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 Solutions
Distribution Forms
70 1/2 Minimum Distribution Form
Use this form if you have reached the mandatory distribution age to withdraw a portion of your funds. | 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.  | 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.) | 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. | 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. | 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. | Download Form |
Special Tax Notice
This notice explains the rules when withdrawing money from a retirement plan. | Download Form |

Retirement Forms

ACH Authorization Form
Use this form to to initiate debit entries to your Checking/Savings account. | 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.) | Download Form |
Client payment Form
Use this form for payment of Retirement Plan Administrative fees. | Download Form |
Contribution Change Form
If you would like to change your deferral percentages, please complete this form and return to us at Dyatech. | Download Form |
Fidelity Bond Application
Use this form to apply for a Fidelity Bond.    | 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.  | Download Form |

b) Fund Add Change Remove Form - Use this form if you would like to add/change/remove a mutual fund option.  | 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. | 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 Be sure to include your name, Social Security Number and the employer's name under which you are listed.)| Download Form |;
Proposal Request Form
Use this form to request a Retirement Plan Proposal Request.    | Download Form |
Rollover Contribution Form
This form is for Dyatech use only. This form may not be used to initiate or request a rollover from your IRA or previous qualified retirement program. Please contact the organization that currently maintains your account or assets and request that institution’s distribution rollover form. | Download Form |

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