F10110 - Cash Withdrawal From Your Keogh Plans

CASH WITHDRAWAL

FROM YOUR KEOGH PLANS

TAHCW/OTCPAYCSH

F10110 (1/23)

NEED HELP? Call TIAA at

800-842-2252, weekdays,

8 a.m.-10 p.m. (ET).

GENERAL INFORMATION

Tax information in this form is not intended as tax advice. If you have any questions about the impact

of a requested distribution on your personal tax situation, you should consult a qualified tax advisor.

Your account will be valued as of market close on the date we receive this form in good order. If your request

is received after market close, it will be valued at the close of the next business day. If you changed your

address with us in the last 14 days, a bank letter is required; otherwise, you must wait 14 days after the

address change to submit the withdrawal request.

If this plan is subject to ERISA, the spousal waiver section is only valid for 180 days from the date the Notary

Public validates it. The signature on the withdrawal form is valid for 365 days.

WITHDRAWALS

Withdrawals from a money purchase Keogh plan due to hardship, as defined by the IRS, are not allowed.

IRS regulations governing withdrawals from a profit-sharing Keogh plan due to hardship provide that

the accumulation available for withdrawal can consist only of contributions, generally not earnings,

andwithdrawals due to hardship are:



Subject to the 10% penalty tax if the withdrawal is made before age 59½;



Subject to optional 10% income tax withholding; and



Not eligible to be rolled over to any IRA or another plan.

We will send you the withdrawal amount after we receive your completed forms in good order. To avoid delays,

be sure to complete all sections.

TAX INFORMATION

Certain plan restrictions may apply to withdrawals under the following circumstances: in-service, separated

from service, disabled, or have encountered a hardship as defined by the Internal Revenue Service (IRS).

You may be subject to a 10% federal tax penalty for early withdrawal if you were under age 55 when your

employment ended or if you are under age 59½ when you take this withdrawal. Please see your tax advisor.

A withdrawal is taxable if it is not rolled over to another tax-deferred account. For rollover eligible withdrawals,

we are required to withhold 20% for federal taxes.

CASH WITHDRAWAL

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F10110 (1/23)

Do you want to receive your money faster? Find out if you can request your withdrawal online - just log in to your account at TIAA.org,

clickon “Manage My Portfolio” and select “Rollover or Withdraw Money.” Some restrictions may apply.

Please print using black ink.

IMPORTANT: A full Social

Security Number/Taxpayer

Identification Number is

required to process

your request.

If you claim residence and

citizenship outside the U.S.,

you must certify your foreign

tax status by providing IRS

Form W-8BEN within the

last three years or submit a

W-8BEN in addition to this

form. To print the W-8BEN

form, go to TIAA.org/forms

and scroll to ‘Find

tax information.’

1. PROVIDE YOUR INFORMATION

Title First Name Middle Initial

Last Name Suffix

Social Security Number/

Taxpayer Identification Number Contact Telephone Number Extension

State of Legal Residence (Including U.S. territories.

If outside the U.S., write in Country of Residence) Citizenship (if not U.S.)

* The Plan and Sub Plan

Numbers should have

been provided when you

requested the form. If you

don’t have them, call

TIAA at 800-842-2252,

weekdays,

8 a.m.-10 p.m. (ET).

2. PROVIDE YOUR CONTRACT NUMBERS

TIAA Number

Plan Number* Sub Plan Number*

Plan Name

Was this contract issued as a result of a Divorce (Qualified Domestic Relations Order)?

Yes No

3. REQUIRED MINIMUM DISTRIBUTIONS

If you are over 72 and using this withdrawal to satisfy IRS Required Minimum Distribution, please complete

this section. If not, please move to next section.

This is to satisfy my required minimum distribution (current year only).

I have provided my own calculation. $

I want TIAA to calculate my minimum distribution.

Are you married? Yes No

Spouse’s Name Spouse’s Date of Birth (mm/dd/yyyy)

CASH WITHDRAWAL

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F10110 (1/23)

Withdrawals from certain

mutual funds may be subject

to redemption fees. See fund

prospectus for additional

information.

PLEASE NOTE: Your account

will be valued as of either

the close of business on the

date we receive this form in

good order, or a future date

if you specified a date in

Option 2.

4. WITHDRAWAL AMOUNT (CHECK ONE)

OPTION 1: Withdraw entire amount available (Skip to Section 8).

OPTION 2: Withdraw only a portion of account balance (Continue to Section 5).

If you have chosen OPTION 1 or OPTION 2 above and do not want these monies sent to you immediately,

please specify a future date for TIAA to send the funds to you.

Date (mm/dd/yyyy)

FUTURE DATE: Please process my withdrawal request on:

OPTION 3: Systematic Withdrawal (Continue to Section 6).

IMPORTANT NOTE: If you

are currently subscribed to

RetirePlus and you choose

specific funds, your account

will be subsequently

rebalanced using your

RetirePlus instructions

onfile.

* Example: If you enter

$15,000 and you’re paying

off $8,000 total in loan(s),

then you will receive a

withdrawal amount of

$7,000.

5. CHOOSE THE AMOUNT TO WITHDRAW FROM INVESTMENTS

How much would you like to withdraw? (please select only one)

I would like to withdraw $

proportionately from all available investments.*

(Enter the dollar amount here and leave the specific investment section below blank.)

