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Clear and reset formRecordkeeperDirect Hardship Withdrawal RequestThe terms and availability of hardship distributions are contained in your plan document.Check with your employer to discuss restrictions and determine eligibility before submitting this form. You must also providesupporting documentation to your employer for review and approval. Additional paperwork may be required. Your hardshipwithdrawal cannot be processed until approved by your employer. If you have questions about this form, call us at (800) 421-4120. You may be able to request this distribution online at www.americanfunds.com/retire. Click the Loan & Withdrawals tab to initiateyour request.1Plan and participant informationImportant: Distribution requests are subject to a 10-day hold after an address change unless your signature is guaranteed in Section 7.If this form includes a signature guarantee, the original copy must be mailed.Plan namePlan ID number – –First name of participantMILastAddress(SSN (provide the last four digits)CityStateZIP)Daytime phoneCitizenship:2 U.S. citizen U.S. resident alien Nonresident alien (Submit an IRS Form W-8BEN.)Amount of withdrawalCheck with your employer to confirm the amount available for your hardship withdrawal. We will deduct a 25 processing fee for this distribution.Additional fees from your plan’s Third-Party Administrator may apply. See your Participant Fee Disclosure document or employer for more information.Distribution amounts are taken proportionately from all investment options in applicable contribution types.Total gross (pre-withholding) amount requested 3A.Delivery instructionsSelect one of the three options below. If no selection is made, a distribution check will be sent via regular mail. Send the distribution electronically (via ACH) to the bank account in Section 4. Once processed, the distribution will be delivered toyour bank within three business days following the transaction. (This option is not available for nonresident alien distributions.)Note: To receive your distribution without delay, either you must provide a signature guarantee, or your bank registration must bevalidated electronically (by Capital Group upon receipt of this form). If neither of these conditions are met, the distribution issubject to a 10-day hold. We reserve the right to reject ACH payment requests and instead send payments via check. Formore information, refer to the Bank Verification Terms & Conditions. Send a check to the address of record via regular mail. Proceed to Section 5.Send a check to the address of record and expedite delivery. Estimated delivery time is two business days from the date the requestC. B.05/22is processed. Proceed to Section 5. (A 25 delivery fee will be deducted. Physical address is required — no P.O. boxes.)1 of 6
RecordkeeperDirectHardship Withdrawal RequestFirst name of participant4MILastPlan ID numberBank information — Complete only if requesting electronic depositElectronic distributions can only be made to a U.S. bank checking account. Your bank information will be retained. We will use a third-party service tovalidate your bank information. Refer to the Bank Verification Terms & Conditions.Attach an unsigned, voided check below. Please do not staple.The check must be preprinted with the bank name and registration, routing number and account number. Your name MUST be included inthe bank registration. If these requirements are not met, an electronic deposit cannot be made, and a physical check will be mailedto you instead.Tape your check here.John DoeDATEDIVOBank account registrationPAY TO THEORDER OFAnytown Bank :999999999 :Bank routing number DOLLARSBank name0000000000 :Bank account numberNote: In lieu of a voided check, you may submit a letter from your bank on the bank’s letterhead providing the: 5bank account registrationrouting numberaccount numberaccount type (checking or savings)Federal income tax withholdingThis distribution is not eligible to be rolled over because it represents a financial hardship distribution. The taxable amount, includingearnings applicable to after-tax contributions, will be subject to 10% withholding unless otherwise indicated below.NOTE: You may withhold more than 10%. Insufficient withholding or underpayment of estimated taxes may result in IRS penalties. If youare under age 59½, you may be subject to an additional 10% penalty tax. Taxes are withheld from the total amount requested.A portion of your Roth distribution may be taxable. DO NOT withhold federal income tax. Your U.S. residence address is required to honor this request (no P.O. boxes).Residence address05/22 Withhold federal income tax at the rate ofCity% (Must be 10% or greater)2 of 6StateZIP
