Pbgc Form 705 - Beneficiary Application For Pension Benefits

Pbgc Form 705 - Beneficiary Application For Pension Benefits - 2006 Page 3

Form 705, page 3 of 4

Beneficiary Application for Pension Benefits

Plan Number:

Participant Name / SSN:

Applicant Name / SSN:

What happens if you do not choose any option?

If you do not choose one of these options, we will withhold Federal taxes as if you were a married

individual with three allowances. The amount we will withhold depends on your monthly pension.

What if you want to pick a different option later?

You may change your decision at any time. To choose a different option, simply call PBGC's Contact

Center at 1-800-400-7242. We will then send you a tax withholding form to complete. Depending

on when we receive it, we will make the change by the next month or the month after that.

What if you don't live in the United States?

If you live outside the United States, you cannot elect option A. You may be eligible for special tax

treatment under a tax treaty with the country you reside in. We will send you additional information after

you file this form.

When determining whether to have Federal tax withholdings you may find it helpful to read the IRS instructions

for completing the IRS Form W-4P (Withholding Certificate for Pension or Annuity Payments). If you would like

a copy, you can either call the PBGC Contact Center at 1-800-400-7242 and request a copy be sent

to you or you can print a copy from the IRS Internet site under Forms and Instructions at

Election

- In general, tax laws require PBGC to withhold Federal income tax from your pension payments,

unless you specifically elect not to have taxes withheld. Complete A or B or C (ONLY ONE).

A. I elect not to have Federal income tax withheld.

B. I elect to have Federal income tax withheld based on IRS instructions.

Single

Married

Marital Status

Number of withholding allowances

.00

Additional monthly amount to be withheld (optional): $

C. I elect to have the following amount withheld for Federal income tax.

.00

The dollar amount to be withheld monthly is: $

If you do not choose an option, we will withhold Federal income taxes as if you were a married individual with

three allowances. This means that for year 2003, we will withhold taxes only if your monthly PBGC benefit is

$1,320 or more.

CONTINUE

Pbgc Form 705 - Beneficiary Application For Pension Benefits - 2006 Page 3