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The form explains restrictions on using it for IRA, inherited IRA, investment-only, nonretirement, or annuity accounts, plus required completion methods. It details key tax considerations, qualified vs. nonqualified Roth distribution rules, spousal joint and survivor consent requirements, address verification for withholding taxes, and special handling notes for securities sales and mutual fund withdrawals.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/one-time-withdrawal-defined-contribution-retirement-plan/302974/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/one-time-withdrawal-defined-contribution-retirement-plan/302974.png","ImageObject",442,249,{"name":88,"@type":89},"Lucas Martin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-04","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is this form used for?","Question",{"text":109,"@type":110},"This form is used to request a one-time withdrawal from a Fidelity Self-Employed 401(k), Roth Self-Employed 401(k), Profit Sharing, or Money Purchase Plan account.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"When can distributions be requested under the plan rules?",{"text":114,"@type":110},"Distributions are permitted only when a participant reaches a triggering event as defined in Section 2; distributions for other reasons may risk plan disqualification.",{"name":116,"@type":107,"acceptedAnswer":117},"What information is required when selecting a request reason?",{"text":118,"@type":110},"You must check only one request reason and meet the corresponding eligibility criteria, such as being at least 59½ for Normal, or qualifying under the plan definition of disability for disability distributions.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},302974,1790115156,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":142},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Questions? Go to [Fidelity.com](Fidelity.com) or call 800-343-3548.  \nOne-Time Withdrawal—Defined Contribution Retirement Plan  \nUse this form to request a one-time withdrawal from a Fidelity Self-Employed 401(k), Roth Self-Employed 401(k), Profit Sharing, or Money Purchase Plan account. Possible requests include a one-time, immediate distribution; a qualified or direct conversion toa Roth IRA from a non-Roth plan; or a direct rollover. Do NOT use this form for any IRA or Inherited IRA accounts; Investment-Only Retirement Plan or nonretirement accounts; or annuities. Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information, make a copy of the relevant page.  \nHelpful to Know  \nYou are encouraged to consult your tax advisor regarding the tax implications associated with this distribution.  \n• Distributions from the Defined Contribution Retirement Plan [i.e., Profit Sharing Plan, Money Purchase Pension Plan, Self-Employed 401(k) Plan, or Roth Self-Employed 401(k) Plan] are only permitted when a participant reaches a triggering event as defined in Section 2. Distributions for any other reason may result in plan disqualification.  \n• Qualified vs. nonqualified distributions from a Roth Self-Employed 401(k) have different tax consequences, including a tax penalty. To take a qualified distribution, the Roth Self-Employed 401(k) Plan account has to have met the 5-year aging period AND you must be at least 59½ years old, disabled, or distributing the assets as an inheritor of the original owner. Consult your tax advisor to determine if your distribution will be qualified or nonqualified prior to submitting this request.  \n• Distributions to married participants from any money purchase plan and certain profit sharing plans must be made in the form of a joint and survivor annuity, unless your spouse waives this right by providing spousal consent on this form. You are encouraged to consult your tax advisor regarding the tax implications associated with each distribution.  \n• You should also confirm that Fidelity has your most current address prior to submission so that we can withhold appropriate taxes. See the General Instructions and the Marginal Rate Tables contained in the IRS Form W-4R at [Fidelity.com/W-4R](Fidelity.com/W-4R for)[ for](Fidelity.com/W-4R for) additional information. To update your address, go to [Fidelity.com](Fidelity.com).  \n• Nonresident aliens must provide IRS Form W-8BEN and a U.S. or foreign tax identification number.  \n• If you are making withdrawals from both a money purchase plan and a profit sharing plan, you must complete a separate form for each account.  \n• If this form directs Fidelity to sell shares of any security, be aware that the timing of the transaction depends on when we receive this form, which is outside of your control. To better control the timing of the transaction, you should direct the sale of securities online or through a Fidelity representative. Note: Certain securities (such as options, certain fixed income securities, and thinly traded securities) may not be eligible to sell via this form, which may result in Fidelity not being able to process this withdrawal as requested.  \n• Any fees charged or expenses incurred in connection  \nwith your instructions will be assessed at the “rep-assisted”rates. Fees and expenses may be lower if you instead place your trades online. Please refer to the Schedule of Fees for more information.  \n• For mutual funds, note that:  \n– Withdrawals could trigger redemption or transaction fees (see the applicable fund prospectus) .  \n– If a fund is closed to new investors, you will not be able to purchase new shares of the fund in the future if you draw your fund balance down to zero.  \n1. Account Owner  \n\n|  |  |  |\n| --- | --- | --- |\n|  | Name | Fidelity Account Number |\n|  |  |  |\n\nPlan Information  \n\n|  | Plan Name |\n| --- | --- |\n|  |  |\n\n Money Purchase Spousal consent and notary required.  \n Profit Sharing [","cbCaic5fp74G2lN9","https://ap.wps.com/l/cbCaic5fp74G2lN9","pdf",1930934,24,"English","# Account Owner\n# Plan Information\n# Request Reason\n## Normal (at least 59½)\n## Disability\n## Qualified birth or adoption distribution\n## Qualified disaster recovery distribution\n## Domestic abuse distribution\n## Military service\n## Qualified reservist distribution","[{\"question\":\"What is this form used for?\",\"answer\":\"This form is used to request a one-time withdrawal from a Fidelity Self-Employed 401(k), Roth Self-Employed 401(k), Profit Sharing, or Money Purchase Plan account.\"},{\"question\":\"When can distributions be requested under the plan rules?\",\"answer\":\"Distributions are permitted only when a participant reaches a triggering event as defined in Section 2; distributions for other reasons may risk plan disqualification.\"},{\"question\":\"What information is required when selecting a request reason?\",\"answer\":\"You must check only one request reason and meet the corresponding eligibility criteria, such as being at least 59½ for Normal, or qualifying under the plan definition of disability for disability distributions.\"}]","One-Time Withdrawal - Defined Contribution Retirement Plan | PDF",1789799305,8]