Lincoln Request Distribution – Fill Out and Use This PDF

Is this the correct form?

This form can be used for the most common distribution reasons. This will result in a payment to another company.

If you would like to request a distribution for another reason, please refer to the

Moving your money to another company can be a big decision.

Understanding whether your rollover, transfer, or exchange of assets is permissible under current regulations will help you to limit any tax consequences. To get you started, we have provided a general summary of the different methods to move your money. For additional information, please consult with a tax advisor and/or go to the IRS website, https://www.irs.gov.

Lincoln website for the applicable form. DO NOT use this form for:

•Hardship or Unforeseeable emergency

•Required minimum distribution (RMD)

•Excess withdrawal (refund)

•Death claim (you are the beneficiary)

•Plan termination

•In-plan Roth conversion

Need additional help?

VISIT

LincolnFinancial.com or

CALL

1-800-234-3500,

M - F, 8 am - 8 pm ET

Methods to move your money

Rollover

A rollover is the movement of assets between two different retirement plans. You can elect a rollover if you:

yy Are no longer employed with the employer administering this plan.

yy Are retired.

yy Meet the age requirements for an in- service withdrawal. (Check with your plan administrator/employer for age restrictions.)

yy Are totally and permanently disabled.

yy Are an alternate payee due to a Qualified Domestic Relations Order.

For example: You could move assets from an existing retirement account that is from a former employer to your retirement account with your current employer or to an IRA.

Refer to the Special Tax Notice for more information about what types of transactions are eligible for rollover.

Please note: If you are required to take a minimum distribution for this calendar year, your annual RMD must be satisfied before a rollover can be processed. If you elect a rollover, we will automatically distribute any outstanding RMD, withhold taxes, and mail a check to your address on record. If you would like more options for RMD withdrawal, please complete the RMD form, available on the Lincoln web site, before electing a rollover.

Contract exchange

A contract exchange is only available to 403(b) plans. It is a tax-free transfer of one 403(b) account to another 403(b) account within the same 403(b) retirement plan. No reason for distribution is necessary, but an exchange must be permitted by the plan.

(A contract exchange may not be available in your plan. Please contact your plan administrator/employer to see if

this option is available.)

For example: Your employer offers multiple retirement plan providers and you may transfer assets from one 403(b) provider to another.

Plan-to-plan transfer

A plan-to plan transfer is a transfer of assets from one retirement plan to another retirement plan. You can elect a plan-to-plan transfer if:

yy The transfer is between the same plan type (such as 403(b) plan to 403(b) plan).

yy Both plans allow for the transfer.

Please note: This type of transfer is usually used when you are not eligible for a distribution/rollover but wish to consolidate your retirement assets within a single plan.

For example:

You are working for an employer that is part of a group of employers. Each employer sponsors their own 403(b) plan. (IE: a group of hospitals, each has their own retirement plan) You transfer employment from one employer to another employer within this group.

(IE: move from one hospital to another within the same organization) You are not eligible for a distribution/ rollover, but you would like all of your retirement assets in one plan. If both employers’ plans permit the transfer, this would allow you to consolidate your retirement assets.

(A plan-to-plan transfer may not be available to your plan. Please contact your plan administrator/employer to see if

this option is available.)

Permissive service credit transfer

A permissive service credit transfer is a type of plan-to-plan transfer used to purchase additional service in a government defined benefit plan.

You may be eligible to transfer money from your current retirement plan to a government defined benefit plan. This money would be used to purchase additional service or benefits under that plan. No reason for distribution is necessary.

(Transfer to purchase service credits may not be available to your plan. Please contact your plan administrator/employer to see if this option is available.)

Is this the correct form?

This form can be used for the most common distribution reasons. This will result in a payment to another company.

If you would like to request a distribution for another reason, please refer to the Lincoln website for the applicable form.

DO NOT use this form for:

1Tell us about yourself.

Marital status: Please provide your martial status in order to ensure timely

processing of your distribution.

Marital status

 I do not have a living spouse.  I have a living spouse.

Employment status (choose one)

 I retired on (mm/dd/yyyy)

/

/

.

Date of birth (mm/dd/yyyy)

Restrictions may apply depending on your plan provisions. Please contact

your plan administrator/employer to discuss what options are available.

If you are totally and permanently disabled: A letter from the Social Security Administration is required.

For Qualified Domestic Relations Orders: A copy of the court order, divorce, or legal separation is required.

If you have Roth and/or after tax money, please verify that your receiving

company will accept your rollover.

When requesting a rollover of pre-tax money to a Roth IRA you will still be liable

for payment of federal and state income tax, if applicable, at the time you prepare your personal tax filing. You may wish to discuss your personal tax liability with a qualified tax advisor.