RecordkeeperDirectHardship Withdrawal RequestFirst name of participant6MILastPlan ID numberState income tax withholdingIf your state requires withholding or if the amount you enter below is less than the minimum for your state, Capital Bank and Trust CompanySM(CB&T) will withhold at least the minimum state tax. CB&T does not withhold state taxes for all states. DO NOT withhold Withhold Note: To review the impacts of state withholding for your state of residence, visit www.americanfunds.com/retire or speak with yourtax consultant. If a state form W-4P is required, the form must be completed and provided to your employer.7Participant signatureI hereby certify that 1) I have read, understand and agree to all pages of this Hardship Withdrawal Request; 2) all information that I haveprovided is true and correct; 3) the withdrawal requested does not exceed the amount of my immediate and heavy financial need (includingany amounts necessary to pay any federal, state or local income taxes or penalties reasonably anticipated to result from the withdrawal);4) I have insufficient cash or other liquid assets to satisfy my financial need; 5) if I am requesting an electronic payment, I have read,understand and agree to the Bank Verification Terms & Conditions, and I authorize Capital Group to access records from public andproprietary sources in order to validate that I am the bank account owner; and 6) I understand that if my bank account cannot be validated,a check will be mailed to me.Name of participant (print)X/Signature of participantDate/(mm/dd/yyyy)This document may not be signed using Adobe Acrobat Reader’s "fill and sign" feature.A signature guarantee is required if requesting an immediatedistribution and:GUARANTOR:Stamp signature guarantee or medallion guarantee here. your address has changed in the last 10 calendar daysOR you are requesting payment to a bank account and the bankregistration cannot be validated electronically.The request is subject to a 10-day hold if a signature guarantee isrequired but not provided.If required, a signature guarantee must be performed by a bank, savings association, credit union, member firm of a domestic stock exchange orthe Financial Industry Regulatory Authority that is an eligible guarantor institution. A notary public is NOT an acceptable guarantor. The guaranteemust be in the form of a stamp or a typewritten or handwritten guarantee that is accompanied by a raised corporate seal.Note: A medallion guarantee is acceptable in place of a signature guarantee.05/22Return this completed form to your employer for authorization. If this form includes a signatureguarantee or medallion guarantee, the original document must be mailed. DO NOT returnthis form directly to American Funds, as this will delay the processing of your request.3 of 6
RecordkeeperDirectHardship Withdrawal RequestFirst name of participant8MILastPlan ID numberConsult your TPA before completing this sectionVesting/Contribution type verificationThe information provided will apply to this distribution request only.Vested percentageIndicate the participant’s vesting in each applicable contribution type. QACA safe harbor matchVested percentage: QACA safe harbor non-elective Match OtherVested percentage:Vested percentage: Profit-sharing%%%Vested percentage:Specify contribution type%Vested percentage:%Hardship withdrawals will be taken proportionately from all applicable contribution types (per plan information on file) unless alternateinstructions are provided below.The information above is correct.(Name of firm05/22Name of Third-Party Administrator (print))Ext.Daytime phoneX/Signature of Third-Party Administrator4 of 6Date/(mm/dd/yyyy)
RecordkeeperDirectHardship Withdrawal RequestFirst name of participant9MILastPlan ID numberSection 9 is to be completed by your employerEmployer authorizationBefore signing, ensure vesting/contribution type verification has been completed in Section 8. Supporting documentation should be retained and keptwith your records.As an authorized signer, I certify that 1) I have read, understand and agree to all pages of this Hardship Withdrawal Request; 2) this distributionis in accordance with the terms of the plan and Internal Revenue Code; 3) any notice requirements applicable to this request have beenprovided to the participant as required by law; 4) spousal consent, if applicable, has been obtained; 5) the information provided in Section 8 iscorrect; 6) I understand that once a payment has been requested, it cannot be changed or reversed; and 7) the recordkeeper is entitled to relyon my authorization and is hereby indemnified from all liability arising from following the instructions