This form is used by former employees who continued their account after termination, former employees receiving Installment Payments, or for beneficiaries of deceased participants to make benefit elections. These elections include: Rollover, Cash out, and Installment Options.

Special Tax Notice(PDF)

This form is used by new or existing employees who would like to rollover previous qualified plan money in to the Warren Equities, Inc. Saving and Retirement 401k Plan. This form is to be completed and given to the Plan Administrator of your previous plan. He/She will then send this form to MassMutual with the Rollover amount.

You must also complete a Rollover Statement which will allow you to make Investment Selections in the Warren Equities, Inc. 401k Plan. This form is to be sent directly to the Warren Equities, Inc. Plan Administrator.

This form is used to request a Hardship from your 401k account for reason of either (1) Expense for Medical Care, (2) Purchase of a Primary Residence, (3) Tuition and Related Education Fees or (4) Prevention of Eviction or Foreclosure on your primary residence.

Please refer to the “Explanation of Hardship and Supporting Documentation” link to view guidelines and necessary documentation you will need to support your request.

In addition to the Hardship form and supporting documentation, you will need to complete the Withdrawal form with amount that you are requesting.

Once Hardship has been authorized by the Plan Administrator, you will be ineligible to participate in the plan for a period of 6 months. Of which time, you will not be able to contribute Pre-Tax and Post Tax contributions as well as receive Company Match.

*Your request will need to be verified and authorized by the Plan Administrator. Simply sending in the form does not guarantee a Hardship Withdrawal.

Withdrawal Form(PDF)

This allows qualifying participants to withdraw money from their Warren Equities, Inc. Savings and Retirement Plan*. You are allowed to withdraw monies from your account if you meet one of the following criteria:

1. You are over the age of 59 ½
2. You have monies in your account from a previous rollover
3. You have After Tax monies in your account

Please bear in mind Federal withholding is optional. However, if you do not elect to have federal tax withheld, you will receive a Form1099 at the end of the tax year.

*Your request will need to be verified and authorized by the Plan Administrator. Simply, sending in the Withdrawal form does not guarantee a Withdrawal.

This form allows for employees who participate in the 401k to make changes to their Marital Status, Pre-Tax and Post Tax Contributions, Name, Address, and Social Security Number.

Use this form to designate or change your beneficiary(ies).

This is used by an employee’s former spouse to make a benefit election after a special court order* has been arranged with the employee and former spouse. This allows the alternate payee (former spouse) to (1) set up a separate account under the Warren Equities, Inc. Savings and Retirement plan, (2) allows for a Rollover into another qualifying company retirement plan or IRA, and (3) allows for a Cash Out option.

*The Court Order along with the form need to be sent to the Plan Administrator for verification and authorization.

Please contact Warren Equities, Inc. Insurance Department for more information about Qualified Domestic Relations Orders, if you have any questions.

Special Tax Notice(PDF)

An important tax notice for Participants and Beneficiaries of the Warren Equities, Inc. Savings and retirement plan which discusses the tax consequences of any distributions.

This form is used by former employees to make a benefit election. By using this form you will either (1) elect a Lump Sum Cash Payment, (2)Installment Payments, or (3) leave the total account balance with MassMutual with the understanding that you can make another election at any time after termination.

Special Tax Notice(PDF)

Please submit all forms to:

Warren Equities, Inc.
Insurance Department
27 Warren Way
Providence, RI 02905
insdept@warreneq.com