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Rollover/Recontribution Request ROLLOVER

ROLLOVER /Recontribution RequestSection C- Investment Election (Participant Completes)Please select either 1 or 2. 1. My ROLLOVER contribution or return of a previous Coronavirus-Related distribution or Qualified Birth or Adoption distribution will be invested in my current investment elections in the plan. If I have not completed an Enrollment Form under this Plan, my ROLLOVER contribution will be invested in the Plan s default investment option. I understand it is my responsibility to provide investment and/ or exchange instructions through my Employer; by accessing my account online at or by calling Empower Retirement s Customer Service Center at My ROLLOVER contribution or return of a previous Coronavirus-Related distribution or Qualified Birth or Adoption distribution will be invested in accordance with my investment elections below.

Rollover/Recontribution Request. Section C- Investment Election (Participant Completes) Please select either 1 or 2. 1. My rollover contribution or return of a previous Coronavirus-Related Distribution or Qualified Birth or Adoption Distribution will be invested in my . current investment elections in the plan

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  Distribution, Request, Rollovers, Recontributions, Rollover recontribution request

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