HARDSHIP WITHDRAWAL APPLICATION FORM
This Hardship Withdrawal Application form is designed for employees seeking to withdraw funds from their 401(k) due to financial hardships. It outlines the required information, penalties, and necessary certifications for the withdrawal. Completing this form correctly is crucial for approval by the company's Plan Committee.
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How do I fill this out?
To fill out the Hardship Withdrawal Application, begin by gathering your personal details, such as your name and social security number. Next, clearly describe the nature of your financial hardship in the appropriate section. Finally, ensure all required signatures are obtained before submission.

How to fill out the HARDSHIP WITHDRAWAL APPLICATION FORM?
1
Gather your personal information, including SSN.
2
Clearly describe the nature of your hardship.
3
Calculate the amount you wish to withdraw.
4
Obtain necessary signatures, if required.
5
Submit the completed application to HR.
Who needs the HARDSHIP WITHDRAWAL APPLICATION FORM?
1
Employees facing financial emergencies need this form.
2
Participants in a 401(k) plan seeking hardship withdrawals require this application.
3
Individuals who have exhausted other resources for financial assistance should fill this out.
4
Married individuals withdrawing over $5,000 must submit this form.
5
Those needing to prove financial hardship for home-related expenses require this application.
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Fill in or adjust the necessary information as needed.
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What are the instructions for submitting this form?
To submit this application, ensure all required fields are accurately filled out. You can send it via email to the HR department or deliver it in person for processing. Make sure to keep a copy for your records, and contact HR if you need assistance with your submission.
What are the important dates for this form in 2024 and 2025?
The key dates for submitting hardship withdrawals depend on your company's policies. For 2024, ensure applications are submitted as required based on your financial situation. In 2025, review any updates to withdrawal policies and apply accordingly.

What is the purpose of this form?
The purpose of the Hardship Withdrawal Application is to help employees access their 401(k) funds during urgent financial crises. It serves to document the specific hardship faced and to confirm that all other financial options have been exhausted. This process ensures that withdrawals are aligned with federal regulations and company policies.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Name: Full name of the applicant.
- 2. Social Security Number: Unique identification number assigned to the employee.
- 3. Current Date: Date of form submission.
- 4. Mailing Address: Complete address for correspondence.
- 5. Date of Birth: Employee's date of birth.
- 6. Home Phone Number: Contact number for the employee.
- 7. Marital Status: Indication of marital status (Single/Married).
- 8. Business Phone Number: Work contact number for the employee.
- 9. Nature of Hardship: Description of the financial difficulty faced.
- 10. Amount Requested: Specific amount employee wishes to withdraw.
What happens if I fail to submit this form?
Failure to submit this application could result in the inability to access necessary funds during a financial crisis. It is essential to ensure submission aligns with company policies and deadlines.
- Delayed Access to Funds: Without submission, employees may remain unable to meet urgent financial needs.
- Increased Financial Burden: Not completing this process may lead to aggravated financial difficulties.
- Potential Penalties: Employees may incur additional costs if funds cannot be accessed timely.
How do I know when to use this form?

- 1. Medical Emergencies: To cover medical expenses that are urgent and necessary.
- 2. Preventing Eviction: To seek financial help preventing eviction or foreclosure.
- 3. Education Costs: For tuition and educational fees necessary for continued education.
Frequently Asked Questions
What is the purpose of the hardship withdrawal application?
This application allows employees to request withdrawals from their retirement accounts due to financial hardships.
Who should fill out this form?
Any employee experiencing financial distress who meets the withdrawal criteria should complete this form.
How do I submit the completed application?
You can submit it via email or hand it to your HR department for processing.
Is there a deadline for submitting the form?
There may be deadlines based on your company's specific guidelines and the nature of your hardship.
What penalties might I face for withdrawing?
Withdrawals may incur a 10% early withdrawal penalty depending on your circumstances.
Can I edit the PDF form?
Yes, PrintFriendly provides tools to edit the PDF before downloading it.
How do I sign the PDF?
You can easily add your signature within the PDF using the provided signing tools.
What if my spouse needs to sign as well?
The form can be signed digitally by both you and your spouse if required.
Will the Plan Committee contact me after submission?
Yes, they may reach out for additional information or clarification.
How can I ensure my application is approved?
By accurately completing the form and providing sufficient documentation of your hardship.
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