This finance template includes 10 fields. Request an early hardship withdrawal from a 401(k) plan with qualifying event documentation. Free to customize and use on ZenBuild.
Employee Full Name (text, required)
Employee ID (text, required)
Email Address (email, required)
Plan Name or Employer (text, required)
Amount Requested ($) (number, required)
Qualifying Hardship Reason (dropdown selection, required) — options: Medical expenses, Purchase of primary residence, Post-secondary tuition (12-month period), Prevention of eviction or foreclosure, Funeral expenses, Repair of primary residence (qualified casualty), Other qualifying hardship
Do you acknowledge the 10% early withdrawal penalty may apply? (multiple choice, required) — options: Yes, No - I believe I qualify for an exception
Do you want federal taxes withheld? (multiple choice, required) — options: Yes - withhold 20%, No - I will handle taxes myself
Supporting Documentation for Hardship (file upload, required)
