401(k) Hardship Withdrawal Request State of Tennessee 401(k ...

If you are a non-resident alien, you must attach IRS Form W-8BEN with an original signature. In general, the withholding rateapplicable to your payment is 30% unless a reduced rate applies because your country of residence has entered into a tax treaty withthe U.S. and the treaty provides for a reduced withholding rate or an exemption from withholding. To obtain the IRS Form W-8BEN,call 1-800-TAX-FORM.Contact your tax professional for more information.][Form 11 ][GWRS FDSTHD ][12/07/12 ][Page 6 of 6][GP22][/306025589][A01:112912