REQUEST FOR WITHDRAWAL FROM A DEFERRED ACCOUNT

Pentegra Retirement Services REQUEST FOR WITHDRAWAL FROM A DEFERRED ACCOUNT IMPORTANT NOTICE: Please carefully review the Special Tax Notice Regarding Plan Payments, which you previously received, prior to completing this form. If you cannot locate this document, contact your Employer, log on to the Pentegra website, www.pentegra.com, or contact Pentegra and a copy will be sent to you. PARTICIPANT DATA (Please Type or Print clearly): (Only to be completed by participants who have separated from service) Name: Current Address: Last First Middle Initial Street City State Zip Social Security Number: E-Mail: Home Phone Number Former Employer Name: Plan ID: TOTAL WITHDRAWAL REQUEST Total Available Vested Balance Check this box if this withdrawal is due to disability FORM OF PAYMENT I irrevocably elect to have (check one): all of my withdrawal directly rolled over to the IRA, Roth IRA or plan listed below. $ or % of the taxable portion of my withdrawal directly rolled over to the IRA, Roth IRA or plan listed below and the remaining portion of my withdrawal paid directly to me. the total amount of my withdrawal (including any taxable portion eligible for rollover) paid directly to me. Other Some or all of your distribution may be subject to Federal and state income tax withholding. If required by law, Federal income tax will be withheld at a flat rate of 20%. If required by your state, state income tax will be withheld at the prevailing rate for your state. Income taxes that have been withheld cannot be refunded by the Plan for any reason. I further understand that this withdrawal will be deducted proportionately from the value of my account in each of the available investment funds. DIRECT ROLLOVER INSTRUCTIONS I hereby instruct the Plan to directly roll over the portion of my taxable distribution indicated above to: Type of Plan (check one): IRA Roth IRA Qualified retirement plan (e.g., 401(k), profit sharing, 403(a), etc.) Eligible Section 457(b) plan Name of Receiving Plan, IRA or Roth IRA: Address of Receiving Plan, IRA or Roth IRA: Annuity Contract under Section 403(b) of the Internal Revenue Code PSI Form 508 Deferred Withdrawal w/out partial payments

Please send my payment via: A check sent regular mail. A check sent overnight mail: a personal check for $25.00, payable to Pentegra Services, Inc., must accompany this request form. A wire transfer: a personal check for $20.00, payable to Pentegra Services, Inc., must accompany this request form.. (complete bank information below) ACH (Automated Clearing House electronic transfer) - No additional charge. (complete bank information below) ABA# Account # Branch # Name of receiving institution Address of receiving institution Account Name: I hereby certify that I have reviewed the Special Tax Notice Regarding Plan Payments within the period required by federal tax law and that I hereby waive the 30 day waiting period as allowed by law. I further certify that the plan or account that I have selected above (if any) is eligible and willing to receive my rollover distributions. I acknowledge a $75 distribution fee will be deducted from the proceeds of my withdrawal. I also certify as outlined in the Special Tax Notice Regarding Plan Payments and in the Plan s Summary Plan Description that my spouse may be required to consent to this withdrawal. Signature of Participant Date State of: ss.: County of: On this day of, personally appeared before me the said named, to me known and known to me to be the person described in and who executed the foregoing instrument, and he(she) acknowledged that he(she) executed the same. (Seal) STAMP OR SEAL REQUIRED My commission expires Date (Notary Public) PSI Form 508 Deferred Withdrawal w/out partial payments Pentegra Retirement Services 108 Corporate Park Drive White Plains NY 10604 www.pentegra.com Phone 1-866-633-4015 Fax 914-694-6429

