Transcription of DISTRIBUTION REQUEST FORM
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DISTRIBUTION REQUEST FORM
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 _____/_____/_____ retirement Date _____/_____/_____ Disability Date _____/_____/_____ (Disability as determined by the plan administrator on the basis of written determination by the Social Security Administration that disabilit)
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. ...
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