List of available forms:

All forms are in Adobe Acrobat PDF Format.

If you have Adobe Acrobat installed as a browser plug-in on your computer, click the form links below to view and print the forms from within your browser. The forms will open in a separate window.

To download the forms, right-click the links below and then choose: 'Save As..." from the pop-up menu.

Loan Application Form (A loan option may or may not be available to you under the terms of your retirement plan. In addition, you must satisfy the loan requirements as outlined in your Summary Plan Description. For further information, please contact your Human Resources Department.)

Hardship Withdrawal Application Form (A hardship withdrawal provision may or may not be available to you under the terms of your retirement plan. Please refer to your Summary Plan Description to determine if this feature is available to you.)

Distribution Election Form (For ALL Distributions)

Beneficiary Change Form

Distribution and Spousal Waiver Form (For account balance GREATER than $5,000.)

Special Tax Notice Regarding Plan Distributions BenefitWorks technology software gives participants internet access to daily account values, administrative forms and real time investment performance. Participants can also change investment selections, transfer dollars between investment choices, rebalance accounts and model loans.

Where to Mail Completed Forms:

BenefitWorks, Inc.
Plan Administration
P.O. Box 1209
Lebanon, PA 17042

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