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 .)

403(b) Transfer or Exchange Out Form.) • a distribution following the death of a plan participant (use the . Beneficiary Election Form.) govnp • 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 ...

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