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SSN: XXX-XX-1234 Name: ADAMS, JOHN DOB: 01/01/1955
Plan Number: 565011 Plan: ABC RETIREMENT SAVINGS PLAN 1

Withdrawal Request

Marital Status Single
This Plan requires spousal consent. If the participant is married, paperwork is required for this transaction.
Termination Date Override (mm/dd/yyyy):
Initiator TPA
Last Updated 11/08/2016 01:08:29 PM
Date 11/08/2016
Time 01:08:29 PM EST
Task Type Withdrawal
Confirmation Number 4012462T612
Request Type Partial Term
Amount or percent of available amount requested. If distribution includes an amount requested as a rollover, see details under rollover section.
Amount:  $1,400.00
Available Amount (Note: The amount displayed may be updated based on a vesting override): $10,184.61
Distribution Fee: $50.00
participant opted out of state withholding   

Vesting Override

The participant is in a status that does not allow vesting to be changed. Please contact the Voya Plan Management Team if a vesting override is needed.

Source Source Name Market Value Vested % Vested Value Override Vesting %
D Employer Matching 10,184.61 100.0 10,184.61
G Roth 44,876.00 100.0 44,876.00
Task Type Roth Withdrawal Transaction
Confirmation Number 4012463T612
Request Type Roth Partial Term
Amount or percent of available amount requested. If distribution includes an amount requested as a rollover, see details under rollover section.
Amount:  $2,000.00
Available Amount (Note: The amount displayed may be updated based on a vesting override): $44,876.00
participant opted out of state withholding   

Delivery Options

  Check here to send all payments by expedited delivery for an additional fee of $50.00
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   Send this distribution check payable to the participant to the address below.
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ACH

The participant would like to have their withdrawal directly deposited into their account in 2 to 3 business days. Below is the participant's account information.

Account Type Checking
Routing Number 565011789
Account Number achtest1234

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