Required Minimum Distribution
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1
22012 Required Minimum Distribution
Mailing Address:
P.O. Box 8963
(RMD) Form
Wilmington, DE 19899-8963
800-209-9010 Fax: 302-999-9554
1. Tell Us About Yourself
(Please complete all fields below)
Name
Daytime Phone
Social Security Number
Account Number
Investment Firm/Account Executive’s Name
Investment Representative & Phone Number
Plan/Account Type:
2. Calculating Your Life Expectancy Factor
The Uniform Lifetime Table below will help you determine your required payment. Here’s how to use it:
Find your age on your 2012 birthday. The figure beside your age is your life expectancy factor.
Divide the December 31, 2011 total value of all assets within your Principal Trust Company retirement account by the life expectancy factor.
STOP!
If you are an IRA beneficiary taking a Required Minimum Distribution, the information on this form cannot be used to calculate the amount of your
distribution. Please refer to our beneficiary RMD calculator located on our website at or call our Client Contact Center at
800.209.9010.
Once you have calculated your RMD you will need to complete sections 4 through 9 in order to process your 2012 RMD.
Uniform Lifetime Table
Life Expectancy
Life Expectancy
Life Expectancy
Life Expectancy
Life Expectancy
Age
Age
Age
Age
Age
Factor
Factor
Factor
Factor
Factor
70
27.4
75
22.9
80
18.7
85
14.8
90
11.4
71
26.5
76
22.0
81
17.9
86
14.1
91
10.8
72
25.6
77
21.2
82
17.1
87
13.4
92
10.2
73
24.7
78
20.3
83
16.3
88
12.7
93
9.6
74
23.8
79
19.5
84
15.5
89
12.0
94
9.1
You can receive additional information about mandatory payments from your local IRS office or by calling the IRS Forms Distribution Center at
800-829-3676. Ask for IRS Publication 590 if you have an IRA or IRS Publication 560 if you are a participant in an employer sponsored plan.
3. Calculating the Minimum Distribution
IMPORTANT:
You must answer all questions below if you want us to calculate and authorize the disbursement of your Required Minimum Distribution.
By completing the information below, you authorize Principal Trust to use this information to calculate your Required Minimum Distribution and
authorize the distribution out of your account. You acknowledge that Principal Trust will not confirm the amount of distribution to you before
processing the distribution. You understand that you should provide information in Section 5 of this form to indicate what percentage of your
distribution should be paid in cash and what percentage should be paid in securities and that if you do not detail this information in Section 5, we
will send generic authorization to your investment firm to make the distribution.
NOTE:
You may only use Joint Life Expectancy if your spouse is your sole beneficiary and is at least ten (10) years younger than you. (You must answer
questions (a) through (d) if you are using Joint Life Expectancy. All others must use the Uniform Lifetime Table and answer questions (a) through (c).)
Which withdrawal calculation method are you using?
Uniform Lifetime
or
Joint Life Expectancy
(a) What is your date of birth?
$
(b) What was the December 31, 2011 market value of your account?
$
(c) What, if any, is the total amount of distribution(s) taken towards your 2012 Required Minimum distribution?
(d) If you are using Joint Life Expectancy, what is your spouse’s date of birth
4. Account Status
I am taking a partial distribution. (My retirement plan will remain open.)
This represents a total closing of my account.
Delaware Charter Guarantee & Trust Company d/b/a Principal Trust Company
TR314-5
1 of 2
12/2011
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