• RETIREMENT PLAN DISTRIBUTION FORM

  • General Information

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  • Reason for Distribution

  • A. Request for a Rollover to Your Next Employer

  • I would like to rollover $ * or * % of my vested balance to another qualified retirement plan.

  • B. Request for a Rollover to an IRA

  • I would like to rollover $ * * % of my vested balance to an IRA.

  • C. Request for a Direct Payment to You

  • Please issue a distribution paid directly to me equal to $ *      *   or * % of my vested balance. I understand that there is a $50.00 processing fee for distributions.

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  • By electing a Direct Deposit (ACH) and by signing below, I hereby authorize ASC TRUST LLC 1.) to initiate credit entries to the depository financial institution named above 2.) to initiate debit entries to adjust for processing errors. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law.

  • D. Death Benefit Payout

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  • Certification:

    I have read this payment request and affirm that the above information and elections made are accurate and any payments made by the Trustee pursuant to the above (subject to terms of the Plan) will relieve the Trustee of any liability. I certify that the above information is true and correct to the best of my knowledge.
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