Fidelity NetBenefits Distribution - Recurring Payments Completed Form Examples and Samples
Explore clear, filled-out examples of the Fidelity NetBenefits Distribution - Recurring Payments form. Our detailed samples and templates guide you through setting up scheduled withdrawals from your retirement account, including tax withholding and direct deposit information.
Fidelity NetBenefits Distribution - Recurring Payments Example: Retiree Setup
How this form was filled:
This example shows a retiree setting up a monthly distribution of $2,500 from their 401(k) starting in 2026. It specifies federal (10%) and state (5%) tax withholding and directs the net payment to a personal checking account via direct deposit.
Information used to fill out the document:
- Retiree Name: Jane A. Smith
- Social Security Number: XXX-XX-1234
- Address: 456 Oak Avenue, Anytown, USA 12345
- Date of Birth: 05/20/1961
- Fidelity Account Number: Z12-345678
- Plan Name: ABC Company 401(k) Plan
- Payment Start Date: 07/01/2026
- Payment Frequency: Monthly
- Gross Payment Amount: $2,500.00
- Payment End Date: No End Date (Continue until depleted)
- Federal Tax Withholding: 10%
- State Tax Withholding: 5%
- Direct Deposit Bank Name: Anytown Financial Bank
- Bank Account Type: Checking
- Bank Routing Number: 012345678
- Bank Account Number: 9876543210
- Signature: Jane A. Smith
- Date: 06/15/2026
What this filled form sample shows:
- Clear selection of a recurring payment schedule (monthly) with a specific start date.
- Specific tax withholding percentages for both federal (10%) and state (5%) taxes.
- Complete direct deposit information, ensuring funds are sent to the correct checking account.
- Indication of a gross distribution amount, from which taxes will be withheld before payment.
Form specifications and details:
| Form Name: | Fidelity NetBenefits Distribution - Recurring Payments |
| Use Case: | Retiree setting up monthly distributions from a 401(k) plan for retirement income. |
Created: February 25, 2026 05:37 PM
