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Blank Transamerica 401K Withdrawal PDF Form

The Transamerica 401K Withdrawal form is a document that allows participants to request distributions from their 401(k) retirement plans. This form must be completed accurately and signed by both the participant and the plan administrator to ensure proper processing. For those looking to withdraw funds, it is essential to fill out the form correctly to avoid delays in receiving your distribution.

To get started, please fill out the form by clicking the button below.

Blank Transamerica 401K Withdrawal PDF Form

Content Overview

The Transamerica 401K Withdrawal form is an essential document for individuals seeking to access their retirement funds. It requires careful completion and submission to ensure a smooth withdrawal process. Before filling out the form, participants must read the attached IRS Special Tax Notice, which provides important tax information related to their distributions. The form is not intended for certain requests, such as death benefit claims or hardship withdrawals. Participants must complete several sections, including personal information, the reason for withdrawal, and the desired form of payment. If married, spousal consent may also be necessary. Missing or incomplete information could delay the processing of the request, so attention to detail is crucial. Once completed, the form must be submitted to the employer for processing, rather than mailed directly to the processing center. Understanding the various options for distribution, including rollovers and cash payments, is vital for making informed decisions about retirement savings. Additionally, participants should be aware of potential tax implications and fees associated with their withdrawals.

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Distribution Request Form

READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF YOUR PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN

EXPLANATION OF QUALIFIED JOINT AND 50% CONTINGENT SURVIVOR ANNUITY FORM OF BENEFIT BEFORE COMPLETING THIS FORM.

Please note: Do not use this form for: (1) Death Benefit Claim (2) Required Minimum Distribution (3) Hardship Withdrawal Request

INSTRUCTIONS AND INFORMATION FOR COMPLETING THIS FORM

This Form Must Be Completed And Signed By You (And Your Spouse If You Are Married And Your Plan Allows For Annuities) And The

Plan Administrator, Trustee Or An Authorized Signer. If any information is missing or incomplete, you may be required to complete a new form or

provide additional information before the distribution can be processed.

If your distribution will be sent to an address outside of the United States, Puerto Rico, the U.S. Virgin Islands or Guam, you must also submit either an

IRS Form W-9 to certify you are a U.S. person or a Form W-8BEN if you are a non-resident alien with respect to the U.S. To obtain these forms or for

assistance in determining which form you should submit, please go to the IRS website at www.irs.gov or consult with a tax advisor. If you do not submit

one of these forms along with this form, 30% tax withholding will be applied to your distribution.

PARTICIPANT INSTRUCTIONS

1. Complete Sections A-H. If you do not have a Roth 401(k) Account, skip Section D. If you are married and your plan allows for annuities,

complete Section H, Spousal Consent.

2. Your signature is required in Section I. (Please note: A signature guarantee is required for distributions of $150,000 or more).

3. Submit this form to your Employer for signature and processing. Do not mail this form directly to the Processing Center listed at the end

of this form.

EMPLOYER INSTRUCTIONS

1. Complete Section J.

2. Your signature is required in Section J. (Please note: A signature guarantee is required for distributions of $150,000 or more).

3. Submit this form to the Processing Center.

SECTION A. Participant Information – Please print

___________________________________________________________________________ ______________________________________

Company/Employer Name Contract Number

__________-__________-__________ __________-__________-__________ __________-__________-__________

Social Security Number Date of Birth (MM-DD-YYYY) Date of Hire (MM-DD-YYYY)

___________________________________________________ _________________________________________________ ________

Last Name First Name MI

___________________________________________________ _________________________________________________________________

Street Address/Apt. No. City State Zip Code

(__________) ____________________ _________________________________ Marital Status:  Married  Not Married

Phone Number Email Address

MAIL DELIVERY

If no address is provided in Section A, the address on file will be used to process this request. All checks will be sent via First Class Mail

unless the Overnight Mail box is checked below.



Send check overnight mail

A fee (up to $50) will be deducted from your account. Please note: A street address must be provided.

Based on plan provisions, a distribution fee may be assessed at the time of processing. Please check with your Plan Administrator for any

questions as to if a distribution fee may apply to your request.

SECTION B. Reason For Distribution Request- Must be completed OR skip this section if your employer

checked off “plan termination in Section J

Check the appropriate box below:



Termination of employment



Disability as determined by the Plan’s fiduciary



Age 59 ½ (if allowed by the Plan)



Withdrawal of After-Tax Contributions (if allowed by the Plan)

 In-service (if allowed by the Plan)

 Withdrawal of Rollover contributions (if allowed by the Plan)

 Retirement

 Payment to alternate payee under QDRO (Only Applies to Divorce Proceedings)

_______________________ ________________________

Alternate Payee’s SSN Name

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SECTION C. Form of Payment for Traditional 401(k) Account – Only choose one of the three options



Option 1 (Rollover) – I am requesting a Direct Rollover of

my Traditional 401(k) account.

If “Age 59 ½, “In-service” or “Withdrawal of Rollover Contributions” is selected in Section B, please indicate the amount to be rolled

over $__________________ (or leave blank if you wish to have your entire account distributed).

Direct Rollover to (Select Only One):

 AN IRA OFFERED THROUGH Transamerica (Minimum rollover amount is $20,000). If you are interested in the Rollover IRA option

through Transamerica, call (866) 691-0030 to learn more and to establish an account. An IRA account number is required before the

rollover can be processed.

 AN ELIGIBLE RETIREMENT PLAN (401(a), 401(k), 403(b), and Governmental 457)

 AN IRA

NEW ACCOUNT INFORMATION: MAILING ADDRESS:

IRA Account Number (Required) / Plan Name Name of Trustee or Custodian for the New Plan or IRA

Make Check Payable To: Address – Number & Street

City State Zip Code

______________________________________________________________________________________________________________________



Option 2 (Combination) – I am requesting a distribution of my entire Traditional 401(k) account to be paid partially to me and partially as a

Direct Rollover. I understand that the portion payable to me may be subject to 20% federal income tax withholding unless I select a

percentage greater than 20% on IRS Form W-4R.

