TN 64 (07-14)

Document Identifier for Word Processor: E4019

A. Exhibit Letter

You asked to withdraw your Retirement application.  You must meet two conditions for us to approve your request.  First, you may only withdraw an application once in your lifetime. Second, you must file your request within 12 months from the date of your entitlement to benefits. 

We cannot approve your request because *F1.

B. Requesting Instructions

Follow the instructions below to prepare the withdrawal denial:

• The Claims Authorizer or the Benefit Authorizer prepares a manual notice using Exhibit E4019.

• The authorizer will furnish the fill-in information and, if necessary, any additional paragraphs that may be needed.

  Fill-ins:

  *F1-1 - we received it after the 12-month time limit.

  *F1-2 – you already withdrew an application.