Understand your withdrawal options
Whether you’re changing jobs or retiring, it’s important to understand your options so you can make an informed decision about what to do with your retirement plan savings at John Hancock. Read more about your choices and next steps, then complete the attached form – or give us a call. We’re here to help.
You have two ways to take action:
Call John Hancock at 1-888-695-4472
We’ll help answer questions about options available to you, such as1:
·Keeping the money in the Plan
·Moving the money to an IRA—including an IRA with John Hancock
·Moving the money to a new employer’s plan, if applicable
·Taking the money in cash2
We’ll introduce you to your plan’s financial professional, if applicable
We’ll help you complete the process, including filling out any paperwork
Work with your financial professional or do it yourself
Review your options with your financial professional1
Fill out the attached Withdrawal – Eligible for Rollover form
Return the form based on the instructions provided to you by your plan administrator
1 There are advantages and disadvantages to all rollover options; you are encouraged to review your options to determine if staying in a retirement plan, rolling over to an IRA, or another option is best for you. 2 Ordinary income taxes are due on withdrawal. Withdrawals before the age of 59½ may be subject to an early distribution penalty of 10%.
John Hancock Personal Financial Services, LLC (JHPFS) is an SEC registered investment adviser.
John Hancock Personal Financial Services, LLC, 200 Berkeley Street, Boston, MA 02116. NOT FDIC INSURED. MAY LOSE VALUE. NOT BANK GUARANTEED.
© 2023 John Hancock. All rights reserved.
Withdrawal – Eligible for Rollover
Have questions or need help?
Call 1-888-695-4472
We’re available Monday through Friday, from 8:30 a.m. to 7:00 p.m., Eastern time.
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Withdrawal - Eligible for Rollover
Important Information about this Form
Your plan may require you to provide supporting documents or additional information before your request can be processed.
As the participant, you complete Sections 1 - 7 of this form and return it to your Plan Representative.
As the Plan Representative, you review Sections 1 - 7, and complete Sections 8 - 10 of this form.
If the participant address provided below is new or different than what is currently on record with John Hancock, we will update our records accordingly. Ensure your next census submission includes revised employee information to avoid your file superseding the information supplied on this form.
A 1099R form will be issued for each distribution and loan default (if applicable) by January 31 of the following year and mailed to the Participant Address provided in Section 1 (or electronically delivered if previously elected by the participant).
This request is subject to the processing and procedure guidelines contained in John Hancock’s Administrative Guidelines for Financial Transactions (“AGFT”). The latest AGFT is available on the John Hancock plan sponsor website or you may contact your
John Hancock representative for a copy.
All changes must be initialed in pen (including items crossed out or changed using correction fluid).
1. General Information
The Trustee of |
{Contractholder_name} |
Plan (“the Plan”) |
{ContractNum2} |
Contractholder Name |
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Contract Number |
{Participant_name} |
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{SSN} |
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Participant Name as displayed on your Social Security Card (Last Name, First Name, Initial) |
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Participant Social Security Number (Full SSN Required) |
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Date |
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{ppt_address} |
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of Birth {DCCIASec3EffectiveDate} |
Participant Address – Street Address |
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Participant |
{PhoneNumber} |
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Phone No. |
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City, State, Zip Code, Country
2. What is the reason for your withdrawal?
It is the responsibility of the Plan Administrator, and not of John Hancock, to ensure that the participant is permitted under the terms of the Plan to receive the distribution selected below.
Select one:
TE – Termination date {FTerminationDate} IR – Employee Money Transferred into Plan
(Must complete Section 3B)
RE – Retirement date {FRetirementDate} DI – Disability
{F15} VC – Employee Voluntary Money |
{F16} PD – Early/Pre-Retirement |
(Must complete Section 3B) |
(If permitted by the Plan) |
Information about Deferred Distributions
Section 1102 of the Pension Protection Act of 2006 requires plans to notify participants that they have the right to defer distributions as well as the consequences of making that choice. The investment options available under your group annuity contract as well as the fees related to the investment options are part of this consideration.
For a description of the investment options available under your group annuity contract, including fees:
Log onto www.johnhancock.com/myplan.
Select: Your contract reports – Investments – Contract investment options and view Selected investment options only.
Alternatively, participants may obtain this information by calling 1-800-395-1113.
You should also review your plan's Summary Plan Description (SPD) which may contain special provisions that may materially affect your decision to defer a distribution. For a copy of the SPD, please contact your Plan Administrator.