Distribute my Traditional 401(k) account based on the following percentages:

__________% paid directly to me, and

__________% applied to the Direct Rollover Account indicated below.

The above two percentages must equal 100%

Direct Rollover to (Select Only One):

 AN IRA OFFERED THROUGH Transamerica (Minimum rollover amount is $20,000). If you are interested in the Rollover IRA option

through Transamerica, call (866) 691-0030 to learn more and to establish an account. An IRA account number is required before the

rollover can be processed.

 AN ELIGIBLE RETIREMENT PLAN (401(a), 401(k), 403(b), and Governmental 457)

 AN IRA

NEW ACCOUNT INFORMATION: MAILING ADDRESS:

IRA Account Number (Required) / Plan Name Name of Trustee or Custodian for the New Plan or IRA

Make Check Payable To: Address – Number & Street

City State Zip Code

______________________________________________________________________________________________________________________

 Option 3 (Cash) – I am requesting a distribution of

my Traditional 401(k) account. I am

not

electing a Direct Rollover of any portion of

the distribution. I understand the check will be made payable to me and that the amount payable to me may be subject to 20%

federal income tax withholding unless I select a percentage greater than 20% on IRS Form W-4R.

If “Age 59 ½, “In-service” or “Withdrawal of Rollover Contributions” is selected in Section B, please indicate the amount to be paid

directly to you $__________________ (or leave blank if you wish to have your entire account distributed).

______________________________________________________________________________________________________________________

DIRECT ROLLOVER

In a Direct Rollover, an eligible rollover distribution is paid from your retirement plan directly to an IRA or your new Employer's 401(a), 401(k), 403(b) or governmental 457 Plan. An

IRS Form 1099-R will still be completed and submitted to the IRS; however, no federal or state income tax is withheld from amounts directly rolled over. The Direct Rollover check will

be made payable to the IRA/plan trustee or custodian for the benefit of the participant or alternate payee unless otherwise indicated above.

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SECTION D. Form of Payment for a Roth 401(k) Account – Complete only if your plan allows for Roth

Contributions. Only choose one of the three options



Option 1 (Rollover) – I am requesting a Direct Rollover of

my Roth 401(k) account.

If “Age 59 ½, “In-service” or “Withdrawal of Rollover Contributions” is selected in Section B, please indicate the amount to be rolled

over $__________________ (or leave blank if you wish to have your entire account distributed).

Direct Rollover to (Select Only One):

 A ROTH IRA OFFERED THROUGH Transamerica (Minimum rollover amount is $20,000). If you are interested in the Rollover IRA

option through Transamerica, call (866) 691-0030 to learn more and to establish an account. An IRA account number is required

before the rollover can be processed.

 A DESIGNATED ROTH ACCOUNT (401(k), 403(b)) or ROTH IRA

NEW ACCOUNT INFORMATION: MAILING ADDRESS:

Roth IRA Account Number (Required) / Plan Name Name of Trustee or Custodian for the New Roth 401(k) or Roth IRA

Make Check Payable To: Address – Number & Street

City State Zip Code

______________________________________________________________________________________________________________________



Option 2 (Combination) – I am requesting a distribution of my entire Roth 401(k) account to be paid partially to me and partially as a Direct

Rollover. I understand that the portion payable to me may be subject to 20% federal income tax withholding unless I select a

percentage greater than 20% on IRS Form W-4R.

Distribute my Roth 401(k) account based on the following percentages:

__________% paid directly to me, and

__________% applied to the Direct Rollover Account indicated below.

The above two percentages must equal 100%

Direct Rollover to (Select Only One):

 A ROTH IRA OFFERED THROUGH Transamerica (Minimum rollover amount is $20,000). If you are interested in the Rollover IRA

option through Transamerica, call (866) 691-0030 to learn more and to establish an account. An IRA account number is required

before the rollover can be processed.

 A DESIGNATED ROTH ACCOUNT (401(k), 403(b)) or ROTH IRA

NEW ACCOUNT INFORMATION: MAILING ADDRESS:

IRA Account Number (Required) / Plan Name Name of Trustee or Custodian for the New Plan or IRA

Make Check Payable To: Address – Number & Street

City State Zip Code

______________________________________________________________________________________________________________________

 Option 3 (Cash) – I am requesting a distribution of

my Roth 401(k) account. I am

not

electing a Direct Rollover of any portion of the

distribution. I understand the check will be made payable to me and that the amount may be subject to 20% federal income tax

withholding unless I select a percentage greater than 20% on IRS Form W-4R.

If “Age 59 ½, “In-service” or “Withdrawal of Rollover Contributions” is selected in Section B, please indicate the amount to be paid

directly to you $__________________ (or leave blank if you wish to have your entire account distributed).

______________________________________________________________________________________________________________________

DIRECT ROLLOVER

In a Direct Rollover, an eligible rollover distribution is paid from your retirement plan directly to an IRA or your new Employer's 401(a), 401(k), 403(b) or governmental 457 Plan. An

IRS Form 1099-R will still be completed and submitted to the IRS; however, no federal or state income tax is withheld from amounts directly rolled over. The Direct Rollover check will

be made payable to the IRA/plan trustee or custodian for the benefit of the participant or alternate payee unless otherwise indicated above.

For participants required to take a minimum distribution during the current year that was not satisfied, please note the following: Your required minimum distribution

(RMD) for the current year will need to be completed and made payable to you prior to the processing of your direct rollover request.

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SECTION E. Annuity Request (Not applicable to vested account under $5,000 or if your plan does not offer

annuities)

Skip this section if you made an election in Section C or D.

