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Request for Involuntary Distribution

RS007901/2022A. Provide plan name and number:Plan or Company Name: _____ Plan/SunGard Number: _____ B. List the participants who are eligible and subject to Involuntary Distribution *: Balances under $1, I instruct Paychex to issue a check to the participant, less mandatory 20% federal and applicable state income tax withholding, if the participant has not returned a completed Distribution form within 30 days of the final notice. Balances exceeding $1, (must be rolled over to an IRA) I instruct Paychex to issue a check to the IRA company named below if the employee has not returned a completed Distribution form within 30 days of the final notice. Important: Balances exceeding $5, may not be distributed unless the plan is Name SSN (Last 4 digits)Address (If different than what is on file)C.

Agreement and the IRA Disclosure Statement. The services provided hereunder shall be subject to the general terms and conditions of the IRA Custodial Account Agreement. Services under this Agreement will commence for Mandatory Distributions made from the Plan on or after the Effective Date. Section 3. Plan Sponsor Directions.

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  Agreement, Account, Custodial, Custodial account agreement

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