Beacon Benefits - Rollover/Distribution Request

Rollover/Distribution Request

In general you may request to either rollover your account or take a distribution of your account when you stop working for your employer.

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For specific rules governing rollovers and distribution, please Request an SPD

Company / Plan Name:
Participant Name:
Participant Phone:
Participant Email:
Participant Address:
City:
State:
Zip Code:
Last Day Worked:
Birth Date:
Month Day Year
Type of Withdrawal:

Termination Retirement
Term / Retire Date:
Month Day Year
Comments / Notes:
By clicking submit, you understand that BBI will draw up the nessacary paperwork, and mail it to the address provided above within 48 hours. Unless, otherwise requested.
Should be Empty:

Please remember your former employer must authorize all plan distributions.

Beacon Benefits, Inc.

205B Willow Street • South Hamilton, MA 01982

p: (978) 468-1555 • f: (978) 468-2221 • info@beacon-benefits.com