By selecting this option your entire account balance will be distributed in order to purchase the annuity

 Annuity: If the plan offers annuities as a form of benefit payment, I elect payment as a monthly annuity with payments to commence

_______________________. Upon my death, my spouse’s payments should be__________% (from 50% to 100%) of my payments. My

spouse’s date of birth is______/______/______. Such annuity will be a Joint and Contingent Survivor Annuity if I am married and a Single

Life Annuity if I am not married. I also understand that if I am married, my spouse need not consent to this election if I choose a Qualified

Joint and Contingent Survivor Annuity (“QJSA”).

I understand that if I request a periodic payment payable over a period of 10 years or more, withholding will be based on a filing status of

single with no adjustments unless I make a different election on IRS Form W-4P.

SECTION F. Outstanding Loan Payoff Instructions –

Skip this section if you do not have an outstanding loan or

are requesting an In-Service Withdrawal, Withdrawal of After-Tax Contributions, 59 ½ Withdrawal or a QDRO.

If you have an outstanding loan please payoff the loan in full prior to submitting this Distribution Form. Submit a completed Distribution Form after

you have submitted the loan payoff amount and the loan is paid in full.

Your outstanding loan balance will be defaulted and become taxable to you if the loan payoff is not processed prior to receiving a completed

Distribution Form.

SECTION G. Income Tax Withholding

The income tax withholding requirements vary depending on whether or not the distribution requested is an eligible rollover distribution. Please see

the attached Special Tax Notice for the definition of eligible rollover distribution and a detailed explanation of the federal income tax withholding rules.

If you request a Direct Rollover, no federal income tax will be withheld from the amount directly rolled over.

FEDERAL INCOME TAX

Withholding is determined by the type of distribution and if you make an independent election to have a different rate apply. If you do not make a

separate election, the following default withholding will apply:

Eligible Rollover Distributions: If you request a Direct Rollover, no federal income tax will be withheld from the amount directly rolled over. If you

request a cash distribution, 20% withholding will apply unless you select a percentage greater than 20% on IRS Form W-4R.

Periodic Payments: If you request a periodic payment payable over a period of 10 years or more, withholding will be based on a filing

status of single with no adjustments unless you make a different election on IRS Form W-4P.

The IRS Form W-4R and IRS Form W-4P can be found at https://www.irs.gov/pub/irs-pdf/fw4r.pdf and https://www.irs.gov/pub/irs-pdf/fw4p.pdf or

from www.irs.gov. If the appropriate form is not included, the default withholding, as described above, will apply.

STATE INCOME TAX

The state of withholding will be presumed to be the state that has been provided in your address as previously provided on the form. Tax

withholding rules vary by state. More likely than not, your home state (a) requires a minimum withholding amount when federal withholding is

required; (b) requires withholding unless you can opt out; (c) allows a voluntary withholding election; or (d) does not have state income tax and

does not permit withholding. Unless requested, state withholding will not be deducted for states with voluntary withholding. Some states require

the completion of their State Withholding Certificate to make an independent election. Consult with your tax advisor or state revenue department

to obtain the most up-to-date information and to confirm if your state's withholding form is required to be submitted. If permitted by your state,

please select one of the options below.

 NO, I ELECT NOT TO HAVE STATE INCOME TAX WITHHELD

 YES, I ELECT TO HAVE _____ % AS STATE INCOME TAX WITHHELD

 YES, I ELECT TO HAVE $______ (WHOLE DOLLAR ONLY) AS STATE INCOME TAX WITHHELD

 YES, I ELECT TO HAVE STATE INCOME TAX WITHHELD USING THE DEFAULT FILING STATUS AS PER MY STATE OF RESIDENCE

WITHHOLDING CERTIFICATE (Note: ONLY CHECK THIS BOX FOR PERIODIC PAYMENTS WITHHOLDING).

NOTE: Withholding may be greater if the amount you select is less than the minimum required. Withholding will be processed for states that require

withholding or do not allow you to opt out without your state's form.

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SECTION H. Spousal Consent

Check with your Employer/Plan Administrator or Summary Plan Description to determine whether your plan is subject to spousal consent

requirements. If spousal consent is required, complete this section. If your plan is not subject to spousal consent requirements, skip to Section I.

Please note: You must have your spouse’s signature notarized or have a plan representative witness your spouse’s signature if your vested

account balance is greater than $5,000 and your plan provides for joint and survivor annuities. However, if your vested account balance is less than

$5,000 spousal consent is not required.

Spousal Consent

I, the undersigned spouse of the participant, have read the “Special Tax Notice Regarding Payments From Qualified Plans” provided to me and

understand the effects of the waiver. I understand that federal law requires that the retirement benefit of my spouse must be paid under a Qualified

Joint and Survivor Annuity Form as described in the attached “Special Tax Notice Regarding Payments From Qualified Plans,” unless I consent

otherwise in writing to another benefit form. I hereby consent to the waiver of the annuity and consent to the form of benefit elected by my spouse.

Signature of Participant’s Spouse:_____________________________________________________________ Date: ___________________

Statement of Plan Representative or Notary Public

The spouse whose signature I have witnessed is known to me and signed this form in my presence.

Plan Representative:_____________________________________ ___________________________________ Date: ___________________

Notary Public Signature:_____________________________________________________________________ Date: ___________________

PLACE SEAL HERE (if applicable)

SECTION I. Participant Signature

A request for a withdrawal of $150,000 or more requires that this completed form be stamped with a medallion signature guarantee. You can obtain a

medallion signature guarantee from a financial institution such as a commercial bank, savings bank, credit union, or broker-dealer. A notary is NOT a

medallion signature guarantee.

The original form, stamped with the medallion signature guarantee, must be presented to your Plan Administrator for approval.

Please note, for this purpose, the value of the withdrawal is based on the amount available (for full distributions and rollovers) on the date of processing

and multiple withdrawal requests within a 14-day period that total $150,000 or more will be subject to the medallion signature guarantee requirements.

PARTICIPANT SIGNATURE

*Participants will receive the price as of market close on the day that all required and completed forms are received by Transamerica in good

order. Forms that are sent in good order, but received after the close of market, will be processed based on the next business day’s market close.

