Follow the steps to effectively complete the authorization form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your personal information in the designated fields. Ensure to print legibly and include your status as either an active or retired participant, along with your full name, social security number, date of birth, and mailing address. Include both home and work phone numbers.
3. Indicate the transaction you are requesting. Specify whether you are requesting an exchange, rollover, distribution, or emergency distribution by checking the appropriate boxes. Be sure to indicate the qualifying event that justifies your transaction.
4. If you are requesting an emergency distribution, you must provide documentation supporting your financial unforeseen emergency. Initial each line confirming you have exhausted all other asset options.
5. Fill in the investment provider information for both the surrendering investment provider (where the money is coming from) and the receiving investment provider (where the money is going). Include account numbers, addresses, and contact information.
6. Review the transaction authorization section. By signing, you recognize that your information may be shared with third parties necessary for administering the plan, including Employee Benefits Services & Advisors, Inc. Sign and date the form accordingly.
7. Once the form is complete, save your changes, and choose to download, print, or share the form as needed.

Take action now and fill out your documents online for a seamless experience.