Pentegra Retirement Services DISTRIBUTION SUBJECT TO QUALIFIED JOINT AND SURVIVOR ANNUITY RULES Please use this form only for a distribution of funds that are subject to the Qualified Joint and Survivor Annuity (QJSA) rules (such as money purchase source funds). Please be sure to review the QJSA Notice and Special Tax Notice Regarding Plan Payments before completing this form. I. PARTICIPANT DATA (Please Type or Print Clearly) Participant s Name (Last) (First) (Middle Initial) Address (Street) (City) (State) (Zip) Social Security # Date of Birth Sex: M F Daytime Telephone # E-Mail Address Plan ID: Employer Name II. METHOD OF PAYMENT Lump Sum Payment (Please also complete the Withdrawal from a Deferred Account Form.) Annuity Contract (The Plan will purchase an annuity contract from an insurance company for your benefit. This option is only available for the portion of your account subject to the QJSA rules. You must complete a separate form for funds that are not subject to the QJSA rules.) If you elect the annuity payment method, you must select one of the following annuity types: Life Annuity Qualified Joint and 50%; 10 year Certain Annuity 75%; 100% Survivor Annuity If you elect one of the QJSA annuities, please indicate the person who will receive the survivor portion of the annuity in the event that you predecease him/her. If you are married, your spouse must be named as the contingent annuitant unless your spouse consents (in Section VI) to an alternate designation. Full Name of Contingent Annuitant Full Address Relationship Social Security No. Date of Birth * As indicated in the QJSA notice, fees, commissions, and other costs directly incurred in connection with the purchase of an annuity will be deducted from your account balance immediately before the purchase. III. PARTICIPANT S CERTIFICATION OF MARITAL STATUS I hereby certify that I am married. (Your spouse must complete Section V unless you elected a Joint and Survivor Annuity in Section II above.) I hereby certify that I am not married. Please specify further below: I have never been married. I am a widow/widower. I am divorced and certify that there are no Plan benefits payable to a former spouse under a Qualified Domestic Relations Order. Pentegra DC Plan Form for Distributions Subject to QJSA Rules Pentegra Retirement Services 108 Corporate Park Drive White Plains NY 10604 www.pentegra.com Ph 1-866-633-4015 Fax 914-694-6429

IV. PARTICIPANT S QJSA WAIVER ELECTION Your signature is required in this section unless you chose an Annuity Contract in Section II that satisfies the QJSA annuity rules (i.e., life annuity if you are not married or a joint and survivor annuity if you are married). As a Plan Participant, I certify that I have read the QJSA Notice and understand that benefits will be paid to me in the form of an annuity unless I waive that form of payment. I understand that if I am married, my spouse must also consent to the waiver. I hereby elect to waive the annuity form of payment as explained in the QJSA Notice. Participant s Signature: Date: V. SPOUSE S CONSENT TO QJSA WAIVER The spouse s signature is required unless the Participant elected a QJSA in Section II. I have read and understand the QJSA Notice and the Special Tax Notice Regarding Plan Payments provided to me by the Plan Administrator. I understand that under the Plan s terms, benefits must be paid in the form of a QJSA unless I consent to a different form of payment. I approve of and consent to the payment option and (if applicable) the contingent annuitant elected by my Spouse in Section II above. I understand the effect of my consent. Spouse s Name: Signature: Date: (The signature of the Spouse must be witnessed by a Notary Public or Plan Representative.) State of: County of: On this of, 20 personally appeared before me the said named, to me known or proved to me on the basis of satisfactory evidence to be the person described in and who executed the foregoing instrument, and he(she) acknowledged that he(she) executed the same. (Notary Public) My commission expires STAMP/ SEAL REQUIRED or Plan Representative s Signature VI. PARTICIPANT S PAYMENT AUTHORIZATION I have received the Special Tax Notice and QJSA Notice provided by the Plan within the past 180 days. I understand my right to a 30-day period to make a payment election and my ability to waive that right by executing this form prior to the end of the 30-day period. I hereby request payment from the Plan in the manner indicated. I certify that all information provided by me is true and accurate, and that no tax advice has been given to me by the Plan Administrator. I expressly assume responsibility for any adverse consequences which may arise from this election and agree that the Plan Administrator shall in no way be responsible for those consequences. Participant s Signature: Date: (The signature of the Participant must be witnessed by a Notary Public or Plan Representative.) State of: County of: On this of, 20 personally appeared before me the said named, to me known or proved to me on the basis of satisfactory evidence to be the person described in and who executed the foregoing instrument, and he(she) acknowledged that he(she) executed the same. STAMP/SEAL REQUIRED or Plan Representative s Signature My commission expires (Notary Public) PSI Form for Distributions Subject to QJSA Rules Pentegra Retirement Services 108 Corporate Park Drive White Plains NY 10604 www.pentegra.com Ph 1-866-633-4015 Fax 914-694-6429

