Fillable Simple Ira Distribution Request (Page 2 of 3) in pdf

3. Method of distribution (continued)

Future payments

New payment request

Update existing payment

Select one of the following:

Systematic withdrawal payments: Payments in the amount of $

will be made on the

day of each month.

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of each month.

Date payments are to begin:

Specify frequency:

Monthly

Quarterly

Semiannually

Annually

Month/year

Life expectancy payments: Payments based on the life expectancy noted below will be determined from the appropriate IRS annuity tables and

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Payments will be made on the

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of each month.

Date payments are to begin:

Specify frequency:

Monthly

Quarterly

Semiannually

Annually

Month/year

Payments will be based on

single life expectancy or

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spouse

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Date of birth (MM/DD/YYYY)

Your prior year-end value is needed to calculate your life expectancy payment. If your SIMPLE IRA assets were not held with John Hancock Investments

as of December 31 of last year, please provide the year-end value of your assets: $

4. Income tax

Federal taxes

Federal income taxes will automatically be withheld from your SIMPLE IRA distribution at a rate of 10% unless you elect NOT to have taxes withheld or select a

greater rate below. If you elect to have no federal taxes withheld from your distribution payments, or if you do not have enough federal income tax withheld from your

distributions, you are still liable for the payment of federal income tax. You may also incur penalties under the estimated tax rules if your withholding and estimated

tax payments are not sufficient. If taxes are withheld on your distribution, the amount you requested in Section 3 will decrease by the amount withheld.

If your distribution is delivered to a post office box and you do not have a U.S. residential address on file with us, or to an address outside of the United States or

one of its possessions, and you are a U.S. person (including a U.S. resident alien) with a valid IRS Form W-9 on file, we are required to withhold 10% in federal

taxes. This withholding may not be waived. If you are not a U.S. person, federal income tax will be withheld at a rate of 30% unless a valid IRS Form W-8BEN

is on file claiming a reduced tax treaty rate.

No, do not withhold federal income tax from my distribution.

Yes, withhold federal income tax at a rate of

% (not less than 10%) and any applicable state taxes.

State taxes

If you live in one of the mandatory withholding states and request federal taxes to be withheld from your distribution, John Hancock will also withhold your state’s

minimum required tax. The mandatory withholding states include AR, CA, DC, DE, IA, KS, MA, ME, MI*, MS, NC, NE, OK, OR, VA, and VT (the list of states may

change as a result of changing legislation). If state tax is withheld from the distribution, the amount you requested in Section 3 will decrease by the amount withheld.

* Residents of MI will have state income taxes withheld regardless of federal income-tax withholding. John Hancock will withhold the state’s minimum required tax

from your distribution unless you select “Do not withhold Michigan state taxes” below.

Do not withhold Michigan state taxes.

5. Method of payment

Select one of the following payee options:

Mail the check directly to me at my address of record.

Mail the check directly to me at my address of record using express mail. A $20.00 fee will be assessed.

Reinvest the proceeds into my existing, individual non-retirement account in the same fund:

. (Please provide your account number.)

Mail to the alternate payee or alternate address listed below. (Your signature must be medallion signature guaranteed in Section 6.)

Direct deposit to my new or existing bank account using an Automated Clearing House (ACH) system. Please include a preprinted voided check for new

bank accounts. This bank information will be added to your account for future transactions. This option would deliver the funds to your bank within two to three

business days of the trade date. Direct deposits to third-party bank accounts will require a medallion signature guarantee in Section 6.

SIRADFM 5/16

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