Used to change and/or correct beneficiary information and participant name information for a participant's account (shown on The Journey^SM or Benefit Statements). Participants generally may update beneficiary designation electronically through The Journey^SM. Spousal consent may be required for a married participant’s beneficiary designation.

Used when a Beneficiary or a QDRO Alternate Payee chooses to leave the account balance with MassMutual. The beneficiary or alternate payee must complete this form and attach it to the Notice of Death election form. If the deceased has multiple beneficiaries, each beneficiary electing to leave the account balance must complete the form and return it with the completed Notice of Death election form.

Used by active Participants who are age 70˝ or older. A 5% owner must request a benefit option each year until retirement, and non-5% owners may delay their benefit or request a withdrawal. NOTE: The Special Tax Notice and the State Tax Information document must be provided to the Participant with this distribution form.

NOTE: The Special Tax Notice and the State Tax Information document must be provided to the Participant with this distribution form.

Used to request: (1) one-sum cash payments or annuities for active 5% owners over age 70˝; (2) distributions for surviving beneficiaries who continued the deceased Participants' accounts, and (3) for plans not serviced by our Retirement Specialist Group, benefit options or partial withdrawals for terminated or retired Participants who continued their accounts. Use the link above if spousal consent is not required for distributions. Otherwise, use the "Spousal Consent Required" link below.

NOTE: The Special Tax Notice and the State Tax Information document must be provided to the Participant with this distribution form.

A Waiver of Qualified Joint and Survivor Annuity form will also need to be completed.

NOTE: The Special Tax Notice and the State Tax Information document must be provided to the Participant with this distribution form.

Used by the Participant's prior employer or IRA to forward a distribution eligible for rollover into your Plan directly to MassMutual.

NOTE: A Rollover Statement is also needed.

Used to request a hardship withdrawal from the Plan prior to separation from service. First, the Participant must complete a Participant Hardship Statement or Primary Beneficiary Hardship Statement as applicable. For withdrawal without financial hardship, complete an In-Service Withdrawal Request form.

• Primary Beneficiary Hardship Statement
  Used by the Plan Administrator to determine that a hardship withdrawal is available to a participant when the plan allows for these withdrawals to be based on a qualifying hardship of the participant’s primary beneficiary. Please do not submit this form to MassMutual.
  
  
• Participant Hardship Statement
  Used by the Plan Administrator to determine, based on safe harbor determination for hardship, whether a Participant has financial hardship qualifying for an in-service withdrawal. Please do not submit this form to MassMutual.

NOTE: The Special Tax Notice and the State Tax Information document must be provided to the Participant with this withdrawal request form.

For Terminated Employees Only - Used to change and/or correct information for Participant's account: the Participant's name, Social Security number, date of birth, marital status, or beneficiary designation.

Please submit all forms to:

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