*Processing usually takes 1-4 business days, but can take several days longer if invested in only fixed funds; however, as noted above, pricing is

based on the day that forms are received in good order.

My signature acknowledges that I have read, understand and agree to all the terms of this Distribution Request form, and affirm that all information that

I have provided is true and correct. Further, I acknowledge that I have received the “Special Tax Notice Regarding Payments From Qualified Plans”

and other required notices. The above information is true and correct to the best of my knowledge. I further understand that I may revoke this

election at any time prior to the distribution taking place.

___________________________________________________________________ _______________________

Signature of Participant Date

PARTICIPANT: RETURN COMPLETED FORM TO YOUR PLAN ADMINISTRATOR FOR PROCESSING

Signature Guarantee – Place Medallion Stamp Below (Required if distribution is $150,000 or more.)

Participant’s Distribution is $150,000 or more

Medallion Signature Guarantee – Place Medallion Stamp Below

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SECTION J. For Completion by Plan Administrator, Trustee Or Authorized Signer Only

______________________________________________________________________________________________________________________

Plan Name

____________________ _________________________ ____________________ ___________________________________

Contract Number Sub ID/Division # (if applicable) Participant’s SSN # Participant’s Termination Date (if applicable)

The Participant is entitled to a vested benefit of ____________% of company contributions.

Please refer to your Plan Document for the vesting schedule.

Is payment of this benefit subject to Plan Termination?  No  Yes

By signing below, I hereby authorize Transamerica to process the distribution described in this form. This request is in compliance with plan

provisions. If spousal consent is not provided, then in accordance with the terms and provisions of the plan and under the current law, spousal

consent is not required for payment of the requested benefit.

 If this request is for a disability distribution, I certify that the participant meets the requirements of Section 72(m)(7).

Only submit this form after final contributions and loan repayments have been processed for termination distributions.

Once this form has been completed with all of the necessary information and required signatures, please forward to the Processing Center for

processing.

This form cannot be processed without the Plan Administrator, Trustee or Authorized Signer’s signature.

Be sure to keep a copy for your records.

___________________________________________________________________ _______________________

By: Signature of MEP Plan Administrator, Trustee or Authorized Signer Date

(Please verify that all information in Section A is completed)

___________________________________________________________________ _______________________

Print Name of MEP Plan Administrator, Trustee or Authorized Signer Date

FOR PLAN ADMINISTRATOR USE ONLY – MAIL TO:

Processing Center, 6400 C Street SW, Cedar Rapids, IA 52499 or Fax to 833-200-9987



 ExplanationofDistributionOptions



Thisinformationonlyappliestodefinedcontributionretirementplansthatarenotsubjecttothejointandsurvivorannuityrequirements.The

informationprovidedinthisExplanationisintendedtobegeneralinnature;notallplanprovisionsandoptionsareavailableunderyourplan. To

confirmthespecifictermsofyourplan,pleaserefertoyourSummaryPlanDescriptionorcontactyourPlanAdministrator.



General

Asaplanparticipant,youmayhavetherighttoreceivebenefitswhenyoureachyournormalretirementageundertheplanorterminate

employment,providedyourplanaccounthasmoniesinitavailableforyourwithdrawal.Ifyourplanallowsin‐servicewithdrawalsforhardshipor

uponyourattainmentofage591/2orforanyotherreasons,youmayalsoelecttoreceivebenefitpaymentsifyouhavesatisfiedtheapplicable

planrequirements.



Pleasenote,theplanmayprovidethatifthecashvalueofyourbenefitislessthanaspecifiedamount(generally$5,000orless,ifany),yourbenefit

willbepaidtoyouinasinglesum,orautomaticallyrolledovertoanIRA(ifrequiredbyfederallaw)unlessyouelectotherwise.



Undertheprovisionsoftheplan,youmayrequestthatyourbenefitbepaidundertheoptionalformofbenefitwhichisbestsuitedtoyour

particularneedsandcircumstances.Theamountofmonthlyincomepayablewilldependupontheformofpaymentelected,yourage(andyour

designatedbeneficiary’sage)aswellasyourvestedaccountbalanceasofyourretirementdate,or,ifearlier,dateofthiselection.



SummaryofFormsofBenefit(Availabilityofthefollowingoptionswilldependuponplanprovisions)



SingleSumPayment:Thevestedbalanceinyouraccountwillbepaidinasinglesum.



InstallmentPayment(specificlimitationsmayapplytothisoptionunderthetermsofyourplan): Thevestedbalanceinyouraccountwillbepaid

inmonthly,quarterly,semi‐annualorannualinstallmentpayments.



PartialPayment:Thevestedbalanceinyouraccountwillbepaidinpartialpayments.



FixedPeriodCertainAnnuity‐No“Life”Guarantee: Amonthlyincomeispayabletoyoubeginningonyourbenefitstartingdate,inequal

installmentsoveraspecifiedperiodofnotlessthan12normorethan240months.Ifyoudieduringthespecifiedperiodelected,theincomewill

becontinuedfortheremainderofthespecifiedperiodtoyourdesignatedbeneficiary.Youmayelectthatsuchpaymenttoyourbeneficiaryistobe

madeinasinglesum.



StraightLifeAnnuity‐No“Years”Certain: Alifetimemonthlyincomeispayabletoyou,beginningonyourbenefitstartingdateandcontinuing

untilthelastpaymentduebeforeyourdeath.Ifyoudieafteryourbenefitstartingdate,therewillbenodeathbenefitpayable.Ifyouaremarried,

youmayelectthisformofpaymentonlywithyourspouse’sconsent.



LifeAnnuitywithPeriodCertain:Alifetimemonthlyincomeispayabletoyou,beginningonyourbenefitstartingdateandcontinuinguntilthelast

paymentduebeforeyourdeath.Ifyoudieduringtheperiodcertainwhichbeginsonyourbenefitstartingdate,themonthlyincomewillbe

continuedtoyourdesignatedbeneficiaryfortheremainderoftheperiodcertain.Thebeneficiarymayelectthatsuchpaymentbemadeinalump

sum.



