Ira Distribution Request Form

Download a blank fillable Ira Distribution Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Ira Distribution Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Reset Form
Print Form
IRA DISTRIBUTION REQUEST
(Including Tax Withholding Election Form)
This form is for distributions from Traditional, Rollover, SEP, SIMPLE and Roth IRAs.
Please do not use this form for distributions from Coverdell ESAs or, inherited IRAs. (You must complete a Distribution Request for
Coverdell ESAs or a Distribution Request for Inherited IRAs.)
A separate form is required for each type of IRA and distribution reason.
Please contact your local branch with questions.
1. IRA ACCOUNT HOLDER INFORMATION
Name (Please Print)
Business Phone
Home Phone
Type of IRA
IRA Account Number
Traditional
Rollover
SEP
Roth
SIMPLE
Home Street Address
Date of Birth
City
Social Security Number
State
ZIP Plus 4
(no dashes)
2. METHOD OF DISTRIBUTION
Check*
Deposit to Scottrade Bank* Account #
Deposit to existing Scottrade non-IRA account #
Wire ($25 fee applies)
Please also complete Scottrade form SF3675, Authorization to Wire Funds
*If alternate payee, please complete alternate payee form.
3. DISTRIBUTION INFORMATION
DISTRIBUTION REASON: I direct Scottrade to make a distribution from my IRA for the following reason:
1. Normal Distribution
1 /
5. Direct Rollover to Employer Plan
(Over Age 59
)
2
Qualified Plan Name
2. Premature Distribution
1
(Under Age 59
)*
/
2
3. Disability Distribution (
pursuant to IRC 72(m)(7))
Qualified Plan Address
4. Revocation (
within 7 days of opening account)
Qualified Plan Account #
6. Excess Contribution Removal
(proceed to section 5 of this form)
* For SIMPLE IRA premature distribution, has it been at least two years since the initial deposit?
Yes
No
4. DISTRIBUTION INSTRUCTIONS
I direct Scottrade to distribute the amount requested as follows:
(Note: Funds must be available in cash.)
1. One-time partial distribution of cash $
2. One-time partial distribution of securities - List securities below* (Note: securities cannot be mailed to you.)
3. Total distribution of cash and securities (Note: securities cannot be mailed to you.)
Close Account
or
Leave account open for future deposits
4. Monthly or quarterly systematic distribution (One systematic distribution per account)
New
or
Amendment to an existing monthly or quarterly distribution
(must complete sections 1-4 and 6-7 of this form.)
(Choose Option A or B, but not both)
Monthly
or
Quarterly
Starting Month
Monthly and Quarterly distributions are processed on the fifth of the month. If the fifth falls on a weekend or holiday, the distribution will be
processed on the following business day. Systematic distributions are only permitted once per month or quarter.
Cash
$
(Note: Funds must be available in cash.)
Securities
- List securities below* (Note: Securities cannot be mailed to you.)
*Investment Name
*Investment Name
*Investment Name
CUSIP or Symbol
CUSIP or Symbol
CUSIP or Symbol
# of Shares or All
# of Shares or All
# of Shares or All
*SF2035*
Scottrade, Inc. - Member
FINRA
and
SIPC
SF2035/11-15
Please continue
Page 1 of 5

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 5