Transaction Request
A separate request must be submitted for each investment company. 
One request may be submitted for multiple transactions at one company if all account numbers are listed.   

Basic Information

Transaction Type Descriptions 
Distribution: Withdraw funds from your 403(b)/457(b) account
Exchange: Move funds to another investment company under the employer's 403(b)/457(b) plan
Rollover: Move funds between the employer's 403(b)/457(b) plan and a non-403(b)/457(b) account
Transfer: Move funds between the employer's 403(b)/457(b) plan and another employer's 403(b)/457(b) plan
Loan: Borrow from your 403(b)/457(b) account
QDRO: Move funds from your 403(b)/457(b) account to comply with a court's qualified domestic relations order
Distribution Reason (matches qualifying event on transaction paperwork) *
 
Rollover Reason (matches qualifying event on transaction paperwork) *
 
Reason for Hardship *
 

Submitter Details

Person Submitting Request *
 

Employee Information

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You Selected Age 59 ½+ as the Transaction Reason *
Potential discrepancy with age 59 ½+ selection
Processing delays could result
Please confirm date of birth and transaction reason
 
 
Send Confirmation Email to Employee (In Addition to Submitter)? *
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403(b)/457(b) Account Information

Additional Documentation (PDFs Only)


Attach the following documentation (select the file or drag & drop):
• Transaction forms from your investment company
• Transaction forms from your investment company (the "from" investment company above)
• Death certificate 
• Birth certificate or adoption certificate
• Documentation of hardship-related expenses
• Documentation of disability
• Certified copy of court's QDRO

Delivery Instructions

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Affirmation

I affirm that the information I have provided is accurate and complete. *
Signature *
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