JointandSurvivorAnnuity:Alifetimemonthlyincomeispayabletoyou,beginningonyourbenefitstartingdateandcontinuinguntilthelast

paymentduebeforeyourdeath.Uponyourdeath,yourjointannuitantwillreceiveamonthlyincomeforlifeequalto,dependingontheprovisions

ofyourplan,atleastone‐half(andnotmorethan100%)oftheamountofmonthlyincomeyouwerereceiving.Ifyouaremarried,yourjoint

annuitantmustbeyourspouseunlessyourspouseconsentstoanotherannuitantonaformprovidedbythePlanAdministrator.



ElectionofAnnuityBenefit

Ifyouaremarried(andyourplanprovidesannuitiesasaformofbenefit)andyouwishtoelectanannuityformofbenefit,otherthanaJointand

SurvivorAnnuitywithyourspouseasyourjointannuitant,yourspousemustconsenttoyourelection,inwriting,witnessedbyyourPlan

AdministratororaNotaryPublic,duringthe180dayperiodbeforeyourbenefitstartingdate.Ifyouaremarriedandwishtodesignateaperson

otherthanyourspouseasyourjointannuitant,youmustobtainyourspouse’swrittenconsenttoyourbeneficiarydesignation.(Ifestablishedto

thesatisfactionofyourPlanAdministratorthatyourspousecannotbelocated,spousalconsentisnotrequired.) Yourspouse’sconsentmustbe

madeonaspecialformavailablefromyourPlanAdministrator.

Page 6 of 17

2220 Distribution Request - ISC MEP

September

2020

ComparisonofFormsofBenefit

Theseexamplescomparebenefitsunderformsofpaymentthatmaybeavailableundertheplan.Theseexamplesarebasedonspecificassumptions

andcertaininterestratesandmortalityrates.Theamountsshownareestimates,providedtoillustratethedifferencesamongthevariousoptions

andarenotintendedtorepresenttheactualamountpayabletoyou.Uponyourrequest,amoreprecisecalculationwillbeprovided.Yourrequest

shouldbesenttotheaddressbelowifinwriting.Ifyouwishtocallinyourrequest,seethenumberprovidedbelowforyoutocall.



Assumeaparticipantretiringatage65hasabeneficiaryofthesameageanda$200,000accountbalance.



Age65Commencement



FormofBenefit Benefit toParticipant

BenefittoSpouse/BeneficiaryAfter

Participant’sDeath

QualifiedJointandSurvivorAnnuity

50% $ 914.31permonth $457.16permonth

66.7% $890.56permonth $593.71permonth

75% $879.15permonth $659.36permonth

100% $846.58permonth $846.58permonth

StraightLifeAnnuity $993.76permonth

LifeAnnuitywith5YearsCertain $988.91permonth

LifeAnnuitywith10YearsCertain $974.01permonth

PeriodCertain5 $3,392.05 permonth

PeriodCertain10Years $1,814.58permonth



Anyannuityelectedwillbeprovidedbypurchasinganannuitycontractfromaninsurancecompanywithyourvestedaccountbalanceunder

theplan.Dollaramountsshowndonotreflectanyrequiredtaxwithholding,ongoingaccountexpenses,orpossiblefeeschargedbytheannuity



provider.



ElectionRights

Youhaveatleast30daystoconsiderwhichformofbenefitpaymentyouwanttoelect.If,afterreceivingthisExplanation,youaffirmativelyelect

adistribution,yourdistributionmaybemadelessthan30daysfromthedatethisExplanationwasgiventoyou.Ifyouelectanannuityformof

payment:



•Yourdistributionelectionisrevocableuntilthelaterof(a)yourbenefitstartingdate,or(b)priortotheexpirationofthe7‐dayperiodthatbegins

thedateafteryoureceivethisExplanation;



•YourbenefitstartingdateisadateafterthedateyoureceivedthisExplanation;



•Distributioninaccordancewithyourbenefitelectionispaidmorethan7daysafterthedatethisExplanationwasprovided.



ConsequencesofYourTakingtheDistributionInsteadofDeferringReceiptoftheDistribution

Ifyouareeligibletoreceiveadistributionfromtheplan,butalsohavetherighttodeferreceiptofsuchdistributionbecause,e.g.,thevalueofyour

nonforfeitableaccountbalanceexceeds$5,000(orsuchlowerautomaticcash‐outlimitsetbytheplan),yourdecisionnottodeferreceiptofyour

distributionincludesthefollowingconsequencesifyoudonotdirectly(orindirectlywithin60daysofreceiptofthedistribution)rolloveryour

distributiontoanIRAoranothereligibleretirementplan: (1)youwillbetaxedonthetaxableamountofthedistributionintheyearthedistribution

ismadeandwillnolong

erbeabletodeferthetaxationofthedistribution,(2)anIRSearlydistribution10%penaltytaxmayapplytothetaxable

portionofyourdistributionifyoureceivethedistributioneitherbeforeattainingage59½orafterseparatingfromservicebeforetheyearinwhich

youattainage55,and(3)youwilllosetheopportunitytodeferthetaxationoffutureearningsonyourdistribution.



PleasenotethatsomecurrentlyavailableinvestmentoptionsmaynotbegenerallyavailableonsimilartermsoutsidethePlan.Inaddition,feesand

expenses(includingadministrativeorinvestment‐relatedfees)outsidethePlanmaybedifferentfromfeesandexpensesthatapplytothePlan’s

accounts.Pleasecontactyourfinancialadvisorforadditionalinformation.



Yourplanmayincludeotherprovisionsthatmightaffectyourdecisionwhethertodeferreceiptofadistribution.Youshouldreviewtheplan’s

summaryplandescriptionbeforedecidingtoelectadistribution,anddiscussthisissuewithyourtaxadvisor.Acopyoftheplan’ssummaryplan

descriptionisavailablefromthePlanAdministrator.