provided in this form. Check this box if the request is to be honored because the appropriate participant’s consent and waivers have been obtained on aseparate form, and the participant has been notified of potential delays due to an address change. This option is not available forelectronic payment requests.Name of authorized signer (print)X/SignatureDate/(mm/dd/yyyy)This document may not be signed using Adobe Acrobat Reader’s "fill and sign" feature.05/22If a participant signature guarantee is required, mail this form to one of the addresses below. Otherwise, you may send it by email or fax.SENDREGULAR MAILOVERNIGHT MAILAmerican Funds RecordkeeperDirectc/o Retirement Plan ServicesP.O. Box 6040Indianapolis, IN 46206-604012711 N. Meridian St.Carmel, IN 46032-9181 KDirect@capitalgroup.comEMAIL R(For employer use only.)FAX (855) 521-99525 of 6
Bank VerificationTerms & ConditionsReview this agreement if you provided bank information.I (we) authorize the Fund and its agents to act upon instructions (by phone, inwriting, online or by other means) believed to be genuine and in accordance withprocedures described in the prospectus (if applicable) for this designated bankaccount. I (we) authorize credits/debits to/from the bank account designated inconjunction with the account option(s) selected. I (we) agree that Capital GroupRetirement Plan Services shall be fully protected in honoring any suchtransaction. I (we) also agree that Capital Group Retirement Plan Services maymake additional attempts to credit/debit my (our) account if the initial attempt failsand I (we) will be liable for any associated costs. All account options elected willbecome part of the account and terms, representations, and conditions thereof.Provide Accurate Information. I (we), the end user, agree to provide true,accurate, current and complete information about myself (ourselves) and my(our) accounts maintained at other web sites and I (we) agree to not misrepresentmy (our) identity or my (our) account information. I (we) agree to keep my (our)account information up to date and accurate.Proprietary Rights. I (we) are permitted to use content delivered to me (us)through the service only on the service. I (we) may not copy, reproduce,distribute, or create derivative works from this content. Further, I (we) agree notto reverse engineer or reverse compile any of the service technology, includingbut not limited to, any Java applets associated with the service.Content You Provide. I (we) are licensing to Capital Group Retirement PlanServices (“Company”) and its service providers (“Service Provider”) anyinformation, data, materials or other content (collectively, “Content”) I (we)provide through or to the service. Company and Service Provider may use,modify, display, distribute and create new material using such Content to providethe service to you. By submitting Content, I (we) automatically agree, or promisethat the owner of such Content has expressly agreed that, without any particulartime limit, and without the payment of any fees, Company and Service Providermay use the Content for the purposes set out above. I (we) agree that, asbetween Company and Service Provider, Company owns your confidentialaccount information.Indemnification. I (we) agree to protect and fully compensate Company,its investment manager, and Service Provider and their employees, officers,trustees, directors, and affiliates from any and all third party claims, liability,damages, expenses and costs (including, but not limited to, reasonable fees)caused by or arising from my (our) use of the service, my (our) violation of theseterms or my (our) infringement, or infringement by any other user of my (our)account, of any intellectual property or other right of anyone. I (we) agree thatthe Company’s investment manager and Service Provider are each a third partybeneficiary of the above provisions, with all rights to enforce such provisions asif the investment manager or Service Provider were a party to this Agreement.Lit. No. RPDRFM-088-0522OThird Party Accounts. By using the service, I (we) authorize Company andService Provider to access third party sites designated by Company, on my(our) behalf, to retrieve information requested by me (us), and to register foraccounts requested by me (us). For all purposes hereof, I (we) hereby grantCompany and Service Provider a limited power of attorney, and I (we) herebyappoint Company and Service Provider as my (our) true and lawful attorney-infact and agent, with full power of substitution and re-substitution, for me (us)and in my (our) name, place and stead, in any and all capacities, to accessthird party internet sites, servers or documents, retrieve information, and