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Select one of the following forms for download. All forms are in Adobe Acrobat® format. To obtain the free Acrobat® Reader, click the link at the bottom of this page. Click the '+' to expand for a description of the form.

Retirement Forms
Client payment Form
Use this form for payment of Retirement Plan Administrative fees. | Download Form |
Distribution Form
Use this form if you no longer work for one of our clients and would like to withdraw your money. Please note the notice at the top of the distribution form regarding automatic rollovers, if applicable. (Note: Please refer to the Special Tax Notice below.) (Updated 4/07) | Download Form |
Automatic IRA Rollover Distribution Form (Plan Administrator Use Only)
For those clients that have adopted the automatic rollover regulations please use this form to distribute participant balances to an IRA.   A Plan cannot cash out benefits worth more than $1,000 unless the participant affirmatively elects to receive cash. In the absence of the participant's election, any involuntary distribution greater than $1,000 must be done as an automatic rollover to an IRA.  (Updated 4/07) | Download Form |
Distribution Due To Death Form
In the unfortunate event of the death of a participant in one of our clients' retirement plans, the beneficiary of the deceased must fill out one of these forms and forward to the deceased's former employer.  (Updated 4/07) | Download Form |
Distribution Due To QDRO Form
In the event of a court ordered payment to a spouse or other beneficiary in the event of a participant's divorce specifically from the qualified retirement plan, this form should be completed, the Qualified Domestic Relations Order signed by the Judge and both attorneys should be attached and both forwarded to the appropriate company representative. (Updated 4/07) | Download Form |
Special Tax Notice
This notice explains the rules when withdrawing money from a retirement plan. (Updated 5/02) | Download Form |
70 1/2 Minimum Distribution Form
Use this form if you have reached the mandatory distribution age to withdraw a portion of your funds.  (Updated 4/07) | Download Form |
Participant Change Form
Use this form to change your name, address, or other personal data. (Or you may use the automated phone system at 1-800-933-4788, when you want to make changes to your investments. You can e-mail name and address changes to support@dyatech.com. Be sure to include your name, Social Security Number and the employer's name under which you are listed.) (Updated 4/07) | Download Form |

 

Loan Request Form
If your plan allows loans, use this form to request a loan from your account. If you are not sure if your plan allows loans, please check with your human resources department. You may borrow fifty percent (50%) of your vested account balance up to $50,000. The minimum loan is $1,000. (Updated 4/07) | Download Form |
Loan Payoff Form
To make any payment not listed on your amortization schedule including an early payoff of the loan, use this form. It must be signed by your company representative prior to submission to Dyatech. (Updated 4/07) | Download Form |
Hardship Withdrawal Form
Use this form if you want to apply for a hardship withdrawal. Please check your plan's Summary Plan Description or contact your Human Resources Department to make sure that your plan allows hardship withdrawals. (Updated 4/07) | Download Form |
In-Service Withdrawal Application
Use this form if you would like to apply for an in-service withdrawal.  Please check your plan's Summary Plan Description or contact you Human Resources Department to make sure that your plan allows in-service withdrawals. (Updated 4/07) | Download Form |
Contribution Change Form
If you would like to change your deferral percentages, please complete this form and return to us at Dyatech. (Updated 4/07) | Download Form |
Beneficiary Change Form
Use this form to change the person(s) who will receive your account balance in the event of your death. (Please Note: If you are married and wish to name someone other than your spouse as beneficiary, you will need to obtain written consent from your spouse.) (Updated 4/07) | Download Form |
Proposal Request Form
Use this form to request a Retirement Plan Proposal Request.  (Updated 4/07)  | Download Form |
Fidelity Bond Application
Use this form to apply for a Fidelity Bond.  (Updated 1/08)  | Download Form |
Financial Advisor Forms
a) Broker Dealer Update Form - Please use this form to update your Financial Advisor information with each fund company.  This may also be used to add yourself as a broker of record on an existing Dyatech plan.  (Updated 4/07) | Download Form |

b) Fund Add Change Remove Form - Use this form if you would like to add/change/remove a mutual fund option.  (Updated 4/07) | Download Form |

Payroll Forms

New Hire / Change Form
This form may be used when adding a new employee or changing employee personal data.
| Download Form |
Payroll Direct Deposit Form
This form may be used for adding direct deposit information for an employee.
| Download Form |
Payroll Proposal Request Form
Use this form to request a Payroll Services Proposal.
| Download Form |
Form W-4
This form is used so that your employer can withhold the correct federal income tax from your pay. Because your tax situation may change, you may want to refigure your withholding each year. | Download Form |
Form I-9
This form is used for Employment Eligibility Verification. | Download Form |
State Tax Link - Forms & Resources
Please note that by clicking on this link, you will leave the Dyatech web site and enter a privately owned web site created, operated and maintained by a separate private business. | Click here |
Processing Fees
Stop Payment - $20
Issued after 8 business days from the date the check was originally mailed.
Check Re-Issue - $20
Issued for address change, incorrect taxes, outdated checks, etc. No fee will be charged if an error made by Dyatech.
Full-Service Distribution Fee - $55
Check Processed for distribution of plan assets, In-service distributions, or Hardship Withdrawals.
PlanLink Distribution Fee - $35
Check Processed for distribution of plan assets, In-service distributions, or Hartford Withdrawals.
Termination Distribution Fee - $80
Check Processed for distribution of plan assets at plan termination.
Overnight - $35
FedEx mailed on Friday for Monday delivery. An additional $15.00 fee applies for Saturday delivery.
Residual Check - $0
Issued for small balances left in account after the distribution was originally processed.
Full-Service Loan Fee - $125
Invoiced to client or may be deducted from participant's loan proceeds.
PlanLink Loan Fee - $55
Invoiced to client or may be deducted from participant’s loan proceeds.



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