RighttoRequestParticipant‐SpecificInformation

Youhavetherighttorequestspecificinformationwithrespecttoeachformofbenefitavailabletoyouundertheplan,includingadescriptionofthe

financialeffectofelectingeachformofbenefitavailabletoyouundertheplan.WrittenrequestsshouldbesenttoyourPlanAdministrator.

Page 7 of 17

2220 Distribution Request - ISC MEP

September

2020

2768-TRS (rev 1/25/21) (Page 1 of 8)

YOUR ROLLOVER OPTIONS

You are receiving this notice because all or a portion of a payment you are receiving from your employer’s retirement plan is eligible to be rolled over

to a Traditional IRA, a Roth IRA or an employer plan. This notice is intended to help you decide whether to do such a rollover.

Section I of this notice describes the rollover rules that apply to payments from the Plan that are not from a designated Roth account (a type of

account in some employer plans that is subject to special tax rules).

Section II applies if you also receive a payment from a designated Roth account in the Plan, in which case the plan administrator or the payor will tell you

the amount that is being paid from each account.

Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules that only apply in certain

circumstances are described in the “Special Rules and Options” section.

Generally, neither a direct rollover nor a payment can be made from the Plan until at least 30 days after your receipt of this notice. Thus, after

receiving this notice, you have at least 30 days to consider whether or not to have your withdrawal directly rolled over. If you do not wish to wait until

this 30-day notice period ends before your election is processed, you may waive the notice period by making an affirmative election indicating

whether or not you wish to make a direct rollover. Your withdrawal will then be processed in accordance with your election as soon as practical after it

is received by the Plan Administrator.

Section I: GENERAL INFORMATION ABOUT ROLLOVERS FROM YOUR RETIREMENT PLAN (Not Including Any Designated Roth Account)

How can a rollover affect my taxes?

You will generally be taxed on a payment from the Plan if you do not roll it over. However, rollovers to a designated Roth account within the Plan or to

a Roth IRA that are not from a designated Roth account are subject to taxation, as discussed below. If you are under age 59½ and do not do a rollover,

you will also have to pay a 10% additional income tax on early distributions (generally, distributions made before age 59½), unless an exception

applies. However, if you do a rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if

those payments are made after you are age 59 1/2 (or if an exception to the 10% additional income tax applies).

What types of retirement accounts and plans may accept my rollover?

You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax- qualified

plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. The rules of the IRA or employer plan that holds the rollover

will determine your investment options, fees, and rights to payment from the IRA or employer plan (for example, IRAs are not subject to spousal consent

rules and IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan.

You may also roll over the payment to a designated Roth account within the Plan.

How do I do a rollover?

There are two ways to do a rollover. You can generally do either a direct rollover or a 60-day rollover.

If you do a direct rollover, the Plan will make the payment directly to your IRA or an employer plan. You should contact the IRA sponsor or the

administrator of the employer plan for information on how to do a direct rollover.

If you do not do a direct rollover, you may still do a rollover by making a deposit into an IRA or eligible employer plan that will accept it. Generally, you will

have 60 days after you receive the payment to make the deposit. If you do not do a direct rollover, the Plan is required to withhold 20% of the payment for

federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment

in a 60-day rollover, you must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment, the portion not

rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59 1/2 (unless an exception

applies).

How much may I roll over?

If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except:

• Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the joint lives or joint life expectancies

of you and your beneficiary);

• Required minimum distributions after age 70 ½ (if you were born before July 1, 1949), after age 72 (if you were born after June 30, 1949) or

after death;

• Hardship distributions;

• Payments of employee stock ownership plan (ESOP) dividends;

• Corrective distributions of contributions that exceed tax law limitations;

• Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends)

• Cost of life insurance paid by the Plan;

• Payments of certain automatic enrollment contributions that you request to withdraw within 90 days of your first contribution;

• Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP (also, there generally will be

adverse tax consequences if you roll over a distribution of S corporation stock to an IRA): and

• Distributions of certain premiums for health and accident insurance

Special Tax Notice Regarding Plan Payments

(Including Payments From Your Designated Roth Account, If Applicable)

2768-TRS (rev 1/25/21) (Page 2 of 8)

The plan administrator or the payor can tell you what portion of a payment is eligible for rollover.

If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions?

If you are under age 59 1/2, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan (including

amounts withheld for income tax) that you do not roll over, unless one of the exceptions listed below applies. This tax applies to the part of the

distribution that you must include in income and is in addition to the regular income tax on the payment not rolled over.

The 10% additional income tax does not apply to the following payments from the Plan:

• Payments made after you separate from service if you will be at least age 55 in the year of the separation;

• Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or

the joint lives or joint life expectancies of you and your beneficiary);

• Payments from a governmental plan made after you separate from service if you are a qualified public safety employee and you will be at least

age 50 in the year of the separation;

• Payments made due to disability;

• Payments after your death;

• Payments of ESOP dividends;

• Corrective distributions of contributions that exceed tax law limitations;

• Cost of life insurance paid by the Plan;

• Payments made directly to the government to satisfy a federal tax levy;

• Payments made under a qualified domestic relations order (QDRO);

• Payments of up to $5,000 made to you from a defined contribution plan if the payment is a qualified birth or adoption distribution;

• Payments up to the amount of your deductible medical expenses (without regard to whether you itemize deductions for the taxable year);

• Certain payments made while you are on active duty if you were a member of a reserve component called to duty after September 11, 2001 for

more than 179 days;

• Payments of certain automatic enrollment contributions that you request to withdraw within 90 days of your first contribution;

• Payments excepted from the additional income tax by federal legislation relating to certain emergencies and disasters; and

• Phased retirement payments made to federal employees.

If I do a rollover to an IRA, will the 10% additional income tax apply to early distributions from the IRA?

