Withdrawal Request Form - MassMutual

Print Clear Withdrawal Request Form 401(a). Plan Sponsor Authorization Required Use this form if you want to Request from your Plan account: Questions? a cash payment of your vested account value Call MassMutual 's Customer a direct rollover of your vested account to another eligible retirement plan or IRA. Service Center direct payment of Qualified Health Insurance Premiums, if the plan permits. (Refer to the Important Information Section for 1-800-528-9009. details.). a transfer to another provider within this Plan Fax 877-526-2531 or Do not use this form if you want to Request : 800-678-8645. a required minimum distribution (RMD) (use the Required Minimum Distribution Request Form.). to establish a beneficiary account following the death of a plan participant (use the Beneficiary Election Form.)

Non-Roth account only to a Roth IRA (i.e., Roth Conversion). I understand that the taxable amount paid from my non-Roth account will be reported on IRS Form 1099-R as taxable income and that I may elect voluntary federal withholding on this amount in Section H, which may be

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