I would like to withdraw the following amount(s). Indicate either the dollar amount OR percentage from

each account. Percentages must be in whole numbers.

Percent of

Investment Account/Fund Name Withdrawal Amount Fund Value

CASH WITHDRAWAL

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F10110 (1/23)

Your last payment may be

less than your requested

amount. The last payment

amount will be the balance

left in your account at the

time that the last payment

transaction occurs.

You can choose to stop

recurring payments

at any time.

6. SYSTEMATIC WITHDRAWALS

Complete this section if you wish to establish a series of systematic payments. If not, move to next section.

How often do you want to receive withdrawals (choose one)? (The amount(s) you note above, will be the

amount you receive at the frequency selected below.)

Monthly Quarterly Semiannually Annually

Your payments will continue as above until there are no monies in designated funds.

When do you want to start receiving withdrawals?

If your plan is funded by a Transfer Payout Annuity (TPA), you may choose any date from the 5

to the 28

of the month. All others may choose any date from the 1

to the 28

(mm/dd/yyyy)

Start Date:

(mm/dd/yyyy)

Stop Date:

7. TELL US WHERE TO SEND YOUR WITHDRAWAL? (CHOOSE ONE)

A. Direct Deposit to my bank account. (Also complete Section 8)

B. Roll over to another TIAA account.* (Also complete Section 10)

C. Roll over to another investment company.* (Also complete Section 11)

D. Mail a check to my current address on file.

Note: To ensure your account is secure, we can’t send a check to a mailing address that has changed in

the last 14 days. So, if you’re requesting that we send the payment to your mailing address and you’ve

recently changed it, we may not be able to process your current request. Call us so we can discuss some

of your options for completing your request.

*If you selected option B or C above, then please tell us how to apply your after-tax monies:

Include in my rollover

Do not include in my rollover. TIAA will send you a check.

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F10110 (1/23)

8. PROVIDE PAYMENT INSTRUCTIONS

OPTION 1: Direct Deposit to my verified bank account

Please provide the bank account information you previously verified with TIAA to request a direct deposit.

If the account has not been verified, follow the steps in the next section. Once this has been completed

and TIAA has verified the bank account, please provide the information below.

Account Number

Bank Name ending in

Checking Account Savings Account

OPTION 2: Mail a check to my current address on file

Note: To ensure your account is secure, we can’t send a check to a mailing address that has changed in

the last 14 days.

9. ADD BANK ACCOUNTS FOR ELECTRONIC TRANSFERS FOR PERSONAL BANK

ACCOUNT AND ESTATE, TRUST AND THIRD-PARTY ACCOUNTS

TIAA must verify your bank account information before making any electronic payments to you. Based on the

type of account to be used, follow the instructions below.

OPTION 1: PERSONAL BANK ACCOUNT

In many instances, personal bank accounts can be verified immediately using your bank routing and account

numbers. Have this information ready before you start. To verify your bank account information, TIAA offers

the following options:

1. Add a bank account online (best option)



Click the Actions tab



Click Manage external accounts



Click Add New Account and follow the instructions on the screen

2. Verify an account by phone



Call TIAA at 800-842-2252, weekdays, 8 a.m. to 10 p.m. (ET)



Explain that you would like to verify a bank account



Provide the account type, bank routing number and account numbers



TIAA will process your request

Account verification often is completed quickly. In some cases, however, we may need to verify your account

using test deposits. This may take one or two business days to complete, and you will be guided on any

actions you may need to take.

NOTE: If any of the items specified above are missing, we will send your payment by check to the current

address on file. To ensure your account is secure, we can’t send a check to a mailing address that has

changed in the last 14 days.

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F10110 (1/23)

OPTION 2: ESTATE, TRUST AND THIRD-PARTY ACCOUNTS

For accounts not owned directly by a TIAA customer, documentation is needed to verify transfer

authorizations. In these cases, please provide the necessary information as noted below:

1. Send by mail, or upload a photo of, an original voided check with this form. Starter checks, deposit

slips and third-party checks are not acceptable.

2. Send by mail, or upload, an original letter from your bank on bank letterhead providing:



Name of the account



Address on the account



Bank/ABA routing number



Account number



Account type (personal checking account or personal savings account)



Authorized signers for the account



Signature of the financial institution’s representative, confirmed by the financial institution’s notary;

or, it must be a signature guarantee including the stamp or seal from the financial institution’s

authorized representative.

NOTE: If any of the items specified above are missing, we will send your payment by check to the current

address on file. To ensure your account is secure, we can’t send a check to a mailing address that has

changed in the last 14 days.

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TAHCW/OTCPAYCSH

F10110 (1/23)

10. ROLL OVER TO ANOTHER TIAA ACCOUNT

What type of account are you rolling over to? (Choose only one and provide account number.)

My existing employer’s plan.

TIAA Number CREF Number

Plan Number Sub Plan Number

Plan Name

My existing Roth or Traditional IRA (Please choose ONE of the following):

I already have my account number:

I opened my account within the last 30 days and do not yet have the account number to provide.

If you checked Roth IRA, and want federal taxes withheld from the pretax amount you’re converting

to a TIAA Roth IRA, please complete Section 12. If you don’t complete Section 12, we will not

withhold federal taxes.

