Required Minimum Distribution (Page 2 of 2) in pdf

5. Tell Us About Your Payment Amount (Please select from one of the following options)

NOTE:

Completing this section will authorize distribution as listed below. If you have asked us to calculate your payment in Section 3, please update

appropriate field below with percentage information. If a dollar amount is entered in any of the fields below, we will authorize the disbursement of

Required Minimum Distribution.

(a)

$ or % Cash Only

(b)

$ or % Securities Only

(You must complete the “Securities to be Reregistered or Liquidated” chart below)

$ or % Securities

(c)

$ or % Cash

and

(You must complete the “Securities to be Reregistered or Liquidated” chart below)

Securities to be Registered or Liquidated (must be completed if (b) or (c) selected above)

How Much

Fund/

Select One

Broker

(Shares, Units, $ Amount or

Name of Asset(s)

Account Number(s)

Agent

Liquidate/Reregister

Held

6. When Should We Send Your Payment(s)?

This is a one-time 2012 payment. Send my payment in

(month).

Beginning in

(month), my payments should be made:

Monthly

Quarterly

NOTE:

If you select monthly or quarterly payments, please ensure there is sufficient time to receive your minimum payment by December 31, 2012

7. Where Should We Send Your Payment(s)?

Home

Other (complete information below)

Street Address

City

State

ZIP

City

State

ZIP

If “Other” selected above, please provide the following additional information:

Payee Firm Name

Routing Number (additional wire charge may be applicable)

Account Type

Account Number

Payment Method

Check

Journal

Checking

Savings

Other:

8. Should We Withhold Taxes?

(a) I do NOT want taxes withheld from my distribution.

(b) I DO want 10% in Federal taxes withheld. Withhold additional:

NOTE:

Federal Income Taxes must be withheld from distributions unless the recipient elects not to have withholding applied. You may elect out of this

withholding by checking option (a) above. If no election is made or if you elect to withholding (b) above, we must withhold taxes at the required flat

10% rate. If you elect to have withholding, you can also elect to have an additional amount or percentage withheld from your payment. If you elect

federal tax withholding and live in a state that requires state tax withholding, we will also deduct state taxes from your payment.

IMPORTANT:

If you are a participant in an employer sponsored plan and withdraw amounts that exceed your minimum required payment, they are subject to the

required 20% tax withholding. Amount for withdrawal that exceeds your RMD, or for a total closing, must be requested using our Qualified Plan

Distribution Request Form.

9. Your Signature

I understand, acknowledge, and agree that, if I request Principal Trust Company to calculate my required minimum distribution payment, it will do so

based solely on the information that I provide. I further understand, acknowledge, and agree that I am solely responsible for verifying the accuracy of

Principal Trust Company’s calculations and the distribution amount when I receive it.

«Dear» Signature

Date

Delaware Charter Guarantee & Trust Company d/b/a Principal Trust Company

TR314-5

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12/2011