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
3. How much do you want to withdraw? Select ONE option only
If no option is selected a TOTAL withdrawal will be processed.
The amounts or percentages below are subject to income tax withholding, as applicable.
A - {F17} Withdraw 100% of my vested account value
OR
B - {F18} Withdraw only a portion of the funds in my plan as follows - Tell us how much to withdraw from each eligible money type (Amount or Percentage). Completing the Investment Fund Code is optional. If the Investment Fund Code is left blank, John Hancock’s standard withdrawal order will be used.
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Money Type |
Investment Fund |
Amount |
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Percentage |
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(Mandatory) |
Code (Optional) |
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{PortionType1} |
{PortionFund1} |
${PortionAmt1} |
OR |
{PortionPct1}% |
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{PortionType2} |
{PortionFund2} |
${PortionAmt2} |
{PortionPct2}% |
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{PortionType3} |
{PortionFund3} |
${PortionAmt3} |
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{PortionPct3}% |
4. What do you want to do with your money?
Complete Section A to have your distribution payable to a single destination. For multiple destinations, complete Section B.
A - {F27} Send my payment to ONE destination – Elect one
{F28} Direct Rollover to an IRA or Roth IRA - Complete Section 5A or 5B
Direct Rollover to Employer Sponsored Qualified Plan - Complete Section 5C Payment Directly to Me - Complete Section 5D
Pay to the Plan Trustee for Deposit into the Plan’s Trust Account - A check will be mailed to the Trustee address on record with John Hancock unless EFT instructions are provided in Section 5C. Taxes will not be withheld and a 1099R Form will not be issued. The Plan Trustee will be responsible for implementing the participant's direction and performing the applicable withholding and reporting obligations. Continue to Section 6.
Leave my money in the Plan. You may defer your distribution to a later date. Consult your Plan Administrator. Continue to Section 6.
B - {F33} Send my payments to MULTIPLE destinations - If applicable, you may provide separate instructions for the taxable and non taxable money that make up your requested withdrawal.
•IRC § 402(c)(2) will apply to any request withdrawing only a portion of the funds in your plan (Section 3B).
•Unless you elect otherwise below, payments directly to you will be deemed to come first from non-taxable amounts (Non- Roth After-Tax contributions, then Roth contributions), followed by taxable amounts in this order: Non-Roth After-Tax earnings, Roth earnings, and Pre-Tax accounts.
•Payments directly to you will be processed first. Any remaining funds will be directly rolled over to the appropriate rollover vehicle indicated below.
•Your withdrawal will be processed in accordance with the time frame described in John Hancock’s Administrative
Guidelines.
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
Split my payment as follows – Select all applicable options and complete the next section
{F36} Pre-Tax and Non-Roth After-Tax Accounts
{F34} Pay $ {TaxDollar} |
or {TaxPercent8} % (elect one) directly to me with the remainder, if any, rolled over as |
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indicated below.
{F37} Roll over my non-taxable balance to:
{F38} Traditional IRA |
{F39} Roth IRA |
{F40} |
(Section 5A) |
(Section 5B) |
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{F41} Roll over my taxable balance to:
{F42} Traditional IRA |
{F43} Roth IRA |
{F44} |
(Section 5A) |
(Section 5B) |
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Employer-sponsored qualified plan
(Section 5C)
Employer-sponsored qualified plan
(Section 5C)
{F45} Roth Account |
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{F54} |
Pay $ {TaxDollar7} |
or {TaxPercent9} % (elect one) directly to me with the remainder, if any, rolled over as |
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indicated below. |
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Roll over my Roth Account to: |
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{F46} |
Roth IRA |
{F47} A designated Roth Account in an Employer-Sponsored Qualified Plan |
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(Section 5B) |
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(Section 5C) |
5. Where do you want your money sent?
Select and complete option(s) A, B, C, and/or D (as applicable)
Federal law requires that 20% of the taxable amount of an eligible rollover distribution be withheld, unless payment is directly rolled over to an eligible retirement plan. The amount withheld may not represent your entire tax bill. The rollover will be reported to the IRS and you are responsible for the payment of the income tax(es) that apply in connection with the rollover. Please refer to the Special Tax Notice provided by your Plan Administrator regarding these tax rules. Contact your tax advisor or Plan Administrator if you have any questions.