A new Roth or Traditional IRA

Check here and attach enrollment form (call 800-842-2252 for form).

We will default to Allocations

on File if no selection is

made.

How would you like the funds allocated? (Choose only one)

Allocations on File (of the receiving plan).

Different Allocations – provide detail below.

Indicate either the dollar amount or percentage to each account/fund. Amounts or percentages must be

whole numbers.

NOTE: If the amount you are

rolling over includes funds

currently invested in the TIAA

Real Estate Account, please

provide your investment

allocations to the right.

Percent of

Investment Account/Fund Name Rollover Amount Fund Value

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F10110 (1/23)

The investment company

receiving your rollover must

complete the Investment

Company Information.

11. ROLL OVER MY WITHDRAWAL TO ANOTHER INVESTMENT COMPANY

What type of account are you rolling over to? (Choose only one)

Traditional IRA (complete the Investment Company Information)

Roth IRA (complete the Investment Company Information)

If you checked Roth IRA, and want federal taxes withheld from the pretax amount you’re converting

toa TIAA Roth IRA, please complete Section 12. If you don’t complete Section 12, we will not withhold

federal taxes.

Other Plan (complete the Investment Company Information)

INVESTMENT COMPANY INFORMATION

Investment Company Name

Investment Company Address

City State Zip Code

Contact Telephone Number Account Number

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F10110 (1/23)

Federal laws may require

mandatory federal income

tax be withheld from your

distributions. Our records

indicate that you are a

U.S. person (U.S. citizen or

resident, non-U.S. citizen)

and may, therefore, be

subject to federal tax

withholding from

cash distributions.

12. TAX WITHHOLDING FOR YOUR ROLLOVER TO A ROTH IRA

Tax withholding from rollover amounts to your Roth IRA will be governed by this section and not by any other

section in this form.

VOLUNTARY FEDERAL WITHHOLDING FOR YOUR ROLLOVER TO YOUR ROTH IRA

For a rollover to a Roth IRA, in accordance with IRS guidance, TIAA will not withhold amounts for federal tax

purposes unless you complete a W-4R Withholding Certificate for Nonperiodic Payments and Eligible Rollover

Distributions. If you desire federal withholding, please check the box below to agree to voluntary withholding:

I hereby notify TIAA that I will provide a federal form W-4R Withholding Certificate, and I will voluntarily

elect federal withholding by entering a rate between 0% and 100% on such form.

I understand that if I do not complete and submit a federal form W-4R Withholding Certicate to TIAA with

this transactional form, TIAA will not withhold federal withholding.

STATE WITHHOLDING FOR YOUR ROLLOVER TO YOUR ROTH IRA

State income tax withholding may be required from your rollover to Roth IRA.

If state withholding is mandatory, we will withhold at the rate required by your state. Please note that

the state may allow you to elect not to have withholding applied, to choose additional withholding,

or to specify the rate of withholding. For more information on state tax withholding, go to

TIAA.org/public/tax-withholding. Call TIAA if you have any questions at 800-842-2252.

CASH WITHDRAWAL

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F10110 (1/23)

If this is a rollover eligible

withdrawal and you did

not select any federal tax

withholding, then TIAA will

not withhold federal taxes.

13. TAX WITHHOLDING FOR AMOUNTS DISTRIBUTED TO YOU

If you have requested a cash withdrawal, such withdrawals are rollover-eligible distributions.

ROLLOVER ELIGIBLE WITHDRAWAL (CHECK ONE)

For all rollover-eligible withdrawals, TIAA is required to withhold the default rate of 20% for federal taxes

unless your payment is being directly rolled over to another tax-deferred account.

I hereby notify TIAA that I decline to provide a substitute federal form W-4R Withholding Certificate for

Nonperiodic Payments and Eligible Rollover Distributions. I understand that federal withholding will be

withheld at the default rate of 20%.

I am providing a substitute federal form W-4R Withholding Certificate for Nonperiodic Payments and

Eligible Rollover Distributions. I am making a federal withholding election of a rate greater than the

default rate of 20% as indicated on my substitute federal form W-4R Withholding Certificate.

If you are a nonresident, non-U.S. citizen, you must certify your foreign tax status by providing IRS Form

W-8BEN prior to requesting a distribution. A W-8BEN is maintained on file for a three-year period. To print the

W-8BEN form, go to TIAA.org/forms and scroll to ‘Find tax information.’

STATE TAX WITHHOLDING

State income tax withholding may be required from your distribution. If state withholding is mandatory,

we will withhold at the rate required by your state. Please note that the state may allow you to elect not to

have withholding applied, to choose additional withholding, or to specify the rate of withholding. For more

information on state tax withholding, go to TIAA.org/public/tax-withholding. Call TIAA if you have any

questions at 800-842-2252.

If this is a non-rollover

eligible withdrawal and you

do not select an available

federal withholding option,

then TIAA will withhold 10%

for federal taxes.

14. TAX WITHHOLDING FOR YOUR HARDSHIP WITHDRAWAL OR RMD

If you receive a hardship withdrawal required minimum distribution, such distributions are nonperiodic

distributions that are non-rollover eligible.

