Form Gp5479Us – Fill Out and Use This PDF

Includes: Withdrawal – Eligible for Rollover Form

Same goal. New choices.

Whether you’re changing jobs or retiring, it’s important to understand your options so you can make an informed decision about what to do with your retirement plan savings at John Hancock. Read more about your choices and next steps, then complete the attached form – or give us a call. We’re here to help.

You have two ways to take action:

Call John Hancock at 1-888-695-4472

Our Rollover Specialists will help answer questions about the options available to you:*

-Keep your money in the Plan

- Roll over to a John Hancock IRA - Roll over to another IRA

- Roll over to new employer-sponsored plan

-Take a cash distribution (see box at right)

We’ll introduce you to your plan’s financial representative if applicable

We’ll help you complete the process, including filling out any paperwork

Work with your financial representative or do-it-yourself

 Review your options with your financial representative*

Fill out the attached Withdrawal – Eligible for Rollover Form

Return it based on the instructions provided to you by your plan administrator

Our Rollover Specialists are here to make your

transition a smooth one. Call us at 1-888-695-4472.

*Each distribution option has its own potential advantages, disadvantages and tax consequences. Anyone interested in these transactions or topics should seek advice based on his or her particular circumstances from independent professional advisors. There may be additional distribution options that are available only under your specific plan. Please check with your plan administrator for more information.

John Hancock Personal Financial Services, LLC, also referred to as “John Hancock”, is an affiliate of John Hancock Retirement Plan Services.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

NOT FDIC INSURED | MAY LOSE VALUE | NOT BANK GUARANTEED

© 2019 All rights reserved.

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Withdrawal - Eligible for Rollover

Important Information about this Form

Your plan may require you to provide supporting documents or additional information before your request can be processed.

As the participant, you complete Sections 1 - 7 of this form and return it to your Plan Representative.

As the Plan Representative, you review Sections 1 - 7, and complete Sections 8 - 10 of this form.

If the participant address provided below is new or different than what is currently on record with John Hancock Retirement Plan Services, we will update our records accordingly. Ensure your next census submission includes revised employee information to avoid your file superseding the information supplied on this form.

A 1099R form will be issued for each distribution and loan default (if applicable) by January 31 of the following year.

This request is subject to the processing and procedure guidelines contained in John Hancock’s Administrative Guidelines for Financial Transactions (“AGFT”). The latest AGFT is available on the John Hancock plan sponsor website or you may contact your John Hancock representative for a copy.

All changes must be initialed in pen (including numbers crossed out or changed using correction fluid).

1. General Information

City, State, Zip Code, Country

2. What is the reason for your withdrawal? – Select  ONE option only

It is the responsibility of the Plan Administrator, and not of John Hancock Retirement Plan Services, to ensure that the participant is permitted under the terms of the Plan to receive the distribution selected below.

Information about Deferred Distributions

Section 1102 of the Pension Protection Act of 2006 requires plans to notify participants that they have the right to defer distributions as well as the consequences of making that choice. The investment options available under your group annuity contract as well as the fees related to the investment options are part of this consideration.

For a description of the investment options available under your group annuity contract, including fees:

Log onto www.johnhancock.com/myplan.

Select: Your contract reports - Investments - Contract investment options and view Selected investment options only. Alternatively, participants may obtain this information by calling our toll free service line at 1-800-395-1113.

You should also review your plan's Summary Plan Description (SPD) which may contain special provisions that may materially affect your decision to defer a distribution. For a copy of the SPD, please contact your Plan Administrator.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

3. How much do you want to withdraw? Select  ONE option only

If no option is selected a TOTAL withdrawal will be processed.

The amount or percentage below will be withdrawn as a gross withdrawal before income tax withholding.

A - Withdraw 100% of my vested account value

OR

B - Withdraw only a portion of the funds in my plan as follows - Tell us how much to withdraw from each eligible money type (Amount or Percentage). Completing the Investment Fund Code is not mandatory. If the Investment Fund Code is left blank, John Hancock Retirement Plan Services’ standard withdrawal order will be used.

4. What do you want to do with your money?

Complete Section A if you wish to make your distribution payable to only a single destination. For multiple destinations, complete Section B.

A - Send my payment to ONE destination only - Select ONE option only.

