Pension Plan Termination Lump Sum Tax Withholding Form
Provide your instructions for tax withholding on your lump sum distribution upon pension plan termination. Please complete all required fields.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Pension Plan Name
*
Lump Sum Distribution Amount (USD)
*
Federal Tax Withholding Election
*
Withhold standard federal amount
Do not withhold federal taxes
Withhold specific percentage
If 'Withhold specific percentage', enter percentage (%)
State Tax Withholding Election
Withhold state taxes as required
Do not withhold state taxes
Withhold specific percentage
If 'Withhold specific percentage' for state, enter percentage (%)
Signature (Please sign to acknowledge your tax withholding instructions)
*
Submit
Submit
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