{F48} A - Traditional IRA
{F51} Direct Rollover to the following John Hancock product. Your funds will be transferred automatically by wire. You must provide the account number. For more information contact John Hancock at 1-888-695-4472.
Elect one:
John Hancock Investments Rollover IRA (RIRS) |
Account Number: {AccNum1} |
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John Hancock Managed IRA (JHMI) |
Account Number: {AccNum2} |
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John Hancock GIFL Rollover Variable Annuity IRA (GIFL) |
Account Number: {AccNumG1} |
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OR |
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{F55} Direct Rollover to another Financial Institution |
Account Number: {AccNum3} |
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{RO_ Inst_Name} |
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Financial Institution Name |
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{RO_ Inst_Addr} |
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Financial Institution Address – Street, City, State, Zip Code, Country |
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
Electronic Fund Transfer Information (REQUIRED)
You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued it will be mailed according to the standard mailing instructions provided by the Plan Trustee on file with John Hancock. Once you receive the check, you are then solely responsible for delivering the check to the other financial institution. John Hancock is not responsible for any losses you may incur after delivery of the check to you.
Estimated Delivery: • Checks: 7-10 business days • Direct Deposit: 2-3 business days • Wires: 1-2 business days
Electronic Fund Transfer Details
{F59}Direct Deposit |
OR |
{F60} Wire – Verify with receiving bank if they accept wires and/or charge a fee |
Provide Domestic Bank details: |
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{BankName} |
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Bank Name |
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{BankABA} |
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{BankAcctNo} |
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Bank ABA/Routing (9 digits) |
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Bank Account No. |
{F64}For international banks, complete and attach the International Banking Instructions form.
{F65} B - Roth IRA
{F62} Direct Rollover to the following John Hancock product. Your funds will be transferred automatically by wire. You must provide the account number. For more information contact John Hancock at 1-888-695-4472.
Elect one:
John Hancock Investments Rollover IRA (RIRS) |
Account Number: {AccNumR1} |
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John Hancock Managed IRA (JMHI) |
Account Number: {AccNumR2} |
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John Hancock GIFL Rollover Variable Annuity IRA (GIFL) Account Number: {AccNumRG1}
OR |
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{F72} Direct Rollover to another Financial Institution |
Account Number: {AccNumR3} |
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{RO_ Inst_NameR} |
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Financial Institution Name |
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{RO_ Inst_AddrR} |
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Financial Institution Address – Street, City, State, Zip Code, Country |
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Electronic Fund Transfer Information (REQUIRED)
You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued it will be mailed according to the standard mailing instructions provided by the Plan Trustee on file with John Hancock. Once you receive the check, you are then solely responsible for delivering the check to the other financial institution. John Hancock is not responsible for any losses you may incur after delivery of the check to you.
Estimated Delivery: • Checks: 7-10 business days • Direct Deposit: 2-3 business days • Wires: 1-2 business days
Electronic Fund Transfer Details |
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{F77} |
Direct Deposit |
OR |
{F78} Wire – Verify with receiving bank if they accept wires and/or charge a fee |
Provide Domestic Bank details: |
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{BankNameR} |
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Bank Name |
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{BankABAR} |
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{BankAcctNoR} |
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Bank ABA/Routing (9 digits) |
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Bank Account No. |
{F82} |
For international banks, complete and attach the International Banking Instructions form. |
{F83} C - Employer Sponsored Qualified Plan
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The Trustee of {Trustee_Name} |
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{PContractNum} |
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Plan Name |
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Plan Account Number |
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{RO_ Inst_NameEP} |
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Financial Institution Name |
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{RO_ Inst_AddrEP} |
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Financial Institution Address – Street, City, State, Zip Code, Country |
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
Electronic Fund Transfer Information (REQUIRED)
You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued it will be mailed according to the standard mailing instructions provided by the Plan Trustee on file with John Hancock. Once you receive the check, you are then solely responsible for delivering the check to the other financial institution. John Hancock is not responsible for any losses you may incur after delivery of the check to you.
Estimated Delivery: • Checks: 7-10 business days • Direct Deposit: 2-3 business days • Wires: 1-2 business days
Electronic Fund Transfer Details
{F88}Direct Deposit |
OR |
{F89} Wire – Verify with receiving bank if they accept wires and/or charge a fee |
Provide Domestic Bank details: |
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{BankNameEP} |
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Bank Name |
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{BankABAEP} |
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{BankAcctNoEP} |
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Bank ABA/Routing (9 digits) |
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Bank Account No. |
{F93}For international banks, complete and attach the International Banking Instructions form.
