Harbor Ira Withholding Options Form

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Harbor IRA Withholding Options
Questions?
Use this form to change the current withholding election on your IRA. Please print in CAPITAL LETTERS and
in black ink.
Call 800-422-1050
To obtain additional forms or to
complete this form online, visit us
at .
Reset
Step
1
Account Owner Information
First Name
M.I. Last Name
Social Security Number
Date of Birth (mm/dd/yyyy)
Account Number
Daytime Telephone Number
Evening Telephone Number
Street Address or P.O. Box Number
City
State
Zip Code
Step
2
Withholding Notice & Election
>
This change will apply to future
Federal Income Tax Withholding (Substitute IRS Form W-4P OMB No. 1545-0074):
withdrawals until further notice.
>
Any election made after a
The distributions you receive from your Harbor Funds IRA (generally excluding Roth IRAs) are subject to a federal
distribution cannot be applied
tax withholding rate of 10% unless you elect not to have withholding apply (provided you have supplied Harbor Funds
with a U.S. address and a correct taxpayer identification number), or you elect to have an additional amount withheld.
retroactively to a prior distribution.
If no change is made, Harbor
Regardless of your withholding election, you must pay any tax due on the taxable portion of your withdrawals. If
federal tax is due, and either your estimated tax payments or the amount you have withheld is insufficient under
Funds will maintain your current
IRS rules, you may be subject to additional taxes and/or penalties. Tax will be withheld on the gross amount of the
withholding election on file.
payment even though you may be receiving amounts that are not subject to withholding because they are excludible
from gross income. This withholding procedure may result in excess withholding on the payment.
Do not withhold federal income tax from my IRA distribution(s).
>
%
Withhold federal income tax of
from my IRA distribution(s).
Amount must be at least 10%.
Step 2 continued on page 2

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