DISTRIBUTION REQUEST FORM

← Back to document page

DISTRIBUTION REQUEST form If you wish to take a DISTRIBUTION or roll over your account to another retirement account , please complete: 1. Participant Information 2. Type of DISTRIBUTION 3. Method of Disbursement 4. Participant Authorization 5. Plan Administrator Authorization and Vesting Verification Fax the completed form to 816-218-0424. PARTICIPANT INFORMATION Plan Name ________________________________________ _______ Plan ID___________________________________ First Name and Middle Initial _________________________________ Last Name ________________________________ Social Security Number ____________________________ Daytime Phone Number_______________________________ Evening Phone Number _______________________________ Address ___________________________________ City ___________________ State ________ ZIP___________ TYPE OF DISTRIBUTION Termination of Employment Date ______/______/______

DISTRIBUTION REQUEST FORM ... You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax-qualified plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. ...

  Form, Distribution, Individuals, Account, Request, Retirement, Annuity, Distribution request form, Individual retirement account, Individual retirement annuity