Transcription of 403(b) Distribution/Rollover Authorization Form
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403(b) Distribution/Rollover Authorization Form
403(b) Distribution/Rollover Authorization form Participant Instructions The 403(b) Distribution/Rollover Authorization form must be submitted to National Benefit Services, LLC (NBS), the third party administrator, to authorize a distribution or rollover of 403(b) funds from your employer or former employer's plan. Hardship distributions require submission of a different form . Your investment provider may require its own paperwork in addition to this form . You may wish to attach your investment provider's paperwork to this form . All attached forms or paperwork will be forwarded to the investment provider indicated on page 2 unless you clearly indicate otherwise.
Form - 403-204FBC (12/2014) 8523 S Redwood Rd, West Jordan, UT 84088 800 274 0503 ext 5 Fax 800) 597-8206 www.FBCretire.com 403(b) Distribution/Rollover Authorization Form 1 Participant Information
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