NONPERIODIC DISTRIBUTIONS THAT ARE NON-ROLLOVER ELIGIBLE (CHECK ONE)

A non-rollover eligible withdrawal is a withdrawal that cannot be rolled over or is considered non-rollover

eligible because of taxation rules. Some examples of non-rollover eligible withdrawals are Hardship and

Required Minimum Distribution (RMD).

Please select one option below.

I hereby notify TIAA that I decline to provide a substitute federal form W-4R Withholding Certificate for

Nonperiodic Payments and Eligible Rollover Distributions. I understand that federal withholding will be

withheld at the default rate of 10%.

I am providing a substitute federal form W-4R Withholding Certificate for Nonperiodic Payments and

Eligible Rollover Distributions. I am making a federal withholding election as indicated on my substitute

federal form W-4R Withholding Certificate by entering a rate between 0% and 100% on line 2.

I am providing a substitute federal form W-4R Withholding Certificate for Nonperiodic Payments and Eligible

Rollover Distributions. I am choosing to have no federal income tax withheld by entering “-0-” on line 2.

Continued on next page

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F10110 (1/23)

You must read, date and sign

where indicated in order to

make a withdrawal.

If you’re married, you must

sign and date this section

before your spouse signs

Section 17.

15. YOUR AUTHORIZATION AND SIGNATURE

By signing in the “Your Signature” box below:



You authorize TIAA to make withdrawals from your TIAA account balances, as stated in this form.



If you requested that your withdrawal be directly deposited, you authorize that the bank charge your

account and refund any overpayments to TIAA. You release your bank from any liability to TIAA for

overpayment above the amount of the funds available at the time TIAA requests a refund.



If you make a direct rollover into another employer’s plan, you understand your right to receive a distribution

of these funds will be determined by the plan that is accepting the rollover and the funds in which your

direct rollover are invested. You further understand that if you make a direct rollover to another employer’s

plan that is subject to the Employee Retirement Income Security Act of 1974 (ERISA), spousal rights will

apply to these funds and you may need a signed waiver from your spouse in order to receive a subsequent

distribution of these funds.



For your protection, TIAA may require additional verification of your identity before accepting your transaction

as in good order. You agree that your transaction will be valued as of the market close on the business day

that all of the steps necessary to verify your identity and the transaction to be in good order have been

completed. You also agree that in the event these steps are completed after the market close on a business

day, then your transaction will be valued as of the market close on the next business day. The amount

of money that you receive will depend on the share or unit price on the day on which your transaction is

deemed to be in good order. Due to market fluctuations, the price your shares or units ultimately receive

could be less than the share or unit price when you initiated this transaction. It is also possible that if we

are unable to reach you to verify this transaction within 5 days, this transaction may be canceled.

Please sign your full

legal name with suffix, if

applicable, using black ink,

or online using TIAA’s digital

signing experience.

Your Signature Today’s Date (mm/dd/yyyy)



Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer

identification number (or I am waiting for a number to be issued to me); 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; and (4) the FATCA code(s) entered on this

form (if any) indicating that I am exempt from FATCA reporting is correct.

Generally, you are not permitted to elect to have federal income tax withheld at a rate of less than 10%

(including 0%) on payments to be delivered outside of the United States and its possessions.

STATE TAX WITHHOLDING

State income tax withholding may be required from your distribution. If state withholding is mandatory, we

will withhold at the rate required by your state. Please note that the state may allow you to elect not to

have withholding applied, to choose additional withholding, or to specify the rate of withholding. For more

information on state tax withholding, go to TIAA.org/public/tax-withholding. Call TIAA if you have any

questions at 800-842-2252.

Continued from previous page

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F10110 (1/23)

Unmarried Verification: If

you are unmarried, ONLY

complete Section 16.

Please sign your full

legal name with suffix, if

applicable, using black ink,

or online using TIAA’s digital

signing experience.

Please sign your full

legal name with suffix, if

applicable, using black ink.

16. UNMARRIED VERIFICATION

I certify that I am not married AND no longer work for the employer that contributed to this plan.

Your Signature Today’s Date (mm/dd/yyyy)

I certify that I am not married AND I am currently working for the employer that contributed to this plan.

Note: The Plan Representative will need to certify in the Plan Representative Certification section below.

Your Signature Today’s Date (mm/dd/yyyy)

PLAN REPRESENTATIVE CERTIFICATION

By signing, you certify that the participant is not married.

Plan Representative’s Signature Today’s Date (mm/dd/yyyy)

Plan Representative’s Name (Please print) Title

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In this space, the Notary Public must provide his/her

notarial number and the date the appointment expires.

To the participant: If you

are married, ONLY your

spouse will need to complete

Section 17.

Your spouse’s consent is

required for distributions

taken in a form other

than a qualified joint and

survivor annuity to the

extent your plan is subject

to the Employee Retirement

Income Security Act (ERISA),

or due to the terms of your

employer’s plan requiring

such consent.

Remember, spouse must

sign and date this waiver on

or after the participant has

signed this form.

This section must be completed

by a Notary Public. TIAA

accepts online notarization.

You may notarize your

documents online by visiting

www.Notarize.com/TIAA.

Notarize.com is a third-party

vendor that charges a fee for

each notary transaction. If

you reside outside the United

States, you can go to a U.S.

