Withdrawal Request Form - MassMutual

Withdrawal Request Form403(b) Notary RequiredUse this form if you want to Request from your plan account: a cash payment a direct rollover of your vested account to another eligible retirement plan or IRA Withdrawal of rollover monies, if the plan permits transfer to purchase Permissive Service Credit under a governmental defined benefit plan, if the plan permits direct payment of Qualified Health Insurance Premiums, if the plan permits Do not use this form if you want to Request : your required minimum distribution (RMD) (use the Required Minimum Distribution Request form .) a contract exchange or transfer to another provider within your Plan (if you plan allows, use the 403(b) Transfer or Exchange Out form .) a distribution following the death of a plan participant (use the Beneficiary Election form .) installment payments (if your Plan allows, use the Systematic Withdrawal /Installment Payment Option Request form .) an annuity (if your Plan offers annuity payments, use the Annuity Request form .)

Withdrawal Request Form. 403(b) Notary Required. Use this form if you want to request from your plan account: • a cash payment • a direct rollover of your vested account to another eligible retirement plan or IRA

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