{F94} D - Payment Directly to Me – All applicable taxes will be withheld {BkmkSec5D}
Federal Tax Withholding Instructions
For an eligible rollover distribution, such as a partial or lump sum paid to you, you are subject to mandatory 20% federal income tax withholding and any applicable state tax withholding. You can choose a rate greater than 20% for federal withholding by completing the attached Form W-4R Withholding Certificate. You may not choose a rate less than 20%.
Check the box below if you are neither a U.S. person nor a U.S. resident alien. In such case, 30% federal tax withholding will apply unless (1) your country of residence shown below has a tax treaty with the U.S. that provides an exemption from U.S. tax or a lower rate of withholding and (2) you attach a completed and valid IRS Form W-8BEN.
{F96} I am neither a U.S. person nor a U.S. resident alien. Country of residence: {CountryRes}
State Tax Withholding Instructions
Your withdrawal is also subject to any applicable state tax and state tax withholding.
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State of |
Enter state of residence at time of withdrawal if state tax withholding should be taken for a state other than |
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Residence {State} |
the state provided on this form. |
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State of Residence |
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Options for State Tax Withholding |
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AR, DC, KS, MA, MD, ME, NC, |
You may not opt out. Since your distribution was subject to federal income tax, these states |
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NE, VA, VT |
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require mandatory state withholding based on the states’ applicable minimum requirements. |
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Generally, state tax withholding will be applied to your taxable distribution at the rate of 6.99%. |
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However, if you elected a partial withdrawal, a flat dollar amount may be withheld instead, but |
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the amount must be calculated based on a completed CT-W4P form provided to the Plan |
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CT |
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Administrator. If no amount is indicated, 6.99% will be withheld. |
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{F100} |
I elected a partial distribution on this form and provided a completed CT-W4P to my |
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Plan Administrator. The calculated amount to be withheld is: ${TaxDollar6} |
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State tax withholding will be applied to your taxable distribution unless one of the following |
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boxes is checked: |
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{F98} |
I elect to opt out of withholding. |
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MI, IA |
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{F99} |
I am eligible to claim exemption of $ |
{TaxDollar2} |
; withhold tax only on the |
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taxable, distributed amount that is in excess of the exempt amount. |
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If you check one of the boxes above, you are required to return a completed Form W-4P to your |
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Plan Administrator. Ensure that the election made above is consistent with the election made |
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on your completed Form W-4P. |
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State tax withholding of 6.25% will be applied to your taxable distribution unless one of the |
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following boxes is checked: |
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MN |
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{F108} |
I elect to opt out of state tax withholding. |
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{F109} |
Withhold {TaxPercentMN} % or $ |
{TaxDollarMN} |
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
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State tax withholding at the minimum rate will be applied to your taxable distribution unless one |
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of the following boxes is checked: |
OK |
{OKTax1} I elect to opt out of state tax withholding. |
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Withhold {TaxPercentOK} % (minimum 4.75%) |
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{OKTax2} |
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CA, OR |
I elect to opt out of mandatory state withholding. |
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{F101} |
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AL, CO, DE, GA, ID, IL, IN, KY, |
You may elect voluntary state income tax withholding by providing a percentage or whole dollar |
amount to be applied for state tax withholding here. Some states mandate a minimum and/or |
LA, MO, MT, ND, NJ, NM, OH, |
maximum percentage. |
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SC, UT, WV, WI |
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{TaxPercent2} |
% or $ {TaxDollar3} |
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Electronic Fund Transfer Information (REQUIRED)
You must provide electronic fund transfer information below, unless the financial institution requires a check be issued. Where a check is issued, it will be mailed according to the standard mailing instructions provided by the Plan Trustee on file with John Hancock. Once you receive the check, you are then solely responsible for delivering the check to the other financial institution. John Hancock is not responsible for any losses you may incur after delivery of the check to you.
