Contract Exchange And Plan Transfer Withdrawal Request
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4CONTRACT EXCHANGE AND
PLAN TRANSFER WITHDRAWAL REQUEST
1. PLAN INFORMATION
(Please print)
__ __ __ __ __ __
EMPLOYER NAME: __________________________________________________ SCHOOL DISTRICT PLAN NUMBER:
(Can be found on your quarterly statement.)
❏
❏
403(b)
457
NAME: ______________________________________________________________________________________________________
LAST
FIRST
MIDDLE
SOCIAL SECURITY NUMBER: ____________________________________________
STREET ADDRESS: ______________________________________________________________________________________________
CITY: ____________________________________________________________
STATE:________________
ZIP: ______________
DAYTIME PHONE: ____________________________________________________
2. WITHDRAWAL AMOUNT
❏
Withdraw 100% of my account to the extent permitted under the CalSTRS Pension2 product(s).
❏
Withdraw a portion of my account, based on the sources indicated below. (Source names can be found on your quarterly statement.)
Employee
Employer
Rollover
Other_____________
$___________ or _______%
$___________ or _______%
$___________ or _______%
$___________ or _______%
• If no election is made, we will withdraw 100% and close your account.
• If the amount available for withdrawal is less than the dollar amount you are requesting, the transaction will be processed for the maximum
amount available. I understand that the withdrawal amount elected above may be subject to contractual limitations under the CalSTRS Pension2 __
product(s). If such contractual limitation applies, my election will be applied to the withdrawal amount available under the CalSTRS Pension2
product(s).
3. WITHDRAWAL ELECTIONS FOR NON ROTH ACCOUNTS
W3TWITHDRAWAL ELECTIONS FOR NON ROTH ACCOUNTSNTS
Letter of Acceptance is required unless (1) request is signed by Employer, OR (2) by special contract between the Company
and the Employer.
INTERNAL Voya TO Voya PLAN TRANSFER/EXCHANGE form should be completed for transfers within Voya.
Withdrawal Type
❏
403(b) Contract Exchange – A participant (or, if applicable, a beneficiary maintaining the 403(b) account) directing the
investment of some or all of the participant account to another approved vendor under the school district’s 403(b) plan.
As a tax-free transfer, this transaction does not generate federal income tax withholding or information reporting.
❏
Plan to Plan Transfer – A participant, (or, if applicable, a beneficiary maintaining the participant account under the applicable
plan of the school district) directs some or all of the participant’s account out of your existing plan established under a specific
IRC section to another plan that is also maintained under that same IRC Section (e.g., 403(b) to another 403(b), governmental
457(b) to another governmental 457(b)). Note that a plan-to-plan transfer among a governmental 457(b) plan and a nonprofit
457(b) plan is prohibited under IRS rules. As a tax-free transfer, this transaction does not generate federal income tax
withholding or information reporting.
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