Pentegra Retirement Services QUALIFIED JOINT AND SURVIVOR ANNUITY NOTICE Explanation of Qualified Joint and Survivor Annuity Payment Form You are receiving this notice because a portion of your defined contribution plan account is attributable to money purchase plan contributions. As such, this portion of your benefits is subject to the Qualified Joint and Survivor Annuity ( QJSA ) rules. Under the QJSA rules, your benefits must be paid in the form of an annuity, unless you elect an alternative form of payment. Provided below is an explanation of the applicable default forms of payment under the QJSA rules. If you are a married participant, the default form of payment is a QJSA, which provides monthly lifetime income to you. Upon your death, monthly lifetime income will be paid to your surviving spouse in an amount equal to 50% of your monthly benefit. You may also elect a Qualified Optional Joint and Survivor Annuity ( QOSA ) which provides for a reduced monthly lifetime income to you and a monthly lifetime income to your surviving spouse in an amount equal to 10yr Certain, 75 or 100% of your monthly benefit. If you are an unmarried participant, the default form of payment is a Straight Life Annuity ( SLA ). The SLA provides monthly lifetime income to you. Upon your death, no further payments are due. Since the plan is a defined contribution plan, the QJSA, QOSA, or SLA will be purchased from an insurance company. Fees, commissions, and other costs directly incurred in connection with the purchase of the annuity will be deducted from your account balance immediately before purchase. Right to Elect Alternative Payment Form As stated above, if you are a married participant at the time your benefits commence, your benefits will be paid in the form of a QJSA with a 50% spousal survivor benefit, unless you and your spouse elect and consent in writing to an alternative payment form. In order to provide for the 50% survivor benefit, your lifetime monthly benefit is actuarially reduced (as compared with a SLA). You may elect a further reduction in your monthly benefit to provide for a larger monthly survivor benefit of 66 2/3, 75 or 100%. You may also elect to decline the QJSA in favor of any other available form of plan benefit of comparable value. Your spouse must consent in writing to such an election to decline QJSA coverage. Your spouse s consent must be witnessed by a notary public. If you elect an alternate form of benefit that would result in the payment of benefits after your death to persons other than your spouse, your spouse must also consent to the non-spousal beneficiary designation. If you are an unmarried participant, your plan benefits will be paid in the form of a SLA, which provides for a monthly benefit for your lifetime, unless you elect another form of benefit. You can elect to decline the SLA in favor of any other available form of plan benefit of comparable value.

Timeframe for Election of an Alternative Payment Form You may elect to decline the QJSA form of benefit during an election period that begins at least 30 days but not more than 180 days prior to your benefit commencement (first distribution) date and ends on such benefit commencement date. However, if you request additional information regarding the default annuity payment form, the 30-180 day period will not be deemed to start running until such information is provided. You and your spouse can waive the 30 day period requirement, but in no event can a distribution occur prior to the 8 th day after this notice was provided. Final elections and any required spousal consents must be executed within 180 days before the benefit commencement date. All elections must be in writing and may not be changed after your benefit commencement date. If you elect to waive the default form of benefit (Qualified Joint and 50% Survivor Annuity form of payment if you are a married participant or a SLA if you are an unmarried participant), then any benefit due after your death will be payable as provided for under the form of benefit that you elected. Description of Alternative Payment Forms The alternative plan payment forms may include a lump sum payment, installment payments, and life expectancy distributions. Please see your Summary Plan Description (SPD) for information about the available payments options under your plan. A lump sum payment is the entire distribution of your account within a period of one year. Partial lump sum payments may also available. To request a lump sum payment, please see the Withdrawal from a Deferred Account Form and Special Tax Notice, which can be obtained from your employer or by accessing www.pentegra.com. Installment payments are annual payments of similar amounts over a specified number of years. To determine if you are eligible to receive installment payments, please review your SPD. To request installment payments, please see the Request for Installment Payments Form and Special Tax Notice, which can be obtained from your employer or by accessing www.pentegra.com. Life expectancy distributions are annual plan payments in accordance with the minimum distribution rules under the Internal Revenue Code. For a participant, life expectancy distributions are not required to begin until after the later of the participant s attainment of age 70 1/2 or severance of employment. You will be notified when required distributions must commence. Additional Information If you have questions regarding this notice or would like additional information regarding the QJSA rules, please contact your employer or the Customer Service Call Center by phone at 1-866-633-4015 or by e-mail at www.pentegra.com. Pentegra Services, Inc. QJSA Notice Pentegra Retirement Services 108 Corporate Park Drive White Plains NY 10604 www.pentegra.com Phone 1-866-633-4015 Fax (914)694-6429