Ira Beneficiary Claim Form Page 2
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4DISTRIBUTION OPTIONS (continued)
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Single Life Expectancy – These are distributions based on the single life expectancy of either the beneficiary or the (deceased) account holder. The
amount may be recalculated or non-recalculated depending on circumstances such as beneficiary relationship and the age of the deceased account holder.
Please submit a new IRA application along with this form. If you would like to set up systematic distributions, please complete numbers 1 and 2 below and
section F.
1. Start date*: __________ /____________ / ____________. (Generally, distributions must start by December 31st of the year following the death of the
account holder however, if you are a spouse beneficiary, there may be alternate start dates you may choose from. All beneficiary types should review IRS
rules regarding Inherited IRAs.)
* We will use the day of the month you have indicated in your start date for future distributions unless you select another date by calling investor services.
2. Frequency of withdrawals:
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All Months
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept Oct
Nov
Dec
or
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Lump Sum – Full liquidation. Please also complete section F.
E. W-4P TAX WITHHOLDING ELECTION
Federal Taxes:
State Taxes:
See “State Tax Withholding” on the
(If no election is made, 10% will be withheld.)
last page of this form for more information.
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Do NOT withhold federal taxes.
Do NOT withhold state taxes unless required by law.
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*Withhold federal taxes at a rate of:
Withhold state taxes at the applicable rate.
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*Minimum 10%, maximum 100%. Whole numbers, no dollar
Maryland Only:
amounts. Note that if there is federal withholding, certain
Voluntary election – Withhold at a rate of:
states require that there also be state withholding.
Percentage
Percentage
%
%
*For systematic distributions, the federal tax withholding election indicated above will remain effective until you change it. You may change or revoke your federal tax withholding
election at any time.
F. DELIVERY INSTRUCTIONS
Choose One:
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Standard mail to the address of record.
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Overnight mail to the address of record. There is a $25 fee for domestic service.
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Mail check to an alternate address or a third party.
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Delivery method:
Standard mail
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Overnight mail. There is a $25 fee for domestic service.
________________________________________________________
Name of Payee
_________________________________________________________
Address
_________________________________________________________
City
State
Zip Code
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ACH transfer to bank account. Please indicate your bank account in section G.
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Wire transfer to bank account. There is a $5 fee for this service. Wire is not available on systematic distributions. Please indicate your bank
account in section G.
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