Direct Rollover to an IRA or Roth IRA - Complete Section 5A or 5B

Direct Rollover to Employer Sponsored Qualified Plan - Complete Section 5C Payment Directly to Me - Complete Section 5D

Pay to the Plan Trustee for Deposit into the Plan’s Trust Account - A check will be mailed to the Trustee address on record with John Hancock Retirement Plan Services unless EFT instructions are provided in Section 5C. Taxes will not be withheld and a 1099R Form will not be issued. The Plan Trustee will be responsible for implementing the participant's direction and performing the applicable withholding and reporting obligations. Continue to Section 6.

Leave my money in the Plan. You may defer your distribution to a later date. Consult your Plan Administrator. Continue to Section 6.

OR

B - Send my payments to MULTIPLE destinations - If applicable, you may provide separate instructions for the taxable and non taxable money that make up your requested withdrawal.

•IRC § 402(c)(2) will apply to any request withdrawing only a portion of the funds in your plan (Section 3B).

•Payments directly to you will be deemed to come first from non-taxable amounts (from Non-Roth After-Tax contributions then Roth contributions followed by taxable amounts) in the following order: Non-Roth After-Tax earnings, Roth earnings and Pre-Tax accounts.

•Payments directly to you will be processed first. Any remaining funds will be directly rolled over to the appropriate rollover vehicle indicated below.

•Your withdrawal will be processed in accordance with the time frame described in our Administrative Guidelines.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

Electronic Fund Transfer Information (REQUIRED)

You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued it will be mailed according to the standard mailing instructions on file with John Hancock Retirement Plan Services, as established by the Plan Trustee.

D - Payment Directly to Me – All applicable taxes will be withheld

Federal Tax

A taxable distribution (and, if applicable, each outstanding loan balance) is subject to 20% mandatory minimum federal tax withholding for a U.S. person (including a U.S. resident alien).

To request a higher tax rate, specify a whole number above 20%: {TaxPercent} % (refer to DOL Field Assistance Bulletin 2004-02 for details).

OR {F96} I am neither a U.S. person nor a U.S. resident alien. Country of residence: {CountryRes}

Unless I have attached a completed IRS Form W-8BEN, withholding federal tax of 30% will apply.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

State Tax Withholding Instructions

Electronic Fund Transfer Information (REQUIRED)

You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued it will be mailed according to the standard mailing instructions on file with John Hancock Retirement Plan Services, as established by the Plan Trustee.

Expected Delivery: • Checks: 7-10 business days • Direct Deposit: 2-3 business days • Wires: 1-2 business days

Wire – Verify with receiving bank if they accept wires and/or charge a fee

Provide domestic bank details:

{BankName4}

Bank Name

{F111}For international banks, complete and attach the International Banking Instructions form.

6. Waiver of Waiting Period

In general, you have a right to a period of at least 30 days to consider the decision of whether to elect a withdrawal from the day that you receive the Special Tax Notice from your Plan Administrator. However, if your plan permits, you may elect to waive this 30-day waiting period and have your benefit paid earlier. To waive the waiting period, check below:

I wish to waive the 30-day waiting period

The information provided in this section shall not be maintained or acted upon by John Hancock Retirement Plan Services.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

7. Participant Signature

If my withdrawal is made from Funds with the Guaranteed Income feature, I acknowledge that I have read and reviewed the Guaranteed Income feature brochure and fully understand the consequences and impact that my withdrawal will have on my Benefit Base and other benefits provided by this feature. I understand that a brief outline of the terms and conditions governing my withdrawal is also contained in the summary entitled “Important Information about the Guaranteed Income Feature” which can be found on the John Hancock Retirement Plan Services participant website or obtained from my Plan Administrator.

John Hancock Retirement Plan Services may charge a fee for this withdrawal request. Other charges or fees may also apply. Please refer to your plan’s 404a-5 Plan & Investment Notice available on the participant website at www.johnhancock.com/myplan for further details.

For participants under a contract issued by John Hancock Life Insurance Company of New York, any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claims for each such violation. For all other states, civil penalties may apply.

Certification required of U.S. persons only (including U.S. citizens or U.S. resident aliens).

Under penalties of perjury, I certify that:

1.The number shown in Section 1 of this form is my correct taxpayer identification number, and

2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3.I am a U.S. citizen or other U.S. person, including a U.S. resident alien (as defined in the IRS Form W-9 instructions).

Certification Instructions

You must check the box below if you have been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest and dividends on your tax return.

{FCB1} I am subject to backup withholding as a result of a failure to report all interest and dividends.

Since the Plan is an account held in the United States, you are not required to provide a code indicating that you are exempt from FATCA reporting.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Please note that, by signing this form, you declare that you make the above certifications under penalties of perjury. Under penalties of perjury, I certify the above statements.