Embassy/U.S. Consulate or

U.S. Bank Branch to obtain a

Notary Public’s signature.

NOTE: A Notary Public or

other officer completing this

certificate verifies only the

identity of the individual

who signed the document

to which this certificate

is attached and not the

truthfulness, accuracy or

validity of that document.

Please contact your benefits

office to complete the Plan

Representative Certification

instead of a Notary Public

Certification.

Please sign in black ink.

17. SPOUSE’S WAIVER OF SURVIVOR BENEFITS

As the spouse of a participant in an employer-sponsored retirement plan, and in accordance with federal

pension law and/or the terms of the participant’s plan, you have the right to receive a survivor benefit of at

least 50% of the participant’s (the account owner’s) accumulation if he or she dies before you (referred to as

a qualified joint and survivor annuity (“QJSA”)). The amount may be more depending on the plan provisions.

With this form, your spouse is requesting a distribution in a form other than the QJSA as well as a required

minimum distribution (RMD) in the event your spouse has provided instructions to roll over the requested

distribution and has not received RMDs in accordance with federal tax law. Because this means that the

money used for the distribution will no longer be available to provide a QJSA survivor benefit to you, we must

get your consent before completing the transaction. Please read and sign the statement below only if you

agree to the distribution in a form other than the QJSA. You do not have to sign this form. If you do not, you

will receive the QJSA survivor benefit described in the Explanation of the Qualified Joint and Survivor Annuity.

By signing, I confirm that I have read and understand the Explanation of the Qualified Joint and Survivor

Annuity, which includes information about the QJSA and the requirements for spousal consent. I hereby agree

to this distribution and understand that the amount to be distributed will not be available as a QJSA survivor

benefit. I also understand that this waiver applies to this request only; it does not apply to future requests.

First Name Last Name

Signature Today’s Date (mm/dd/yyyy)

OPTION 1: NOTARY PUBLIC CERTIFICATION

State County Notary Expiration Date (mm/dd/yyyy)

On the date noted below, the subscriber known to me to be the person described in and who executed the

foregoing instrument and he/she acknowledged to me that he/she executed the same.

Notary Public’s Signature

Today’s Date (mm/dd/yyyy)

FOR NOTARY PUBLICS IN FLORIDA

The foregoing instrument was acknowledged before me, by means of:

Physical presence

Online notarization

OPTION 2: PLAN REPRESENTATIVE CERTIFICATION

By signing, you are certifying you witnessed the spouse’s signature.

Plan Representative’s Signature Today’s Date (mm/dd/yyyy)

Plan Representative’s Name (Please print) Title

IMPORTANT: You must have your signature witnessed by a Notary Public OR the contributing employer’s Plan

Representative. You must sign and date this waiver on or after your spouse has signed the distribution form.

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To the Plan Owner:

You must complete and

sign this section if the early

withdrawal is due

to disability.

Please sign using black ink.

18. EARLY WITHDRAWAL CERTIFICATION–DISABILITY

Your employer’s plan representative must complete and sign this section if your withdrawal is because

of disability.

I certify that the person named below is eligible for a distribution of retirement plan contributions, as

permitted by the Internal Revenue Code (IRC) and the terms of the retirement plan, because he/she is

disabled as defined by the IRC. The individual is unable to engage in any substantial gainful activity by

reason of a medically determinable physical or mental impairment that is expected to result in death or to

be of a long-continued and indefinite duration. The disability was as of the following date:

First Name of Participant Middle Name of Participant

Disability Date

Last Name of Participant of Participant (mm/dd/yyyy)

EMPLOYER PLAN REPRESENTATIVE CERTIFICATION

Employer Plan Representative’s Signature Today’s Date (mm/dd/yyyy)

Employer Plan Representative’s Name (please print) Title

Telephone Number

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Enter the percentage or

dollar amount if you want

taxes withheld. If you are a

U.S. citizen residing outside

the United States, you must

elect income tax withholding.

Nonresident, non-U.S.

citizens must complete

Form W-8BEN.

If we did not include a copy,

please visit our website

at TIAA.org to print

Form W-8BEN, or call

us, and we’ll mail one to

you. Form W-8BEN is also

available from the Internal

Revenue Service website

atirs.gov.

19. EARLY WITHDRAWAL CERTIFICATION–HARDSHIP

You and your employer’s plan representative must complete this section.

A. YOU COMPLETE THIS PORTION.

Yes, I certify I have an immediate and heavy financial need and I am requesting a hardship withdrawal.

Please complete Section 14 for federal and state tax withholding.

B. YOUR EMPLOYER COMPLETES THIS PORTION.

I certify that, having met the Internal Revenue Code and regulations financial hardship definition as of the

date shown, the below-named person is eligible for a distribution of any of the following:



403(b) and/or 401(k) elective deferral contributions (excluding post-1988 403(b) earnings);



employer contributions, as permitted by the employer’s plan, to a 401(a) profit sharing plan or to a 403(b)

(1) annuity contract.

I understand that it is my responsibility to verify whether a participant is entitled to receive an in-service

distribution or plan loan and whether the participant will be required to take such a distribution or loan prior

to authorizing the hardship distribution.

Please sign using black ink.

