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Write down the requested particulars in Name and Address, Name and Address, Name and Address, QP/401(k) Plan 403(b) Plan, 403(a) Plan 457(b) Plan, Traditional IRA Roth IRA, Traditional IRA Roth IRA, Account Number Account Number , NOTE: Eligible rollover, WITHHOLDING ELECTION Form W-4P OMB, NOTE: This Withholding Election, Do not withhold Federal Income Tax, Do not withhold State Income Tax, Withholding Rate % (must be at, and AUTHORIZATION section.
You will be asked to write down the information to help the program prepare the area Plan Administrator Use Only Date, Termination, Attainment of Normal Retirement Age, Disability, Signature of Plan Administrator , Page 1 of 2, and ©2007 Ascensus.
The area Periodic distributions are treated, Withholding Allowances Marital, Single Married Married, Additional dollar amount to be, Nonperiodic Distributions If you, Remember that there are penalties, Authorization You must authorize, Plan Administrator Use Only Please, Please sign and date the form to, Page 2 of 2, and ©2007 Ascensus is where to indicate each side's rights and obligations.
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