Form 5305-Rb - Roth Individual Retirement Annuity Endorsement Page 2
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Form 5305-RB (Rev. 4-2017)
Page
Article VIII
This endorsement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other
published guidance. Other amendments may be made with the consent of the persons whose signatures appear on the contract.
Article IX
Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If
provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply
that they have been reviewed or pre-approved by the IRS.
General Instructions
not includible in gross income. For more
Article V. This article describes how
information on Roth IRAs, including the
distributions will be made from the Roth
Section references are to the Internal
required disclosures the issuer must give
IRA after the annuitant’s death. Elections
Revenue Code unless otherwise noted.
the annuitant, see Pub. 590-A,
made pursuant to this article should be
Contributions to Individual Retirement
reviewed periodically to ensure they
Purpose of Form
Arrangements (IRAs), and Pub. 590-B,
correspond to the annuitant’s intent.
Distributions from Individual Retirement
Under paragraph 2 of Article V, the
Form 5305-RB is a model annuity
Arrangements (IRAs).
annuitant’s spouse is treated as the
endorsement that meets the
owner of the Roth IRA upon the death of
requirements of section 408A. However,
Definitions
the annuitant, rather than as the
only Articles I through VIII have been
beneficiary. If the spouse is to be treated
reviewed by the IRS. A Roth individual
Issuer. The issuer is the insurance
as the beneficiary, and not the owner, an
retirement annuity (Roth IRA) is
company providing the annuity contract.
overriding provision should be added to
established after the contract, which
The insurance company may use other
Article IX.
includes this endorsement, is fully
terms besides “issuer” to refer to itself,
executed by both the individual
such as, “company,” “insurer,” or “us.”
Article IX. Article IX and any that follow
(annuitant) and the issuer. To make a
it may incorporate additional provisions
Annuitant. The annuitant is the person
regular contribution to a Roth IRA for a
that are agreed to by the annuitant and
who establishes the annuity contract.
year, the IRA must be established no
issuer to complete the contract. They
The insurance company may use other
later than the due date (excluding
may include, for example, definitions,
terms besides “annuitant” to refer to the
extensions) of the individual’s income tax
investment powers, voting rights,
person who establishes the annuity
return for the year. The contract must be
exculpatory provisions, amendment and
contract, such as, “owner,” “applicant,”
for the exclusive benefit of the annuitant
termination, removal of the issuer,
“insured,” or “you.”
and his or her beneficiaries.
issuer’s fees, state law requirements,
Specific Instructions
beginning date of distributions,
Do not file Form 5305-RB with the
accepting only cash, treatment of
IRS. Instead, keep it with your records.
excess contributions, prohibited
Article I. The annuitant may be subject
transactions with the annuitant, etc.
to a 6% tax on excess contributions if
Unlike contributions to traditional
Attach additional pages if necessary.
(1) contributions to other individual
individual retirement arrangements,
contributions to a Roth IRA are not
retirement arrangements of the annuitant
deductible from the annuitant’s gross
have been made for the same tax year,
(2) the annuitant’s adjusted gross
income; and distributions after 5 years
that are made when the annuitant is
income exceeds the applicable limits in
years of age or older or on
Article II for the tax year, or (3) the
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annuitant’s and spouse’s compensation
account of death, disability, or the
purchase of a home by a first-time
is less than the amount contributed by
homebuyer (limited to $10,000), are
or on behalf of them for the tax year.
5305-RB
Form
(Rev. 4-2017)
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