First Name of Participant Middle Name of Participant

Last Name of Participant Date of Eligibility (mm/dd/yyyy)

/ /

EMPLOYER PLAN REPRESENTATIVE CERTIFICATION

Plan Name Amount Approved for Hardship

Employer Plan Representative’s Signature Today’s Date (mm/dd/yyyy)

/ /

2 0

Employer Plan Representative’s Name (please print) Title

Telephone Number

CASH WITHDRAWAL

FROM YOUR KEOGH PLANS

Page 15 of 15

TAHCW/OTCPAYCSH

F10110 (1/23)

Complete this section if your

plan permits you to make

withdrawals while

still employed.

20. CERTIFICATION OF OTHER PLAN REQUIREMENTS

I certify that all plan requirements for a preretirement (in-service) cash withdrawal have been met.

Employer Plan Representative’s Signature Title

Plan Name Telephone Number

The employer that contributed

to your plan must complete

this section.

This section must be

completed in order to make

a withdrawal.

Please sign using black ink.

21. EMPLOYER’S PLAN REPRESENTATIVE

Separation Date

(mm/dd/yyyy)

EMPLOYER PLAN REPRESENTATIVE CERTIFICATION

Employer Plan Representative’s Signature Today’s Date (mm/dd/yyyy)

Employer Plan Representative’s Name (please print) Title

CASH WITHDRAWAL

FROM YOUR KEOGH PLANS

TAHCW/OTCPAYCSH

F10110 (1/23)

Please return ALL numbered

pages including any pages you

did not need to complete.

To ensure your account is

secure, we can’t send a check

to a mailing address that has

changed in the last 14 days.

Callus to discuss your options.

OPTIONS TO RETURN COMPLETED FORM(S)

OPTION 1: Digitally sign and submit your form.



If you received a digital form, complete the online signature digital process.

OPTION 2: Use the TIAA mobile app to quickly upload your completed document(s). It’s as simple as taking

a picture. Haven’t downloaded the TIAA mobile app? Get it today in the App Store or Google Play.



Tap the Message Center icon in the upper-right corner of your main screen.



Go to the Files tab, select Upload and then follow the instructions.

OPTION 3: If you are using your personal computer, here’s what you’ll need to do to upload your

completed document(s):



Choose Upload document(s) from the options presented.



Select Upload Files and follow the step-by-step instructions.

OPTION 4: If you prefer to fax or mail this form, use the information provided below:

FAX:

800-914-8922

(within U.S.)

704-595-5795

(outside U.S.)

STANDARD MAIL:

TIAA

P.O. Box 1268

Charlotte, NC 28201-1268

OVERNIGHT DELIVERY:

TIAA

8500 Andrew Carnegie Blvd.

Charlotte, NC 28262

CASH WITHDRAWAL

FROM YOUR KEOGH PLANS

TAHCW/OTCPAYCSH

F10110 (1/23)

FRAUD WARNING

FOR YOUR PROTECTION, WE PROVIDE THIS NOTICE/WARNING REQUIRED BY MANY STATES

This notice/warning does not apply in New York.

Any person who, knowingly and with intent to defraud any insurance company or other person, files

an application for insurance or a statement of claim for insurance benefits containing 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 and may be subject to criminal penalties, including

confinement in prison, and civil penalties. Such action may entitle the insurance company to deny or void

coverage or benefits.

Colorado residents, please note: Any insurance company or agent of an insurance company who knowingly

provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of

defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable

from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of

Regulatory Agencies.

Virginia and Washington, D.C., residents, please note: Any person who knowingly presents a false or

fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application

for insurance is guilty of a crime and may be subject to fines and confinement in prison.

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

F11436 (2/23)

IMPORTANT INFORMATION

PLEASE READ BEFORE FILLING OUT FORM

This substitute form W-4R applies to non-rollover eligible payments that are nonperiodic and rollover-eligible payments. For periodic

payments, submit a substitute form W-4P instead of this substitute form W-4R.

Federal laws may require mandatory federal income tax be withheld from cash withdrawals. Our records indicate that you are a U.S. person

(U.S. citizen or resident non-U.S. citizen), and may, therefore, be subject to federal tax withholding from your cash distribution. If you claim

residence AND citizenship outside the United States, you must complete Form W-8BEN instead of this form W-4R to certify your foreign

tax status. To print the W-8BEN form, go to TIAA.org/forms and scroll to Find tax forms. U.S. citizens living abroad, except in any U.S.

territories, must elect to have taxes withheld. Distributions from retirement plans are subject to a federal default withholding rate depending

on the type of payment. If you want the federal default rate applied, you do not need to submit this form as the federal default rate will

be applied automatically. If you want a rate other than the federal default rate for either a non-periodic payment or an eligible rollover

distribution or want no withholding on a non-periodic payment, please submit this form.

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

Page 1 of 2

F11436 (2/23)

1. PROVIDE YOUR INFORMATION

STEP 1A.

Title First Name Middle Initial

Last Name Suffix

Mailing Address

City State Zip Code

Contact Telephone Number Extension

STEP 1B.

Social Security Number/

Taxpayer Identification Number

PROVIDE YOUR CONTRACT NUMBERS

Note: Please indicate the contract number to which your tax election will apply. (No dashes required.)

STEP 1C.

