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Get Roth Termination Form

D Annuity) Make check payable to: Name of Institution/Trustee TRADITIONAL 401(k) – If you have chosen Both Direct Transfer & Lump Sum, please select the dollar or percent of your Traditional 401(k) account to be transferred. The remaining amount will be paid to you in a lump sum. $ . % $ . % Direct transfer amount: (Must be at least $500) OR ROTH 401(k) – If you have chosen Both Direct Transfer & Lump Sum, please select the dollar or percent of your Roth 401(k) account to be transfe.

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