To apply, fill out the Self-Certification Unforeseeable Emergency Form (PDF) and return it to us via mail. Please list your actual hardship expenses.Benefit Distribution Request (PDF) (PDF) – Start the process needed to request a distribution from the Plan. Submit your forms as follows: 1) Inquries and questions can be sent via email to the Plan. If you have any questions about completing this form, or about applying for a withdrawal on your own behalf, please contact Carolina Lopez at (510) 464-6208.