The following sections are to be completed by the Plan Representative.

8. Withdrawal Details

Has the final contribution been submitted for this participant?

If the final payroll for this participant has not been submitted

to John Hancock Retirement Plan Services, provide the final payroll ending date.

If a date is provided, John Hancock Retirement Plan Services will coordinate processing of this distribution with receipt of the final payroll to avoid additional contribution payouts that often remain uncashed.

Is the participant withdrawing In-Plan Roth Rollover (IRR) assets?

For a total withdrawal, we will report the original rollover amount processed as the amount allocable to IRR assets. For a partial withdrawal, provide the amount allocable to IRR assets $ {TaxDollar4}

Note: All Roth assets held by the participant would need to be taken into consideration when calculating the amount allocable to the IRR. If left blank, we will report the amount requested as being first allocable to the IRR assets.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.

10. Trustee/Authorized Signer Signature

If the participant fails to sign the Signature section, the Trustee/Authorized Signer below certifies, under penalties of perjury, that based on the plan sponsor's record, (i) the name shown on this form is the legal name of the participant; (ii) the number shown on this form is the correct taxpayer identification number (Social Security Number) of the participant; and, (iii) the participant is a U.S. person (including a U.S. resident alien) unless indicated otherwise above. I acknowledge that John Hancock Retirement Plan Services will rely on this certification in determining the tax withholding and reporting requirements applicable to the requested distribution and agree to hold John Hancock Retirement Plan Services harmless for any errors made in reliance upon this certification.

I hereby authorize John Hancock Retirement Plan Services to rely and act upon the instructions provided on this form. I understand that it is my responsibility to ensure that the withdrawal(s) requested herein are permitted by law and, if applicable, consistent with the terms of the Plan. If the amount withdrawn is paid directly to the Plan Trustee, I also agree and acknowledge that I am responsible for the proper handling of the funds in accordance with the requirements of the law.

I certify that all the above information is complete and correct, that the required participant elections and consent and, if applicable, spousal consent for married participants as required by IRC Sec. 417, have been properly obtained, and that the funds being withdrawn are not for the purpose of prohibited transactions as defined in IRC Sec. 4975. I also certify that all necessary and applicable information required to be furnished to the participant under IRC Sec. 417 and an explanation of the direct rollover option and related tax rules required by IRC Sec. 402 have been provided. I also certify that, if applicable, (i) the participant has waived the 30-day waiting period; and (ii) the Withholding Certificate for Pension or Annuity Payments (Form W-4P) for the states of Michigan and Iowa have been properly obtained, completed in accordance with Michigan and Iowa law, and that any amount exempt from state tax withholding described above accurately reflects such Withholding Certificate submitted by the participant.

In the event that the participant is under the age of 18, I certify that consent to this request has been obtained from the parent or legal guardian authorized to act on the participant's behalf.

I hereby direct John Hancock Retirement Plan Services to pay to the Third Party Administrator currently on record the above referenced fee (if applicable). I understand that this fee will be deducted from the participant's account balance at the time of the distribution using standard withdrawal protocol and will be held in the general business account of John Hancock Retirement Plan Services until paid to the Third Party Administrator. I hereby represent that this fee is in accordance with the fee schedule that has been approved by the plan's trustee or named fiduciary as reasonable and authorized under the terms of the plan.

On behalf of the Plan Sponsor, the Plan and its related trust, and the Plan Trustee or named Fiduciary, I further agree to indemnify and hold harmless John Hancock Retirement Plan Services, its employees, agents, directors, and officers from any liability, penalties, and taxes that may be incurred as a result of the requested distribution giving rise to one or more prohibited transactions or for implementing requests (including, if applicable, a direct rollover request) based solely on the instructions provided on this form, or if any of the certifications provided on this form are incorrect.

Group annuity contracts and recordkeeping agreements are issued by: John Hancock Life Insurance Company (U.S.A.) (“John Hancock USA”), Boston, MA (not licensed in New York) and John Hancock Life Insurance Company of New York (“John Hancock NY”), Valhalla, NY. Product features and availability may differ by state. John Hancock USA and John Hancock NY each make available a platform of investment alternatives to sponsors or administrators of retirement plans without regard to the individualized needs of any plan. Unless otherwise specifically stated in writing, John Hancock USA and John Hancock NY do not, and are not undertaking to, provide impartial investment advice or give advice in a fiduciary capacity.