useyour information, all as described above, with the full power and authority todo and perform each and every act and thing requisite and necessary to bedone in connection with such activities, as fully to all intents and purposes asyou might or could do in person. I (WE) ACKNOWLEDGE AND AGREE THATWHEN COMPANY OR SERVICE PROVIDER ACCESSES AND RETRIEVESINFORMATION FROM THIRD PARTY SITES, COMPANY AND SERVICEPROVIDER ARE ACTING AS MY (OUR) AGENT, AND NOT THE AGENTOR ON BEHALF OF THE THIRD PARTY. I (we) agree that third party accountproviders shall be entitled to rely on the foregoing authorization, agency andpower of attorney granted by me (us). I (we) understand and agree that theservice is not endorsed or sponsored by any third party account providersaccessible through the service.LIMITATION OF LIABILITY. I (WE) AGREE THAT NEITHER COMPANY, ITSINVESTMENT MANAGER, OR SERVICE PROVIDER NOR ANY OF THEIREMPLOYEES, OFFICERS, TRUSTEES, DIRECTORS, AFFILIATES, ACCOUNTPROVIDERS OR ANY OF THEIR AFFILIATES WILL BE LIABLE FOR ANYHARMS, WHICH LAWYERS AND COURTS OFTEN CALL DIRECT, INDIRECT,INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES,INCLUDING, BUT NOT LIMITED TO, DAMAGES FOR LOSS OF PROFITS,GOODWILL, USE, DATA OR OTHER INTANGIBLE LOSSES, EVEN IFCOMPANY OR SERVICE PROVIDER HAS BEEN ADVISED OF THEPOSSIBILITY OF SUCH DAMAGES, RESULTING FROM: (i) THE USE OR THEINABILITY TO USE THE SERVICE; (ii) THE COST OF GETTING SUBSTITUTEGOODS AND SERVICES, (iii) ANY PRODUCTS, DATA, INFORMATION ORSERVICES PURCHASED OR OBTAINED OR MESSAGES RECEIVED ORTRANSACTIONS ENTERED INTO, THROUGH OR FROM THE SERVICE; (iv)UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONSOR DATA; (v) STATEMENTS OR CONDUCT OF ANYONE ON THE SERVICE;(vi) THE USE, INABILITY TO USE, UNAUTHORIZED USE, PERFORMANCEOR NON-PERFORMANCE OF ANY THIRD PARTY ACCOUNT PROVIDERSITE, EVEN IF THE PROVIDER HAS BEEN ADVISED PREVIOUSLY OF THEPOSSIBILITY OF SUCH DAMAGES; OR (vii) ANY OTHER MATTER RELATINGTO THE SERVICE. 2022 Capital Group. All rights reserved.Agreement and Bank Verification Terms & Conditionsof Use of the ServiceDISCLAIMER OF WARRANTIES. I (WE) EXPRESSLY UNDERSTAND ANDAGREE THAT: MY (OUR) USE OF THE SERVICE AND ALL INFORMATION,PRODUCTS AND OTHER CONTENT (INCLUDING THAT OF THIRD PARTIES)INCLUDED IN OR ACCESSIBLE FROM THE SERVICE IS AT MY (OUR) SOLERISK. THE SERVICE IS PROVIDED ON AN “AS IS” AND “AS AVAILABLE”BASIS. COMPANY AND SERVICE PROVIDER EXPRESSLY DISCLAIM ALLWARRANTIES OF ANY KIND AS TO THE SERVICE AND ALL INFORMATION,PRODUCTS AND OTHER CONTENT (INCLUDING THAT OF THIRD PARTIES)INCLUDED IN OR ACCESSIBLE FROM THE SERVICE, WHETHER EXPRESSOR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIEDWARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULARPURPOSE AND NONINFRINGEMENT. COMPANY AND SERVICE PROVIDERMAKE NO WARRANTY THAT (i) THE SERVICE WILL MEET MY (OUR)REQUIREMENTS, (ii) THE SERVICE WILL BE UNINTERRUPTED, TIMELY,SECURE, OR ERROR-FREE, (iii) THE RESULTS THAT MAY BE OBTAINEDFROM THE USE OF THE SERVICE WILL BE ACCURATE OR RELIABLE,(iv) THE QUALITY OF ANY PRODUCTS, SERVICES, INFORMATION, OROTHER MATERIAL PURCHASED OR OBTAINED BY ME (US) THROUGH THESERVICE WILL MEET MY (OUR) EXPECTATIONS, OR (v) ANY ERRORS INTHE TECHNOLOGY WILL BE CORRECTED. ANY MATERIAL DOWNLOADEDOR OTHERWISE OBTAINED THROUGH THE USE OF THE SERVICE ISDONE AT MY (OUR) OWN DISCRETION AND RISK AND I (WE) ARE SOLELYRESPONSIBLE FOR ANY DAMAGE TO MY (OUR) COMPUTER SYSTEMOR LOSS OF DATA THAT RESULTS FROM THE DOWNLOAD OF ANY SUCHMATERIAL. NO ADVICE OR INFORMATION, WHETHER ORAL OR WRITTEN,OBTAINED BY ME (US) FROM COMPANY OR SERVICE PROVIDERTHROUGH OR FROM THE SERVICE WILL CREATE ANY WARRANTY NOTEXPRESSLY STATED IN THESE TERMS.CGD/6367-S85188Electronic bank verification is conducted through a third party service providerthat is unaffiliated with Capital Group Retirement Plan Services. If you chooseto add a bank account electronically, you must agree to the Bank VerificationTerms & Conditions of Use set forth below. The Fund or the Fund’s transferagent will send your information to the third party service provider, who willthen compare your information with their database to verify the information youprovided. Please read and agree to the Bank Verification Terms & Conditionsof Use for the third party service in order to continue.6 of 6
3 of 6 RecordkeeperDirect Hardship Withdrawal Request 05/22 First name of participant MI Last Plan ID number 6tate income tax withholdingS If your state requires withholding or if the amount you enter below is less than the minimum for your state, Capital Bank and Trust Company SM (CB&T) will withhold at least the minimum state tax.CB&T does not withhold state taxes for all states.
