401k Hardship Withdrawal Letter for COVID-19 Sample

Use this sample letter as a template for your successful hardship withdrawal letter.

sample COVID-19 hardship withdrawal letter from a 401k

Employee’s Name
Employee’s Address
City, State, Zip Code

DATE

Designated Person’s Name
Designated Person’s Position
Company’s Name
Company’s Address
City, State, Zip Code

RE: Request for a withdrawal from 401k account number NUMBER

Dear 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 was diagnosed with COVID-19 and required emergency surgery. 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 Employee
Printed Name of Employee
List of Enclosures: Proper Forms, Medical Report