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Disability Withdrawal Request 401(k) Plan

Disability Withdrawal Request401(k) PlanSTD FDSTDB ][04/07/17)(98960-01 WITHDRAWALNO_GRPG 421/][GU22)(/][GP22 DOC ID: 477279085)(Page 1 of 19 Texa$aver 401(k) Plan98960-01 When would I use this form?When I am requesting a Withdrawal due to my Disability or making a change to an existing periodic installment payment due to Disability . If my Withdrawal is for any reason other than Disability or if I am age 59 or older, I would need to complete either the In-Service Withdrawal Request ,if I am still employed with the Employer/Company sponsoring this plan , or the Separation from Employment/Retirement Withdrawal Request , if I amno longer working for the Employer/Company sponsoring this Information For purposes of this form, the terminology ' Withdrawal ' is the same as 'Distribution'.

Disability Withdrawal Request 401(k) Plan STD FDSTDB ][04/07/17)(98960-01 WITHDRAWALNO_GRPG 421/][GU22][GP22DOC ID: 477279085 Page 1 of 19 Texa$aver 401(k) Plan 98960 ...

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  Plan, Request, Withdrawal, Disability, Disability withdrawal request 401

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