TIAA Number CREF Number

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

Page 2 of 2

F11436 (2/23)

Your withholding rate is determined by the type of payment you will receive.



For nonperiodic payments, the default withholding rate is 10%. You can choose to have a different rate by entering a rate between 0% and

100% on line 2. Generally, you can’t choose less than 10% for payments to be delivered outside the United States and its territories.



For an eligible rollover distribution, the default withholding rate is 20%. You can choose a rate greater than 20% by entering the rate on line

2. You may not choose a rate less than 20%.

See IRS Form W-4R Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions Instructions attached at the end of

this form for more information.

Step 2

Complete this line if you would like a rate of withholding that is different from the default withholding rate.

See the IRS Form W-4R Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions

Instructions and the Marginal Rate Tables attached at the end of this form for additional information.

Enter the rate as a whole number (no decimals) ________________________________________________________________

Line 2

________

STEP 3. YOUR SIGNATURE

The form will become effective with your next available payment. You may revoke this election at any time by filing a new federal income tax

withholding election form with TIAA.

Please sign your full legal name with suffix, if applicable, using black ink, or online using TIAA’s digital signing experience.

Your Signature

Today’s Date (mm/dd/yyyy)

2 0

Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number (or I am waiting

for a number to be issued to me); 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; and (4) the FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

F11436 (2/23)

OPTIONS TO RETURN COMPLETED FORM(S)

Option 1: Digitally sign and submit your form.



If you received a digital form, complete the online signature digital process.

OPTION 2: Use the TIAA mobile app to quickly upload your completed document(s). It’s as simple as taking a picture. Haven’t

downloaded the TIAA mobile app? Get it today in the App Store or Google Play.



Tap the Message Center icon in the upper-right corner of your main screen.



Go to the Files tab, select Upload and then follow the instructions.

OPTION 3: If you are using your personal computer, here’s what you’ll need to do to upload your completed document(s):



Choose Upload document(s) from the options presented.



Select Upload Files and follow the step-by-step instructions.

OPTION 4: If you prefer to fax or mail this form, use the information provided below:

FAX:

800-914-8922

(within U.S.)

704-595-5795

(outside U.S.)

STANDARD MAIL:

TIAA

P.O. Box 1268

Charlotte, NC 28201-1268

OVERNIGHT DELIVERY:

TIAA

8500 Andrew Carnegie Blvd.

Charlotte, NC 28262

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

F11436 (2/23)

IRS FORM W-4R WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS AND ELIGIBLE ROLLOVER

DISTRIBUTIONS INSTRUCTIONS

GENERAL INSTRUCTIONS

Section references are to the Internal Revenue Code.

Future developments. For the latest information about any future developments related to Form W-4R, such as legislation enacted after it was published, go to

www.irs.gov/FormW4R.

Purpose of form. Complete Form W-4R to have payers withhold the correct amount of federal income tax from your nonperiodic payment or eligible

rollover distribution from an employer retirement plan, annuity (including a commercial annuity), or individual retirement arrangement (IRA). See page 2 for

the rules and options that are available for each type of payment. Don’t use Form W-4R for periodic payments (payments made in installments at regular

intervals over a period of more than 1 year) from these plans or arrangements. Instead, use Form W-4P, Withholding Certificate for Periodic Pension or

Annuity Payments. For more information on withholding, see Pub. 505, Tax Withholding and Estimated Tax.

Caution: If you have too little tax withheld, you will generally owe tax when you file your tax return and may owe a penalty unless you make timely

payments of estimated tax. If too much tax is withheld, you will generally be due a refund when you file your tax return. Your withholding choice (or an

election not to have withholding on a nonperiodic payment) will generally apply to any future payment from the same plan or IRA. Submit a new Form

W-4R if you want to change your election.

2023 MARGINAL RATE TABLES

You may use these tables to help you select the appropriate withholding rate for this payment or distribution. Add your income from all sources and use the

column that matches your filing status to find the corresponding rate of withholding. See the next page for more information on how to use this table.

Single

Married filing seperately

Married filing jointly

Qualifying surviving spouse

Head of Household

Total income

over—

Tax rate for every

dollar more

Total income

over—

Tax rate for every

dollar more

Total income

over—

Tax rate for every

dollar more

$0 0% $0 0% $0 0%

13,850 10% 27,700 10% 20,800 10%

24,850 12% 49,700 12% 36,500 12%

58,575 22% 117,150 22% 80,650 22%

109,225 24% 218,450 24% 116,150 24%

195,950 32% 391,900 32% 202,900 32%

245,100 35% 490,200 35% 252,050 35%

591,975* 37% 721,450 37% 598,900 37%

* If married filing separately, use $360,725 instead for this 37% rate.

GENERAL INSTRUCTIONS (CONTINUED)

Nonperiodic payments—10% withholding. Your payer must withhold at a default 10% rate from the taxable amount of nonperiodic payments unless you

enter a different rate on line 2. Distributions from an IRA that are payable on demand are treated as nonperiodic payments. Note that the default rate

of withholding may not be appropriate for your tax situation. You may choose to have no federal income tax withheld by entering “-0-” on line 2. See the

specific instructions below for more information. Generally, you are not permitted to elect to have federal income tax withheld at a rate of less than 10%

(including “-0-”) on any payments to be delivered outside the United States and its territories.

