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    In-Service Withdrawal Form

    Uploaded by

    lanzahouse
    This form is for requesting an in-service withdrawal from a retirement plan account. To qualify, the account balance must be under $5,000 and there have been no contributions or previous withdrawals in the past two years. The participant can choose to receive the funds directly or do a direct rollover to another eligible retirement plan or IRA. They must provide details of the receiving plan or IRA and authorize Nationwide Retirement Solutions to process the withdrawal.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    In-Service Withdrawal Form

    Uploaded by

    lanzahouse
    32 views1 page
    This form is for requesting an in-service withdrawal from a retirement plan account. To qualify, the account balance must be under $5,000 and there have been no contributions or previous withdrawals in the past two years. The participant can choose to receive the funds directly or do a direct rollover to another eligible retirement plan or IRA. They must provide details of the receiving plan or IRA and authorize Nationwide Retirement Solutions to process the withdrawal.

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    © Attribution Non-Commercial (BY-NC)

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    This form is for requesting an in-service withdrawal from a retirement plan account. To qualify, the account balance must be under $5,000 and there have been no contributions or previous withdrawals in the past two years. The participant can choose to receive the funds directly or do a direct rollover to another eligible retirement plan or IRA. They must provide details of the receiving plan or IRA and authorize Nationwide Retirement Solutions to process the withdrawal.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views1 page

    In-Service Withdrawal Form

    Uploaded by

    lanzahouse
    This form is for requesting an in-service withdrawal from a retirement plan account. To qualify, the account balance must be under $5,000 and there have been no contributions or previous withdrawals in the past two years. The participant can choose to receive the funds directly or do a direct rollover to another eligible retirement plan or IRA. They must provide details of the receiving plan or IRA and authorize Nationwide Retirement Solutions to process the withdrawal.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    In-Service Withdrawal Form

    Participant Information
    Name (Please Print) Address City, State, & Zip Code Email Address Social Security Number Employer/Entity Number Contact Phone Number

    In-Service Withdrawal

    Please process In-Service Withdrawal immediately. To qualify for an in-service withdrawal, you must meet the following criteria: Account balance under $5,000.00 No deferrals received during the two years previous to this request No previous in-service withdrawal distribution Pay directly to me. I understand 20% of the taxable amount of the eligible rollover distribution will be withheld for federal taxes. Direct Rollover: I wish to have 100% of the eligible rollover distribution directly rolled over to the eligible retirement plan or IRA designated below. I wish to have $___________________(at least $500) directly rolled over to the eligible retirement plan or IRA designated below. Pay remaining portion directly to me. I understand 20% of the taxable portion of the distribution paid to me will be withheld for federal income taxes. Direct Rollover Plan Designation (Select ONE only) To another eligible retirement plan:
    Caution: You are advised to verify that the Plan will accept this direct rollover. Name of Plan Address City, State and Zip Code

    Eligible Rollover Distribution

    To an IRA*
    Name of Plan Address City, State and Zip Code

    *You must establish an IRA account at your financial institution prior to our sending the distribution. An account number and forwarding instructions must be submitted with this form in order to process the direct rollover to an IRA.

    My distribution must begin no later than April 1st following the year I reach age 70. If I work beyond age 70, then my payout must begin no later than April 1st following the year I have a severance from employment or retire. All distributions are taxable according to tax laws.
    If you need assistance completing this paperwork, please call Nationwide Retirement Solutions at 1-877-677-3678.

    Authorization

    Federal Income Tax will be withheld from your payment as required by the Internal Revenue Code. You must submit a current W-4P with this request for withholding of the correct amount of taxes. State taxes will be withheld where applicable. I certify that I have received and read the Special Tax Notice Regarding Plan Payments. Signature of Participant Date

    DC-2634-0707(COMPAS)

    Nationwide Retirement Solutions P.O. Box 182797 Original- Nationwide Retirement Solutions

    Columbus, Ohio 43218-2797 Copy- Participant

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