Estimated Delivery: • Checks: 7-10 business days • Direct Deposit: 2-3 business days • Wires: 1-2 business days
Electronic Fund Transfer Details
{F104} Direct Deposit – My personal bank account is: {F105} Checking OR {F106} Savings
OR
{F107} Wire – Verify with receiving bank if they accept wires and/or charge a fee
Provide domestic bank details:
{BankName4}
Bank Name
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{BankABA4} |
{BankAcctNo4} |
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Bank ABA/Routing (9 digits) |
Bank Account No. |
{F111} |
For international banks, complete and attach the International Banking Instructions form. |
6. Waiver of Waiting Period
In general, you have a right to a period of at least 30 days to consider the decision of whether to elect a withdrawal from the day that you receive the Special Tax Notice from your Plan Administrator. However, if your plan permits, you may elect to waive this 30-day waiting period and have your benefit paid earlier. To waive the waiting period, check below:
{F112} I wish to waive the 30-day waiting period
The information provided in this section shall not be maintained or acted upon by John Hancock.
7. Participant Signature
If my withdrawal is made from Funds with the Guaranteed Income feature, I acknowledge that I have read and reviewed the Guaranteed Income feature brochure and fully understand the consequences and impact that my withdrawal will have on my Benefit Base and other benefits provided by this feature. I understand that a brief outline of the terms and conditions governing my withdrawal is also contained in the summary entitled “Important Information about the Guaranteed Income Feature” which can be found on the John Hancock participant website or obtained from my Plan Administrator.
I understand that John Hancock may charge a fee for this withdrawal and that other charges or fees may also apply. I acknowledge that I can refer to my Plan’s 404a-5 Plan & Investment Notice available on the participant website at www.johnhancock.com/myplan for further details.
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
If I am a participant in a contract issued by John Hancock Life Insurance Company of New York, I understand that if any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, shall be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claims for each such violation. I understand that, if I am a participant under a contract issued by John Hancock Life Insurance Company (U.S.A.), civil penalties may apply.
Certification required of U.S. persons only (including U.S. citizens or U.S. resident aliens).
Under penalties of perjury, I certify that:
1.The number shown in Section 1 of this form is my correct taxpayer identification number, and
2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3.I am a U.S. citizen or other U.S. person, including a U.S. resident alien (as defined in the IRS Form W-9 instructions).
Certification Instructions
You must check the box below if you have been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest and dividends on your tax return.
{FCB1} I am subject to backup withholding as a result of a failure to report all interest and dividends.
Since the Plan is an account held in the United States, you are not required to provide a code indicating that you are exempt from FATCA reporting.
Under penalties of perjury, I certify the above statements.
Note: The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
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{FNamePrint} |
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{FSigDate} |
Signature of Participant |
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Name - please print |
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Date |
The following sections are to be completed by the Plan Representative.
8. Withdrawal Details
Has the final contribution been submitted for this participant?
If the final payroll for this participant has not been submitted to John Hancock, provide the final payroll ending date. If a date is provided, John Hancock will coordinate processing of the distribution with receipt of the final payroll to avoid additional contribution payouts that often remain uncashed. If no date is provided, the distribution will be processed as soon as administratively possible upon receipt of the form in good order.
{DCCIASec3EffectiveDate}
Is the participant withdrawing In-Plan Roth Rollover (IRR) assets?
For a total withdrawal, we will report the original rollover amount processed as the amount allocable to IRR assets. For a partial withdrawal, provide the amount allocable to IRR assets $ {TaxDollar4}
Note: All Roth assets held by the participant need to be taken into consideration when calculating the amount allocable to the IRR. If left blank, we will report the amount requested as being first allocable to the IRR assets.
IRS Distribution Code
The applicable IRS distribution code will be based on the type of distribution and/or age of the participant. If the early distribution exception code applies, check here. {F119} (Code 2 will be applied)
Loans
If a loan is active at time of distribution (Termination, Retirement or Disability), the applicable age dependent loan distribution code will apply. Loans can only be rolled over to an employer sponsored qualified plan.
If the loan rollover code applies, check here. {F120} (Code G will be applied.)
GP5479US (1/2026) |
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
Vesting percentage(s)
Vesting is mandatory for partial and total termination, retirement, disability and total early/pre-retirement withdrawals. The unvested money will be forfeited using instructions given in the Employer Unvested Money section below. For all other withdrawals vesting is not required.
