Certificate of Withdrawal (Form LP-102). Important information about this form: •.I am writing this letter to withdraw my admission. It is to humbly request you to kindly cancel my admission. Review and complete Unforeseeable Emergency Requirements to determine if you are ELIGIBLE to take a unforeseeable emergency withdrawal. We will send you the withdrawal amount after we receive your completed forms in good order. To avoid delays, be sure to complete all sections. We keep it simple: you can take out your money when you need it. Use this form to request a one-time withdrawal from a Fidelity Self-Employed 401(k), Profit Sharing, or Money Purchase Plan account. Find forms to withdraw or rollover funds from your TIAA accounts.