Forms

FBC / Nationwide Plan Forms

These forms are used to create or make changes to your Fringe Benefits Consortium / Nationwide plan account.  Select the category that best describes your employer below:

San Diego County Employer

Riverside County Employer

Imperial County Employer

San Diego Community College District

Corona-Norco Unified School District

Withdrawal Authorization Forms (Other Vendor Plan Forms)

Withdrawal transaction (distribution/rollover, hardship withdrawal, or loan) from a non-Nationwide 403(b) plan provider require that you complete your provider's withdrawal forms as well as a corresponding authorization form provided below.  These authorization forms are required by your employer to assist in monitoring your account for compliance with IRS rules and limits.  Your 403(b) provider should not process a withdrawal transaction for your account without a completed Authorization Form.

403(b) Loan Authorization Form

403(b) Hardship Withdrawal Authorization Form

403(b) Distribution Rollover Authorization Form

403(b) Transfer Authorization Form

Adobe Reader is required to view all forms.  It may be downloaded for free here.