Receiving company information: If your receiving company information is incomplete or inaccurate, we will issue the check to the receiving company but mail it to your address. You will be responsible for mailing the check to the receiving company to complete the transaction.

 I am no longer working for the employer that administers this plan as of​

 I am currently employed with the employer that administers this plan. (Restrictions may apply.)   I am totally and permanently disabled. 

 I am not an employee. (You are the alternate payee due to a Qualified Domestic Relations Order.) 

2How should we move your funds to another company?

Please refer to “Requesting a distribution to another company” included with this form.

I would like to distribute my money in the form of a (choose one)

 Rollover

If you have after tax contributions and you elect a rollover, Lincoln will automatically include your after tax contributions unless you tell us otherwise by checking this box:  Do not include my after tax contributions in this rollover. 

 Contract exchange (Restrictions may apply.)   Plan-to-plan transfer (Restrictions may apply.) 

 Permissive service credit transfer (Restrictions may apply.) 

Type of receiving plan/account (choose one)

 401(k)   403(b)   401(a)   457(b) governmental

 Individual Retirement Account (IRA) (Traditional, SEP, SIMPLE, etc.)

 Roth IRA    Defined benefit plan

Restrictions may apply to options (where noted) on this form depending on your plan.

Please contact your plan administrator/ employer to discuss what options are available.

Amount options (choose one)

 Send 100% of my account balance to another If applicable, your distribution will automatically include the

provided. Skip to Step 6.) (Restrictions may apply.) 

Direct Deposit: If your bank account information is illegible or incomplete,

Lincoln will issue a check and mail to your address on file.

Please note: We cannot direct deposit to reloadable bank cards.

If you direct deposit to a checking account: A voided

check or a verification of deposit from your financial institution is required.

If you direct deposit to a savings account: A verification of deposit from your financial institution is required.

The amount you receive:

The total amount you receive from this distribution will be reduced by the total amount of taxes withheld. Depending on your available balance, you may adjust your requested distribution amount to account for additional taxes that may be assessed as part of your tax liability.

Federal tax withholding election: If you do not provide a rate, or if you

provide a federal tax withholding rate that is less than 20%, we are still required to withhold the applicable minimum.

Please note: Your distribution may be subject to an additional 10% early distribution penalty tax. This penalty tax will be assessed when you file your tax returns as part of your tax liability and is not automatically included in your tax withholding for this distribution.

PAD-2185169-071918

RPS92618-AL-T (7/18)

 Send me a partial cash payment of

$and send the remainder of my account balance to another company as described in Step 2. (Dollar amount must be

provided. Continue to Step 4.)

4How would you like to receive your payment?

Only complete this section if you are receiving a partial cash payment.

I would like my payment to be sent as a (choose one)

 Direct deposit to my personal bank account as described here:

Type of account:   Checking    Savings

 Check, mailed to my address on file. 

5How do taxes impact your partial cash payment?

Only complete this section if you are receiving a partial cash payment.

Lincoln will withhold taxes from your distribution at the rates detailed below and automatically send the withholding to the IRS on your behalf. Please refer to the Special Tax Notice for more information.

Taxes withheld from your distribution will include:

yy Federal tax (if applicable) 

20% mandatory withholding applies to distributions that are eligible for rollover.

Indicate here if you would like to withhold federal taxes at a higher rate than the mandatory 20%:

Did you know?

If you move this year: Please update your address to receive your tax documents for use when you file your income taxes.

To update your address: If you are an active employee, contact your employer; if you are no longer employed, call Lincoln.

6Sign and date this form.

For New York residents only: 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 civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

By signing below, I certify that:

yy I have read and understand the Important Fraud Notice and Important Information sections on the last page of this form.

yy I have received the Special Tax Notice, and if applicable, I waive the required 30-day notice period before receiving my distribution.

yy I am responsible for meeting the federal tax law requirements to qualify for this distribution. yy My answers on this form and any documents I have attached are true and accurate.

yy If there are not enough funds in my retirement account for the amount requested, Lincoln will process the withdrawal from the amount available.

yy If applicable to this plan, I have received the Qualified Joint and Survivor Annuity (QJSA) notice; waive the 30 day review period and normal QJSA form of payment; and instead; elect to receive this distribution as detailed on this form.

/

/

If spousal consent is required and if your plan administrator does not sign

here as a witness to your spouse’s signature, you must have a notary sign, seal, and date where noted to the right.

7Your spouse’s signature may be required.

In some instances, your spouse may be required to sign this form. Please call your plan administrator/ employer to determine if this is required for your plan. This section is not needed for distributions due to Qualified Domestic Relations Order.

By signing below, I certify that I am the spouse of the individual named above and that:

yy If applicable to this plan, I have received the QJSA notice, consent to my spouse’s election to waive the normal QJSA form of payment, and consent to my spouse’s election to an immediate distribution as detailed on this form.