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Here is a good sample for you, please feel free to modify..
Employee’s NameEmployee’s AddressCity, State, Zip CodeDATEDesignated Person’s NameDesignated Person’s PositionCompany’s NameCompany’s AddressCity, State, Zip CodeRE: Request for a withdrawal from 401k account number NUMBERDear Designated Person’s Name:This letter is a formal request to withdraw ten thousand dollars ($10,000) from my 401k account because of unexpected medical expenses for my wife. The account currently contains thirty-five thousand dollars ($35,000). I have completed and enclosed the required forms for this request. My wife required emergency surgery for a tumor in her stomach, which turned out to be benign. My health insurance covered the cost of the surgery, but she cannot return to work for three months, during which time our income will be reduced.If you grant my request, we will have no trouble continuing our mortgage payments and not fall behind, which could result in foreclosure. I have tried to get a loan to cover the expenses, but the interest payments were too much of a burden for our income even when my wife is able to work.I have included copies of my wife’s medical reports. If you have any questions, you can reach me at Email Address or at Phone Number. Thank you for taking the time to consider my request.Sincerely,Signature of EmployeePrinted Name of EmployeeList of Enclosures: Proper Forms, Medical Report
I appreciate the chance to help you tonight.Good luck here, thanks again.
Some of the main reasons that qualify are:• Medical expenses for the employee or a dependent• Down payment for a primary residence• Mortgage payment to prevent foreclosure of eviction• Educational expenses• Essential house repairs• Funeral expenses
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