Form An07119 - Rmd Withdrawal Form - Fixed And Indexed Annuity Withdrawal - Lincoln Financial Group Page 3
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1
2
3IMPORTANT INFORMATION
The information provided in this form is based upon the Company’s interpretation of current tax laws and regulations. Such information
is not intended to serve as legal and/or tax advice. You should consult with your tax advisor or legal counsel to determine which options
are suitable for your personal situation.
Required minimum distributions: The Internal Revenue
requires that you begin receiving distributions from your contract by a
(IRS)
certain date. The distributions that you must receive are known as required minimum distributions.
Required beginning date: The required beginning date is April 1
following the year the contract owner attains age 70½.
st
If you delay taking your first required minimum distribution until April 1
, you will be required to take your second required minimum
st
d
distribution by December 31
st
of that same year.
Required minimum distributions for each subsequent year will need to be taken by December 31
st
of each calender year.
d
If you fail to take your required minimum distribution when due, the Internal Revenue Service may assess a penalty.
d
A change in beneficiary designation may significantly affect the required minimum distribution election.
d
The joint life must be based on your spousal beneficiary.
d
6. AUTHORIZATION AND SIGNATURE
By signing below, you certify that you:
Understand that if the one time distribution is elected as the payment method, this form must be submitted on an annual basis in order
d
to receive your Required Minimum Distribution amount.
Understand the withdrawal and surrender features and process as stated in the contract or prospectus
.
(if applicable)
d
Understand and assume full responsibility for meeting the Internal Revenue Code requirements to qualify for this distribution. You
d
further agree to hold the Company harmless for any adverse tax ramification that may arise based on the information provided on this
form.
Authorize the direct deposit of the payment into the account identified on this form. This authorization requires the financial
d
institution to be a member of the National Automated Clearing House Association
. The Company is also authorized to initiate
(NACHA)
corrections, if necessary, to any amounts credited or debited to your account in error. You also agree to hold the Company harmless
for the date funds are actually credited to your account by your financial institution.
Understand that you should carefully plan when you want to take your first income payment under the Lincoln Living Income
SM
d
Advantage Rider option. The payment percentage will be set at that time and will remain unchanged throughout the rest of your
life. All withdrawals, in excess of the Required Minimum Distribution, above the Guaranteed Payment Amount will reduce your
subsequent Guaranteed Payment Amount pro rata or proportionally. This means that any withdrawal will reduce your payments by
the same percentage that it reduced your contract value.
__________________________________________________________________________
_______________________________
Contract Owner’s Signature
Date
__________________________________________________________________________
_______________________________
Joint Contract Owner’s Signature (if applicable)
Date
__________________________________________________________________________
_______________________________
Agent/Representative Name
Agent/Representative Telephone Number
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