If you receive a payment from an IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions on the part

of the distribution that you must include in income, unless an exception applies. In general, the exceptions to the 10% additional income tax for early

distributions from an IRA are the same as the exceptions listed above for early distributions from a plan. However, there are a few differences for

payments from an IRA, including:

• The exception for payments made after you separate from service if you will be at least age 55 in the year of the separation (or age 50 for

qualified public safety employees) does not apply.

• The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a

divorce or separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse); and

• The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to

whether you have had a separation from service.

Additional exceptions apply for payments from an IRA, including:

• Payments for qualified higher education expenses,

• Payments up to $10,000 used in a qualified first-time home purchase, and

• Payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have

been eligible to receive unemployment compensation but for self-employed status.)

Will I owe State income taxes?

This notice does not address any State or local income tax rules (including withholding rules).

SPECIAL RULES AND OPTIONS For Payments From Your Retirement Account (Not Including Your Designated Roth Account)

If your payment includes after-tax contributions:

After-tax contributions included in a payment are not taxed. If you receive a partial payment of your total benefit, an allocable portion of your after-tax

contributions is included in the payment, so you cannot take a payment of only after-tax contributions. However, if you have pre-1987 after-tax

contributions maintained in a separate account, a special rule may apply to determine whether the after-tax contributions are included in the payment.

In addition, special rules apply when you do a rollover, as described below.

You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of

the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs). If

you do a direct rollover of only a portion of the amount paid from the Plan and at the same time the rest is paid by you, the portion rolled over consists

➤ PDF File

Form Specifications

Fact Name	Description
Eligibility Requirements	Participants must complete and sign the form, and if married, their spouse must also sign if the plan allows for annuities.
Distribution Options	Participants can choose from several distribution methods, including direct rollovers, cash distributions, or combinations of both.
Tax Implications	Federal income tax withholding may apply, especially if the distribution is not rolled over. A 20% withholding applies to certain distributions.
State-Specific Considerations	State income tax rules vary. Participants should consult state laws regarding withholding requirements, as some states mandate withholding while others allow for independent elections.

Transamerica 401K Withdrawal: Usage Guidelines

Completing the Transamerica 401K Withdrawal form is an important step in accessing your retirement funds. It is essential to follow the instructions carefully to ensure that your request is processed without delays. After you submit the completed form to your employer, it will need to be signed and processed by them before it can be sent to the processing center.

Begin by filling out Sections A through H. If you do not have a Roth 401(k) account, you can skip Section D. If you are married and your plan allows for annuities, complete Section H for spousal consent.
Sign your name in Section I to confirm that all information provided is accurate.
Submit the form to your employer for their signature and processing. Do not mail the form directly to the processing center.

Your Questions, Answered

What is the purpose of the Transamerica 401K Withdrawal form?

The Transamerica 401K Withdrawal form is used to request a distribution from your 401(k) retirement plan. This form allows you to specify how you want to receive your funds, whether through a direct rollover to another retirement account, a combination of cash and rollover, or a cash distribution. It is essential to complete this form accurately to ensure your withdrawal is processed without delays.

Who needs to sign the Transamerica 401K Withdrawal form?

The form must be completed and signed by you, the participant. If you are married and your plan allows for annuities, your spouse must also sign the form to provide spousal consent. Additionally, the Plan Administrator, Trustee, or an authorized signer must sign the form to validate the request. Missing signatures can lead to processing delays or require a new form submission.

What should I do if I have missing information on the form?

If any information is incomplete or missing, you may be required to fill out a new form or provide additional information before your distribution can be processed. It is crucial to double-check all sections of the form, including your personal information and distribution preferences, to avoid any issues.

Are there any fees associated with the withdrawal?

There may be fees associated with processing your distribution request, depending on your plan provisions. It is advisable to check with your Plan Administrator for details about any potential distribution fees that may apply. Additionally, if you choose to receive your distribution via overnight mail, there will be an express charge of $25 deducted from your check.

What happens if I do not complete the required minimum distribution (RMD)?

If you are required to take a minimum distribution for the current year and have not satisfied this requirement, your RMD must be completed and made payable to you before your direct rollover request can be processed. Failing to take your RMD can lead to tax penalties, so it is important to address this requirement promptly.

Common mistakes

Incomplete Sections: Failing to complete all required sections (A-H) can lead to delays. Ensure that each section relevant to your situation is fully filled out.
Missing Signatures: Neglecting to sign the form in Section I is a common oversight. Your signature, and your spouse's if applicable, is essential for processing.
Incorrect Payment Option: Selecting the wrong payment option in Sections C or D can cause issues. Review your choices carefully to ensure they align with your needs.
Skipping Spousal Consent: If you are married and your plan requires spousal consent, failing to complete Section H can halt your request. Always check if this is necessary.
Improper Submission: Submitting the form directly to the Processing Center instead of your employer can lead to rejection. Always follow the submission guidelines outlined in the instructions.
Ignoring Tax Implications: Overlooking the tax withholding requirements can result in unexpected tax liabilities. Familiarize yourself with the tax implications of your distribution.
Missing Contact Information: Not providing a current mailing address in Section A means your distribution may be sent to an outdated address. Always double-check this information.
Failure to Attach Necessary Documentation: If you have an outstanding loan, not including payment details or relevant documentation can delay processing. Make sure to include everything required.

Documents used along the form

When considering a withdrawal from your Transamerica 401(k), several other forms and documents may be necessary to complete the process. Each of these documents serves a specific purpose and helps ensure that your request is handled correctly. Below is a list of commonly used forms alongside the Transamerica 401(k) Withdrawal form.

