Individual Retirement Account (IRA) Required Minimum Distribution

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1 Prudential Mutual Fund Services LLC (PMFS) a Prudential Financial company Why This Form is Important Individual Retirement Account (IRA) Required Minimum Distribution For assistance: Clients (800) Pruco representatives (800) Financial professionals (888) When you reach age 70½, the tax law requires that you withdraw a certain amount of money each year from your retirement account and pay taxes on this amount. These annual withdrawals are known as required minimum distributions. Fill out this form to begin taking the required minimum distribution from your PMFS mutual fund Individual Retirement Account. Note: The required minimum distribution will be based on the year-end balances of all funds within your account. You should plan these withdrawals carefully. You need to take into account your income needs as well as the future income needs of your spouse, children, or other beneficiaries. Some of the choices you make cannot be changed. Also, the Internal Revenue Service (IRS) imposes stiff penalties if certain rules are not followed. For these reasons, we suggest that you consult with your tax adviser because neither we nor our representatives can provide tax advice. On these pages, I, you, and your refer to the account owner. We and our refers to PMFS. Mailing Standard Prudential Mutual Fund Services LLC mail to: PO Box 9658 Providence, RI Overnight mail to: Prudential Mutual Fund Services LLC 101 Sabin Street Pawtucket, RI Account Owner Information 2 Calculation 3 Life Expectancy Method Your name, address, and Social Security number should match the information on your quarterly PMFS mutual fund IRA statement. We will calculate your required minimum distribution amount based upon your PMFS mutual fund IRA value as of the preceding December 31. Please indicate whether you would like us to calculate your first-year distribution only or calculate each year on an ongoing basis. Your required minimum distribution is determined by dividing the total amount in your IRA on December 31 of the previous year by your life expectancy factor. The Uniform Lifetime Table is used for everyone age 70 and older. An exception to this rule applies where the account owner is married to a spouse who is the sole primary beneficiary and is more than 10 years younger than the account owner. The Joint Life and Last Survivor Expectancy Table (recalculation method) would be used to determine the distribution payment of the owner and spouse. You can find the IRS life expectancy tables by contacting the IRS Forms Distribution Center at (800) (TAX-FORM) or by downloading Publication 590 from Calculation Method. Under the float (recalculation) method, you will refer to the life expectancy tables each year to figure out your new life expectancy. Page 1 of 6

2 4 Tax Withholding Election 5 Distribution 6 Tax Certification and Signature Indicate what percentage, if any, that we should withhold for income taxes. The IRS generally requires you to "pay as you go" while you are taking money out of your retirement accounts. Writing one check each year to cover the taxes on your withdrawals may subject you to IRS penalties for failing to make estimated payments. You should consult with your tax adviser to determine how much to withhold. You can wait until April 1 of the year after you turn 70½ to take your first withdrawal; however, you must take your next withdrawal by December 31 of the same year. Failure to make required distributions on time may result in IRS penalties. Please consult your tax adviser. Please indicate: when you want the distributions to begin, how often the distributions should be made, and if we should allocate the distribution from all funds or allocate only from the specified funds. Receiving your distributions. There are three ways to receive your required minimum distribution: A. Reinvest the required minimum distribution into a non-retirement PMFS mutual fund account. We will reinvest the distribution from your IRA account. The distribution will be calculated proportionately across all funds within the account number unless otherwise specified. The distribution will be taken from the fund(s) named in the Systematic Exchange From section into the existing fund(s) and account number you name in the Systematic Exchange To section. If a non-ira does not exist, you are required to include a completed Mutual Fund Account Application with this form to establish the non-ira. The IRA mutual fund must be within the same share class and same fund family as the non-ira mutual fund. There are usually no sales charges for moving money from one fund to another fund within the same share class. There might be restrictions on reinvesting your distributions into certain money market funds. See the Fund prospectus for additional information. B. You may also choose to have your distribution wired to your bank account. You can receive your distributions quickly and easily with direct deposit. Be sure to attach a voided check or deposit slip from your bank account, and allow up to three weeks to activate the first direct deposit. C. Receive a check. Please sign and date where indicated. We cannot process this form without your signature. Page 2 of 6

