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Tax forms decision chart: Tier One/Tier Two

Which tax forms do you need to fill out and send with your application?

The chart below will help you determine which tax forms must accompany your Tier One/Tier Two retirement application.

If you have selected……You will need to complete the forms marked with an “X” in the column directly across from the option you selected:If rolling lump-sum

Option you chose

Payment Type

Form 1


Form 2

W-4R Lump Sum Tax Withholding

Form 3

Tier One/Tier Two Program Direct Transfer Rollover Acceptance
Option 1
Option 2
Option 2A
Option 3
Option 3A
15-Year Certain
Refund Annuity
Monthly benefit X   
Lump Sum 1
Lump Sum 2
Lump Sum 2A
Lump Sum 3
Lump Sum 3A
Monthly benefit X   
Lump-sum benefit   X X
Total Lump-Sum Lump-sum benefit   X X