QP/401(k) Separation From Service Distribution Request Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Participant Information section. Enter your Social Security Number, full name, and address. If your address has changed since your last statement, check the corresponding box.
3. In the Distribution Instructions section, select how you wish to receive your distribution. Choose from options such as receiving your entire vested account or rolling over a portion to another plan or IRA.
4. If applicable, complete the Insurance Information section regarding any life insurance associated with your account. Indicate whether you want to cash surrender the policy or assign it.
5. Fill out the Direct Rollover Information if you are rolling over funds. Specify the financial organization and account numbers for where you want to roll over your distribution.
6. Complete the Withholding Election section if necessary, indicating whether you want federal and state taxes withheld from your distribution.
7. Finally, sign and date the Authorization section to certify that all information is accurate before submitting it to your plan administrator.

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