3 Please print using blue or black ink. 1 Account Owner Information Name of account owner (first, middle initial, last name) Street Individual Retirement Account (IRA) Required Minimum Distribution Apt. City State Zip code Daytime telephone number Extension Home telephone number Social Security number (optional) or Account number (required) Date of birth (month/day/year) 2 Calculation (Check one.) 3 Life Expectancy Method 4 Tax Withholding Election Please tell us how frequently you want PMFS to calculate your required minimum distribution amount. Calculate one time only. We will calculate the amount of your first distribution only. By selecting this option, you will be responsible for calculating all future required minimum distribution amounts. Calculate each year. We will calculate your required minimum distribution withdrawals each year on an ongoing basis, based upon your PMFS mutual fund IRA value as of December 31 of the prior year. Complete this section only if your spouse is your sole primary beneficiary and is more than 10 years younger. The joint life expectancy table (recalculation method) will be used. Please provide your spouse's date of birth. Spouse s date of birth (month/day/year) The taxable portion of the withdrawal that you receive will be subject to federal income tax withholding and state income tax withholding, where applicable, unless you elect not to have withholding apply. The taxable portion of your withdrawal will normally be subject to federal income tax withholding at a rate of 10 percent for non-annuity payments, and is based on withholding tables for annuity payments. Your withdrawal may also be subject to state income tax withholding in certain states. Please note that if you are a U.S. citizen and your address of record is a non-u.s. address, we are required to withhold income tax unless you provide us with a U.S. residential address. If applicable, please include your U.S. residential address with this form. By signing and dating this form and making no entries in this section, you can elect not to have any taxes (federal or state) withheld, but you will still be liable for payment of any taxes due. Please check the appropriate boxes if you want to have federal and/or state income tax withheld. Withhold 10 percent federal income taxes on the taxable portion of my distribution. (If you want to have more than 10 percent withheld, please indicate it in the box below.) Percent (minimum 10 percent) or Dollar amount $,. (Amount cannot be less than 10 percent of distribution.) If you want to have state income taxes withheld from the taxable portion of your withdrawal, please complete the appropriate box(es) below. Please be advised that if your resident state requires mandatory withholding, we will withhold the default amount your state requires if you elect no withholding. Withhold state income taxes on the taxable portion of my withdrawal based on the following criteria: Percent or Specific dollar amount $,. Note: The percent or dollar amount cannot be less than the minimum required by your state of residence. If the amount you selected is less, we will withhold the required amount. Page 3 of 6

4 5 Distribution Date of first payment (month/day/year) Account number If applicable, indicate the frequency of your distribution payments: Monthly Quarterly Semiannually Annually Check one: Establish distribution on all funds. Distribution will be allocated proportionately across all funds within the account number stated above, unless otherwise specified below. I do not want to establish the distribution on all funds. Please establish distributions on only the name(s) listed below: Fund Name Share Class Receiving Your Distributions There are three ways to receive your required minimum distributions. (Check either A, B, or C.) A. Reinvest the required minimum distribution into a non-retirement PMFS mutual fund account. We will reinvest the distribution into the fund(s) you name below. (See instructions on page 2 before completing this section.) *If Yes, specify non-ira number. *If Yes, specify non-ira number. Page 4 of 6

5 5 Receiving Your Distributions (continued) *If Yes, specify non-ira number. *If Yes, specify non-ira number. *If Yes, specify non-ira number. Page 5 of 6

6 5 Receiving Your Distributions (continued) Attach voided check here. B. Direct deposit to your bank account. Bank name Bank account number ABA routing number (To ensure accuracy, verify with your bank.) Type of account Checking Savings Name of depositor on bank records (first, middle initial, last name) Name of joint depositor on bank records (first, middle initial, last name) C. Send a check to the address listed on your account. 6 Tax Certification and Signature(s) By signing below, I certify and acknowledge that the information provided on this form is correct. Under the penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), 2. I am not subject to backup withholding because: a) I am exempt from backup withholding, or b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. You must cross out item 3 above if you are not a U.S. person (including a U.S. resident alien). You must cross out the entire Tax Certification box if you have not provided your social security number in Section 1. The IRS does not require your consent to any provision of this document other than certification required to avoid backup withholding. X Account owner s signature month day year Page 6 of 6

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