Form 5305-Rb - Roth Individual Retirement Annuity Endorsement Page 2
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Form 5305-RB (Rev. 3-2002)
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.
General Instructions
Definitions
The annuitant should see the
disclosure statement or Pub. 590 for
IRA Conversion Contributions. IRA
Section references are to the Inter nal
more information.
Conversion Contributions are amounts
Revenue Code unless otherwise noted.
Article V. This article describes how
rolled over, transferred, or considered
distributions will be made from the Roth
Purpose of Form
transferred from a nonRoth IRA to a
IRA after the annuitant’s death. Elections
Roth IRA. A nonRoth IRA is an individual
Form 5305-RB is a model annuity
made pursuant to this article should be
retirement account or annuity described
endorsement that meets the
reviewed periodically to ensure they
in section 408(a) or 408(b), other than a
requirements of section 408A and has
correspond to the annuitant’s intent.
Roth IRA.
been pre-approved by the IRS. A Roth
Under paragraph 2 of Article V, the
Issuer. The issuer is the insurance
individual retirement annuity (Roth IRA)
annuitant’s spouse is treated as the
company providing the annuity contract.
is established after the contract, which
owner of the Roth IRA upon the death of
The insurance company may use other
includes this endorsement, is fully
the annuitant, rather than as the
terms besides “issuer” to refer to itself,
executed by both the individual
beneficiary. If the spouse is to be treated
such as, “company,” “insurer,” or “us.”
(annuitant) and the issuer. The contract
as the beneficiary, and not the owner, an
must be for the exclusive benefit of the
Annuitant. The annuitant is the person
overriding provision should be added to
annuitant and his or her beneficiaries.
who establishes the annuity contract.
Article IX.
The insurance company may use other
Do not file Form 5305-RB with the
Article IX. Article IX and any that follow
terms besides “annuitant” to refer to the
IRS. Instead, keep it with your records.
it may incorporate additional provisions
person who establishes the annuity
that are agreed to by the annuitant and
Unlike contributions to traditional
contract, such as, “owner,” “applicant,”
issuer to complete the contract. They
individual retirement arrangements,
“insured,” or “you.”
may include, for example, definitions,
contributions to a Roth IRA are not
investment powers, voting rights,
deductible from the annuitant’s gross
Specific Instructions
exculpatory provisions, amendment and
income; and distributions after 5 years
termination, removal of the issuer,
Article I. The annuitant may be subject
that are made when the annuitant is
issuer’s fees, state law requirements,
to a 6% tax on excess contributions if
59
1
⁄
years of age or older or on account
2
beginning date of distributions,
(1) contributions to other individual
of death, disability, or the purchase of a
accepting only cash, treatment of
retirement arrangements of the annuitant
home by a first-time homebuyer (limited
excess contributions, prohibited
have been made for the same tax year,
to $10,000), are not includible in gross
transactions with the annuitant, etc.
(2) the annuitant’s adjusted gross
income. For more information on Roth
Attach additional pages if necessary.
income exceeds the applicable limits in
IRAs, including the required disclosures
Article II for the tax year, or (3) the
the issuer must give the annuitant, see
annuitant’s and spouse’s compensation
Pub. 590, Individual Retirement
is less than the amount contributed by
Arrangements (IRAs).
or on behalf of them for the tax year.
5305-RB
Form
(Rev. 3-2002)
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