years Maximum Purchase of Primary Residence Maximum Purchase of Primary Residence – repayment longer than 5 years is available.Did the participant work more than 1,000 hours in the current Plan Year?* Yes No Date of next payroll MM slash DD slash YYYY Payroll frequency:* Weekly (52 payments/year) Bi-Weekly (26 payments/year) Semi-Monthly (24 payments/year) Monthly (12 payments/year) We will prepare the forms necessary to process this distribution and send them to you. How would you like to receive them?* Email to you Mail to provided address We will prepare the forms necessary to process this distribution and send them to you via email.HiddenHardship DistributionYou have requested a Hardship Distribution from your retirement plan. Hardship Distributions are taxable when received. If the distribution is taken before age 59 ½, there is a 10% penalty. Please continue by completing the questions below.Amount of Hardship Distribution requested:This amount is the gross amount before taxes.What is the reason for the Hardship Distribution?* Medical expenses Educational expenses Purchase of principal residence Prevent eviction from principal residence Funeral expenses We will prepare the forms necessary to process this distribution and send them to you. How would you like to receive them?* Email to you Mail to provided address HiddenIn-Service DistributionYou have requested an In-Service Distribution from your retirement plan. In-Service Distributions are taxable when received. In-Service Distributions are only permitted after age 59-1/2 to avoid a 10% penalty. Please continue by completing the questions below.Amount of In-Service Distribution requested:Is this amount* The gross amount before taxes The net amount after taxes We will prepare the forms necessary to process this distribution and send them to you. How would you like to receive them?* Send directly to the Participant Email to you Δ