Note: If you don’t give Form W-4R to your payer, you don’t provide an SSN, or the IRS notifies the payer that you gave an incorrect SSN, then the payer

must withhold 10% of the payment for federal income tax and can’t honor requests to have a lower (or no) amount withheld. Generally, for payments that

began before 2023, your current withholding election (or your default rate) remains in effect unless you submit a Form W-4R.

Eligible rollover distributions—20% withholding. Distributions you receive from qualified retirement plans (for example, 401(k) plans and section 457(b)

plans maintained by a governmental employer) or tax-sheltered annuities that are eligible to be rolled over to an IRA or qualified plan are subject to a 20%

default rate of withholding on the taxable amount of the distribution. You can’t choose withholding at a rate of less than 20% (including “-0-”). Note that

the default rate of withholding may be too low for your tax situation. You may choose to enter a rate higher than 20% on line 2. Don’t give Form W-4R to

your payer unless you want more than 20% withheld.

WITHHOLDING CERTIFICATE FOR NONPERIODIC PAYMENTS

AND ELIGIBLE ROLLOVER DISTRIBUTIONS

SUBSTITUTE FORM W-4R FOR CASH WITHDRAWALS

F11436 (2/23)

Note that the following payments are not eligible rollover distributions: (a) qualifying “hardship” distributions, and (b) distributions required by federal law,

such as required minimum distributions. See Pub. 505 for details. See also Nonperiodic payments—10% withholding above.

Payments to nonresident aliens and foreign estates. Do not use Form W-4R. See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities,

and Pub. 519, U.S. Tax Guide for Aliens, for more information.

Tax relief for victims of terrorist attacks. If your disability payments for injuries incurred as a direct result of a terrorist attack are not taxable, enter “-0-”

on line 2. See Pub. 3920, Tax Relief for Victims of Terrorist Attacks, for more details.

SPECIFIC INSTRUCTIONS

LINE 1B

For an estate, enter the estate’s employer identification number (EIN) in the area reserved for “Social security number.”

LINE 2

More withholding. If you want more than the default rate withheld from your payment, you may enter a higher rate on line 2.

Less withholding (nonperiodic payments only). If permitted, you may enter a lower rate on line 2 (including “-0-”) if you want less than the 10% default rate

withheld from your payment. If you have already paid, or plan to pay, your tax on this payment through other withholding or estimated tax payments, you may

want to enter “-0-”.

Suggestion for determining withholding. Consider using the Marginal Rate Tables on the previous page to help you select the appropriate withholding rate

for this payment or distribution. The tables are most accurate if the appropriate amount of tax on all other sources of income, deductions, and credits has

been paid through other withholding or estimated tax payments. If the appropriate amount of tax on those sources of income has not been paid through

other withholding or estimated tax payments, you can pay that tax through withholding on this payment by entering a rate that is greater than the rate in the

Marginal Rate Tables.

The marginal tax rate is the rate of tax on each additional dollar of income you receive above a particular amount of income. You can use the table for your

filing status as a guide to find a rate of withholding for amounts above the total income level in the table.

To determine the appropriate rate of withholding from the table, do the following. Step 1: Find the rate that corresponds with your total income not including

the payment. Step 2: Add your total income and the taxable amount of the payment and find the corresponding rate.

If these two rates are the same, enter that rate on line 2. (See Example 1 below.)

If the two rates differ, multiply (a) the amount in the lower rate bracket by the rate for that bracket, and (b) the amount in the higher rate bracket by the rate

for that bracket. Add these two numbers; this is the expected tax for this payment. To get the rate to have withheld, divide this amount by the taxable amount of

the payment. Round up to the next whole number and enter that rate on line 2. (See Example 2 below.)

If you prefer a simpler approach (but one that may lead to overwithholding), find the rate that corresponds to your total income including the payment and

enter that rate on line 2.

Examples. Assume the following facts for Examples 1 and 2. Your filing status is single. You expect the taxable amount of your payment to be $20,000.

Appropriate amounts have been withheld for all other sources of income and any deductions or credits.

Example 1. You expect your total income to be $60,000 without the payment. Step 1: Because your total income without the payment, $60,000, is greater

than $58,575 but less than $109,225, the corresponding rate is 22%. Step 2: Because your total income with the payment, $80,000, is greater than

$58,575 but less than $109,225, the corresponding rate is 22%. Because these two rates are the same, enter “22” on line 2.

Example 2. You expect your total income to be $42,500 without the payment. Step 1: Because your total income without the payment, $42,500, is

greater than $24,850 but less than $58,575, the corresponding rate is 12%. Step 2: Because your total income with the payment, $62,500, is greater

than $58,575 but less than $109,225, the corresponding rate is 22%. The two rates differ. $16,075 of the $20,000 payment is in the lower bracket

($58,575 less your total income of $42,500 without the payment), and $3,925 is in the higher bracket ($20,000 less the $16,075 that is in the lower

bracket). Multiply $16,075 by 12% to get $1,929. Multiply $3,925 by 22% to get $863.50. The sum of these two amounts is $2,792.50. This is the

estimated tax on your payment. This amount corresponds to 14% of the $20,000 payment ($2,792.50 divided by $20,000). Enter “14” on line 2.