{TaxPercent3}% for ALL Employer money types
OR
Vesting varies by money type as indicated below
Money Type |
% |
|
|
ER Match |
{VestPct} |
Profit Sharing |
{VestPct2} |
Employer Unvested Money
Other ER Money |
% |
|
|
{PortionTypeER1} |
{VestPct3} |
{PortionTypeER2} |
{VestPct4} |
Other ER Money |
% |
|
|
{PortionTypeER3} |
{VestPct5} |
{PortionTypeER4} |
{VestPct6} |
If no box is selected below, direction for forfeitures previously provided to John Hancock will be applied to any unvested money in the participant’s account. If no direction for forfeitures has been provided and no box is selected below, any unvested money will remain in the participant’s account invested according to the current investment instructions.
If you determine the unvested portion of the account is not forfeitable, then you may wish to select leave in participant’s account as invested so that the participant continues to have the ability to direct the investment of the full balance of his/her account (including any unvested money).
Transfer to Cash Account Refund to Plan Trustee
Pay outstanding John Hancock charges
Leave in Participant account and transfer to default fund Leave in Participant account as invested
9. Third Party Administrator (TPA) Withdrawal Fee
Complete this section to direct John Hancock to pay the fee indicated below from the participant’s account balance to the Third Party Administrator currently on record for the Contract. No fee will be applied if this section is not completed.
The fee will be deducted from the participant’s account balance at the time of the distribution using the standard withdrawal protocol and will be held in John Hancock’s general business account until paid to the TPA.
${TaxDollar5} |
OR |
{TaxPercent4}% |
|
|
|
|
|
Flat Fee Amount |
|
Percentage of |
|
|
|
Invested Balance |
John Hancock is not responsible for any uncollected fee amounts as a result of insufficient funds. These shortages will be reported on the transaction and summary confirmations.
10. Trustee/Authorized Signer Signature
If the participant does not sign the participant Signature section, I, the undersigned, certify, under penalties of perjury that, the participant, as applicable, certified to me that (i) the name shown on this form is the legal name of the participant; (ii) the number shown on this form is the correct taxpayer identification number (Social Security Number) of the participant; and, (iii) the participant is a U.S. person (including a U.S. resident alien) unless indicated otherwise above.
I hereby direct and authorize John Hancock to implement the instructions provided on this form. I represent that the certifications, directions, acknowledgements, authorizations, and agreements contained in this form are complete and correct and agree that John Hancock will rely on them, including to determine the tax withholding and reporting requirements applicable to the requested withdrawal. I represent that the withdrawal(s) requested herein are permitted by law and in accordance with the Plan. If the amount withdrawn is paid directly to the Plan Trustee, I also agree that I am responsible for the proper handling of the funds in accordance with the law. I represent that any Third Party Administrator fee is in accordance with the agreement with the Third Party Administrator and is reasonable and authorized under the terms of the Plan.
I certify that the required participant elections and consents to this withdrawal including, if applicable, spousal consent for married participants as required by IRC Sec. 417, have been properly obtained. I further certify that all necessary and applicable information required under IRC Sec. 417 and an explanation of the direct rollover option and related tax rules required under IRC Sec. 402 have been provided to the participant. I further certify that the funds being withdrawn are not for the purpose of prohibited transactions as defined in IRC Sec. 4975. I also certify that, if applicable, (i) the participant has waived the 30-day waiting period; and (ii) the Withholding Certificate for Pension or Annuity Payments (Form W-4P) for the states of Michigan and Iowa have been properly obtained, completed in accordance with Michigan and Iowa law, and that any amount exempt from state tax withholding described above accurately reflects such Withholding Certificate submitted by the participant.
If the participant is under the age of 18, I certify that consent to this request has been obtained from the parent or legal guardian authorized to act on the participant's behalf.
GP5479US (1/2026) |
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Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.
On behalf of the Plan Sponsor, the Plan and its related trust, I further agree to indemnify and hold harmless John Hancock and its affiliates, and each of their employees, agents, directors, and officers from and against any and all losses, liabilities, penalties, and taxes that it or they may incur as a result of complying with the instructions provided on this form or any of the certifications provided on this form being incorrect.
|
|
{FNamePrint} |
|
{FSigDate} |
Signature of Trustee/Authorized Signer |
|
Name - please print |
|
Date |
GP5479US (1/2026) |
Page 9 of 12 |
Manulife, Manulife Retirement, Stylized M Design, and Manulife Retirement & Stylized M Design are trademarks of The Manufacturers Life Insurance Company and John Hancock and the Stylized John Hancock Design are trademarks of John Hancock Life Insurance Company (U.S.A.). Each are used by it and by its affiliates under license.
© 2025 Manulife John Hancock Retirement. All rights reserved.