Method to Obtain a Distribution: Please contact Fidelity to determine if you may request a distribution by telephone or by a standard 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Alternate Payee Information' section. Use a black pen and print clearly in capital letters. Provide your Social Security number, date of birth, name, address, and phone numbers.
3. Next, complete the 'Participant Information' section with the participant's Social Security number and plan number if known.
4. In the 'Participant’s Employer Information' section, enter the name of the employer or plan sponsor associated with your retirement plan.
5. Select the reason for your distribution in Section 4. Ensure you understand any restrictions that may apply based on your selection.
6. Choose your distribution options in Section 5. Make sure to select only one option that suits your needs.
7. Indicate how you would like to receive payments in Section 7. Choose from options such as check or electronic funds transfer.
8. Complete Section 8 regarding income tax withholding based on your status as an alternate payee.
9. Sign and date the form in Section 9, certifying that all information is accurate.
10. If required, ensure that Section 10 is completed for plan sponsor approval before mailing your form to Fidelity Investments at the provided address.

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