Forms

The forms listed below are the most frequently used forms. Log in to your account or contact us if you have questions about which form to use.

Enroll

EZ Enrollment and Participation Agreement (PDF)

Participation Agreement (PDF)


Use these forms to:

  • Enroll in the plan
  • Change your contributions
  • Elect or change annual automatic contribution increase
  • Select or change beneficiaries
  • Select or change investment options

Manage my money

Incoming Assets Form (PDF)

Use this form to:

  • Roll money over from other retirement savings accounts into your Plan
  • Decide which investments you want the rollover money to go into
  • Decide if you want to enroll in Asset Rebalancing

457(b) Plan Distribution Request Form (PDF)

Use this form to:

  • Select your payout options when you end your employment or retire
  • Request a payout
  • Stop current payouts
  • Change a current payout
  • Restart a payout
  • Defer payout until Required Minimum Distribution (RMD) is required at age 70½

Withholding Certificate for Pension or Annuity Statements - Form MO W-4PZ (PDF)

Missouri is a Mandatory-Voluntary State, which means that state taxes will only be withheld from your 457(b) Deferred Compensation Plan distribution if you request them to be withheld. If you reside outside of Missouri, your state of residence’s tax rules will apply to any distribution you take from your 457(b) Deferred Compensation Plan.

If you’d like Missouri state taxes withheld from your distribution, you must complete the Form MO W-4P. Please note:

For non-periodic distributions, including partial lump sum or entire balance distributions, the minimum withholding is 5.4% of your gross distribution. The Form MO W-4P, however, requires a dollar amount. Any amount indicated on the Form MO W 4P that is less than the dollar equivalent of 5.4% will not be honored, and the flat rate of 5.4% will be withheld.

For periodic distributions, including fixed payment or fixed period distributions, the disbursement is considered wages, and therefore subject to state taxes per the Missouri wage calculation. Any request to withhold Missouri state taxes via the Form MO W-4P for a periodic distribution will be added to the amount calculated.

It is strongly recommended that you consult with a tax advisor prior to requesting a distribution.

Public Safety Officer Insurance Premium Payment Authorization (PDF)

Use this form to:

  • Request payments from the Plan to directly pay health and long–term care premiums on a tax–free basis. NOTE: This applies to eligible public safety officers.

Required Minimum Distribution (RMD) Form (PDF)

Use this form to:

  • Change your payout options for Required Minimum Distribution (RMD) required at age 70½

Deferred Compensation Unforeseeable Emergency Distribution Application (PDF)

Use this form to:

  • Apply for an unforeseeable emergency distribution

Manage my account

Beneficiary Change Form (PDF)

Use this forms to change beneficiary information:

  • Select primary and contingent beneficiaries
  • Change how your money will be divided between your beneficiaries
  • Remove and add beneficiaries

Automatic Deposit Authorization (PDF)

Use this form to:

  • Add or change your checking or savings information for automatic deposits to your bank account

Manage someone else's account

Divorce (Domestic Relations Orders)

Follow this link to view/print the information you and your attorney will need to provide in the event of a divorce.

Military Leave

Follow this link to view/print information on how to notify us if you are going on military leave.

Beneficiary Distribution Form (PDF)

Alternate Payee Claim Form (PDF)

Use these forms if you're a beneficiary or an alternate payee, such as a former spouse or a dependant of a Plan member:

  • Report the death of a Plan member. Please remember to submit a certified copy of the death certificate if you are reporting the death of a plan member.
  • Update your beneficiary information.
  • Request a payout.
NRW-2891MO-PD.2
NRW-2891MO-PD.2
Modal Dialog Start Close

You are going to a page that is not part of this website

We make no endorsement of its content or guarantee of its accuracy. If the Continue button does not work, the page may have been moved or removed.

Please consider logging out of your account before you proceed.

NRW-2913AO.1
Modal Dialog End