Transcription of Disability Withdrawal Request 401(k) Plan
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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'.
98960-01 Last Name First Name M.I. Social Security Number Number STD FDSTDB ][04/07/17)(98960-01 WITHDRAWALNO_GRPG 421/][GU22][GP22DOC ID: 477279085)(Page 3 of 19 D If I am requesting a Rollover or Direct Rollover of Self-Directed Brokerage Account Assets, To whom do I want my withdrawal payable and where should it be sent?
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