HARDSHIP WITHDRAWAL APPLICATION - CalSTRS.com

1 PERSONAL INFORMATION (please print clearly using black or blue ink) NAME: _____ SOCIAL SECURITY NUMBER: _____ ADDRESS: _____ APT: _____ CITY: _____ STATE: _____ ZIP CODE: _____ DAY PHONE:_____ EVENING PHONE: _____ EMAIL: _____ SCHOOL DISTRICT PLAN NUMBER: _____ _DATE OF BIRTH: _____ /_____ /_____ (Not required) INSTRUCTIONSHARDSHIPWITHDRAWAL APPLICATIONPAGE 1 of 6 PLEASE NOTE: AN INCOMPLETE APPLICATION OR NOT SUPPLYING ALL REQUIRED DOCUMENTATION WILL CAUSE A DELAY IN RECEIVING YOUR Review and complete HARDSHIP Requirements to determine if you are ELIGIBLE to take a HARDSHIP WITHDRAWAL .

2 2. Choose AMOUNT type, AMOUNT requested, WITHHOLDING, GROSS UP and DELIVERY Indicate REASON and supply DOCUMENTATION, SIGN and MAIL your form for processing. 4. All checks issued by Voya Financial are mailed to your current address on record. Before submitting this form, please contact a Customer ServiceAssociate or go online to verify that the Plan has your current address. Failure to do so may result in your check being mailed to an incorrect contact information is available on the last page of this form. If the address on record is incorrect, please contact your employer to update yourcurrent address and verify that the Plan has been updated prior to submitting this form.

3 HARDSHIP REQUIREMENTS1. Some plans are administered on a Facts and Circumstances basis. To qualify for a HARDSHIP WITHDRAWAL under these plans, the following must be true: The need cannot reasonably be satisfied through insurance reimbursement, liquidation of assets, cessation of elective contributions under the plan orloans from the plan, or from commercial plans are administered on a Safe Harbor basis. To qualify for a HARDSHIP WITHDRAWAL under these plans, the following conditions generally apply: Your Employer will be notified of this HARDSHIP WITHDRAWAL . A WITHDRAWAL requires that elective contributions under all plans maintained by the Employer,including this plan, cease for a period of at least six ORDERGood order is receipt at our designated location of this form accurately and entirely completed, including all necessary signatures.

4 If we determine that thisform is not received in good order, it may be returned to you for correction and processed upon resubmission in good order at our designated location, at theaddress AND CONDITIONSThe WITHDRAWAL effective date will be the date our designated location has received the request and any other required documentation or forms in good purposes of calculating the amount to be withdrawn, the value of the individual account will be determined after the final close of business of the NewYork Stock Exchange (NYSE) on the date good order is determined. A valuation date is any normal business day, Monday through Friday, that the NYSE isopen.

5 All withdrawals may be subject to one or more of the following: Voya contractual fees, deferred sales charges, or market value adjustments. There maybe WITHDRAWAL restrictions on certain funds (please refer to your prospectus). Any fees will be deducted from the remaining account balance. Any taxes will bededucted from the amount you request. Amounts will be withdrawn from each investment option in the same proportion as its value is to the total IRS allows HARDSHIP withdrawals only when other financial resources are not reasonably available. Since a loan and other distributions from the plan areconsidered other resources, you should take them from all plans maintained by the employer first, if available, unless the taking of a loan would increase theamount of my financial need and/or create an adverse financial situation.

6 If you have any questions regarding other available resources, please contact aCustomer Service Associate or go online. The contact information is available on the last page of this form. qYou are not required to take a loan if repaying it would increase your HARDSHIP . Repayment of a loan from the calstrs Pension2 would increase my , I do not wish to take a loan at this time. If this box is not checked and you have loan availability, your HARDSHIP request will be have exhausted all other means available. I understand that if a loan is available to me under the calstrs Pension2, my HARDSHIP request will be have exhausted all other means available.

7 I understand that if other distributions are available in the calstrs Pension2, my HARDSHIP request will be have not requested a HARDSHIP WITHDRAWAL for the same HARDSHIP reason from any other retirement plans in which I participate that would cause theamount that I received to be in excess of my stated HARDSHIP need. 4. Please check with your TPA and or Employer for information on whether your 403(b) plan requires a suspension of contributions to the plan for the6 months following a HARDSHIP WITHDRAWAL . CZ400CZ2 HARDSHNHARDSHIP WITHDRAWAL APPLICATIONHARDSHIP WITHDRAWAL / PAGE 2 of 6 CHOOSE TAX WITHHOLDING AND GROSS UP ELECTIONTax Withholding Elections:Regardless of whether or not federal or state income tax is withheld, you are liable for taxes on the taxable portion of the payment.

8 If youdo not have a sufficient amount withheld, you may be subject to tax penalties under the Estimated Tax Payment rules. An election made for a single non-recurringdistribution applies only to the payment for which it is being made. You are responsible for understanding and planning for the tax implications of any may wish to contact your financial/tax advisor before submitting this Withholding Rules: Non-periodic payments 10% withholding. Non-periodic, non-rollover eligible payments from pensions, annuities, and IRA s are subjectto a flat 10% federal withholding rate unless you choose not to have federal income tax withheld.

9 These include for example, required minimum distributions andhardship withdrawals. You can choose not to have withholding applied to your non-periodic distribution by checking the applicable box below. You may also electwithholding in excess of the flat 10% Withholding Elections:q DO NOTwithhold any federal income tax unless mandated by DOwithhold federal taxes using the default withholding rate of 10%.qAdditional amountyou want withheld from your payment$_____ (Note:This amount is in addition to the default withholding rate of 10%.) Note: If no federal withholding election is checked above, we will withhold using the default withholding rate of 10%.

10 Notice:Payments to non-resident aliens are subject to a 30% federal withholding tax, and persons with a residential mailing address outside the UnitedStates may be subject to a 30% federal withholding tax, unless they are eligible for a reduced rate or exemption under a tax treaty and the required IRS taxforms are submitted. State Withholding Elections:q DO NOTwithhold any state income tax unless mandated by DOwithhold state taxes in the amount of $_____ or _____%(If you make this election, a dollar amount or percentage must be specified and cannot be less than any required withholding.) Note:If no state withholding election is checked above or if your state requires a greater amount of withholding, we will withhold at the rate specified byyour state of residence for the type of payment you are receiving.