IRS Special Tax Notice: This notice provides important information regarding the tax implications of your withdrawal. It outlines potential tax withholding and penalties that may apply to your distribution.
Spousal Consent Form: If you are married and your plan requires spousal consent for withdrawals, this form must be signed by your spouse. It acknowledges their understanding of the withdrawal and its implications.
Distribution Fee Disclosure: This document informs you of any fees associated with processing your withdrawal. It’s essential to understand these costs before proceeding.
Loan Payoff Request Form: If you have an outstanding loan against your 401(k), this form is necessary to address the loan balance before processing your withdrawal request.
Rollover IRA Account Application: If you choose to roll over your funds to an IRA, this application is required to set up the new account. It typically includes your personal information and details about the IRA custodian.
Required Minimum Distribution (RMD) Form: If you are 72 or older, you may need to submit this form to confirm that you are taking your required minimum distribution for the year.
Hardship Withdrawal Form: If your withdrawal is due to a financial hardship, this form must be completed to demonstrate your eligibility for such a distribution.
Qualified Domestic Relations Order (QDRO): This legal order is necessary if you are splitting your retirement account as part of a divorce settlement. It directs the plan administrator on how to distribute the funds.
Employer Authorization Form: This form requires your employer's signature to verify that they approve your withdrawal request and that it complies with the plan's rules.

Understanding these forms and documents can help streamline the withdrawal process from your Transamerica 401(k). Always ensure that you have all necessary paperwork completed and submitted to avoid delays in receiving your funds.

Similar forms

The Transamerica 401K Withdrawal form shares similarities with several other financial and legal documents. Below is a list of documents that resemble it in terms of purpose, structure, or required information.

IRA Distribution Request Form: Similar in that both forms request the distribution of retirement funds. They require personal information and specify the method of payment.
401(k) Loan Application: This document also involves participant information and outlines the terms of a loan against the retirement account, similar to how the withdrawal form details the distribution process.
Qualified Domestic Relations Order (QDRO): Like the withdrawal form, a QDRO outlines the distribution of retirement benefits, specifically in divorce cases, necessitating similar participant and spouse information.
Retirement Account Rollover Form: This form facilitates the transfer of funds from one retirement account to another. It shares the requirement for participant identification and specifics about the receiving account.
Spousal Consent Form: Often included with withdrawal requests, this document ensures that a spouse agrees to the distribution of funds, paralleling the spousal consent section of the 401K Withdrawal form.
Tax Withholding Election Form: This document allows individuals to specify how much tax should be withheld from distributions. It is similar in that it requires financial details and personal information.
Plan Termination Notice: This document informs participants of the termination of their retirement plan. It often requires similar information about the participant and their vested benefits.
Benefit Election Form: Used to select benefits during retirement, this form collects participant information and choices, akin to the options available on the withdrawal form.
Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: While primarily related to health information, this form also requires personal identification and consent, similar to the withdrawal form's requirements for participant and spouse signatures.

Dos and Don'ts

Things to Do:

Complete all required sections (A-H) accurately, ensuring no information is missing.
Sign the form in Section I to confirm your understanding and agreement.
Consult your Plan Administrator if you have questions about distribution fees or requirements.
Provide a valid mailing address to ensure timely delivery of your distribution check.

Things Not to Do:

Do not skip any sections that apply to your situation, as incomplete forms may delay processing.
Do not mail the form directly to the Processing Center; submit it to your Employer for signature.
Do not forget to include your spouse's consent if required by your plan and if your account balance exceeds $5,000.
Do not assume that all distributions are tax-free; consult the IRS Special Tax Notice for details.

Misconceptions

Understanding the Transamerica 401K Withdrawal form is essential for making informed decisions about your retirement savings. However, there are several misconceptions that can lead to confusion. Here are six common misconceptions:

All withdrawals are the same. Many people believe that all types of withdrawals from a 401K are identical. In reality, the form distinguishes between various withdrawal reasons, such as retirement, disability, or hardship withdrawals. Each type may have different tax implications and eligibility requirements.
Spousal consent is always required. While spousal consent is necessary for certain distributions, it is not required for all cases. If your vested account balance is less than $5,000, spousal consent is not needed, which can simplify the process.
You can submit the form directly to the Processing Center. Some individuals think they can mail the form directly to the Processing Center. However, the correct procedure is to submit the completed form to your employer for signature and processing first.
There are no tax implications for withdrawals. It’s a common belief that all withdrawals are tax-free. In fact, distributions may be subject to federal and state income tax withholding, depending on the type of withdrawal and your specific circumstances.
Any missing information will delay the process. While it’s true that incomplete forms can cause delays, you may not necessarily need to fill out a new form. The plan administrator may reach out for the missing information, allowing the process to continue without starting over.
Partial withdrawals are not allowed. Many assume that they can only withdraw their entire balance. However, partial withdrawals are permitted, provided they comply with the plan's rules. This flexibility can be beneficial for managing your finances.

By clarifying these misconceptions, you can navigate the Transamerica 401K Withdrawal form with greater confidence and understanding.

Key takeaways

Understanding the Transamerica 401K Withdrawal form is essential for making informed decisions about your retirement funds. Here are some key takeaways to consider:

Eligibility Matters: Ensure you meet the eligibility criteria for withdrawal. This form cannot be used for death benefit claims, required minimum distributions, or hardship withdrawal requests.
Complete All Sections: Fill out Sections A-H thoroughly. Missing information may delay your request or require you to start over.
Spousal Consent: If you are married and your plan allows for annuities, your spouse's consent is necessary. This is especially important if your vested account balance exceeds $5,000.
Choose Your Payment Option: Decide whether you want a direct rollover, a combination of cash and rollover, or a cash distribution. Each option has different tax implications.
Tax Withholding Awareness: Be aware that cash distributions are subject to 20% federal income tax withholding. Rollover amounts generally are not taxed at the time of distribution.
Mail Delivery Preferences: Specify your delivery preference. If no address is provided, the one on file will be used. Overnight delivery incurs additional fees.
Outstanding Loans: If you have an outstanding loan, you may need to pay it off to avoid it becoming taxable. Make sure to follow the instructions carefully.
Submit Properly: Do not mail the form directly to the processing center. Instead, submit it to your employer for signature and processing to avoid delays.

By keeping these points in mind, you can navigate the withdrawal process more smoothly and make the most of your retirement savings.