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IMPORTANT INSTRUCTIONS FOR COMPLETING …

IMPORTANT INSTRUCTIONS FOR. COMPLETING THE qualified RETIREMENT plan Lincoln Benefit Life Company Box 758520, Topeka , KS 66675-8520. DISTRIBUTION FORM 1-800-643-8190 FAX: 1-785-286-6121. This form is to be used with the following Fiduciary Owned Tax qualified plan Types: 401(a) MP, 401(a) PS, 401(a) MP/PS, Section 457. Admin, Section 457, Keogh/HR-10, Corporate Pension 401(k), Termfund, VIP Profit Sharing plan , 401(a) Trust, Pension and Pension Trust PLEASE READ CAREFULLY. These INSTRUCTIONS are designed to help you complete the qualified Retirement plan Distribution Form. If this form is not completed accurately and in its entirety, or you do not provide the required documentation as specified, we will not process your request.

Page 1 of 5 FIC90RES (03/15) IMPORTANT INSTRUCTIONS FOR COMPLETING THE QUALIFIED RETIREMENT PLAN DISTRIBUTION FORM This form is to be used with the following Fiduciary Owned Tax Qualified Plan Types: 401(a) MP, 401(a) PS, 401(a) MP/PS, Section 457

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