New York Life Retirement Plan Services SIMPLE IRA Account Service Form

Transcription

1 New Yk Life Retirement Plan Services SIMPLE IRA Account Service Fm Please complete this fm to change your address name; establish change your beneficiary designation; establish a Right of Accumulation Letter of Intent; request a one-time exchange; request a single distribution; establish a periodic distribution on your SIMPLE IRA account. Account balances of less than $1,000 will be charged an annual per account fee. F additional infmation, including certain exceptions, please see the Prospectus. The fee will be charged on a Fund-by-Fund basis. Contact your tax advis the Internal Revenue Service with any questions you may have concerning taxation. PLEASE PRINT OR TYPE 1 CURRENT ACCOUNT INFORMATION (Required f all requests.) PARTICIPANT NAME MIDDLE INITIAL LAST NAME SUFFIX PLAN NAME PARTICIPANT SOCIAL SECURITY NUMBER DATE OF BIRTH (MM/DD/YYYY) 2 ADDRESS CHANGE NEW ADDRESS MAILING ADDRESS (If mailing address is different than residence/street address if mailing address is a P.O. Box, please provide residence/street address below.) STREET P.O. BOX CITY STATE ZIP CODE RESIDENCE/STREET ADDRESS (Cannot be a P.O. Box.) STREET CITY STATE ZIP CODE 3 NAME CHANGE F ptfolio balances less than $100,000 Attach a photocopy of the appropriate name change document (Marriage Certificate, Divce Decree, Court Order), certified by the issuing authity. F ptfolio balances $100,000 me Attach a certified copy of the appropriate name change document (Marriage Certificate, Divce Decree, Court Order), certified by the issuing authity. To obtain proper certification, the name change document ( photocopy of the iginal) must be certified in ink by the issuing authity and bear an iginal certification seal stamp. A Notary Stamp is not an acceptable fm of certification. OR Provide signatures f both fmer and new names with a Medallion Signature Guarantee. FORMER NAME NEW NAME 1

2 4 BENEFICIARY DESIGNATION I hereby designate the following person(s) as my primary and contingent beneficiary(-ies) to receive all of the assets in my SIMPLE IRA account that remain undistributed at the time of my death. I hereby revoke all previous beneficiary designations, if any, with respect to this SIMPLE IRA account. I reserve the right to change this beneficiary designation by executing a new beneficiary designation on a fm acceptable to the Custodian and filing it with the Custodian during my lifetime. If at least one primary beneficiary survives me, no contingent beneficiaries will receive assets pursuant to this designation. F each designation, Primary and Contingent, the allocated percentages must total 100%. n Check here if you have no spouse. (Required, if applicable.) If you are married and live in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA) live in a marital property state (WI), and designate a primary beneficiary other than your spouse to receive me than half of your account, your spouse must sign below to evidence his her consent to such beneficiary designation. If you have any questions regarding community property states, please consult an attney. I hereby consent to my spouse s beneficiary designation. Signature of SIMPLE IRA account holder s spouse. X n Add new Beneficiaries to Existing Beneficiary Designation PRIMARY BENEFICIARY S FULL NAME n Revoke all previous Beneficiary Designations RELATIONSHIP TO OWNER SOCIAL SECURITY/TAX IDENTIFICATION NUMBER DATE OF BIRTH (MM/DD/YYYY) SHARE % PRIMARY BENEFICIARY S FULL NAME RELATIONSHIP TO OWNER SOCIAL SECURITY/TAX IDENTIFICATION NUMBER DATE OF BIRTH (MM/DD/YYYY) SHARE % CONTINGENT BENEFICIARY S FULL NAME RELATIONSHIP TO OWNER SOCIAL SECURITY/TAX IDENTIFICATION NUMBER DATE OF BIRTH (MM/DD/YYYY) SHARE % CONTINGENT BENEFICIARY S FULL NAME RELATIONSHIP TO OWNER SOCIAL SECURITY/TAX IDENTIFICATION NUMBER DATE OF BIRTH (MM/DD/YYYY) SHARE % 2

3 5 REDUCED SALES CHARGES (Invest Class and Class A shares only.) Please list any existing accounts that you wish to be considered f a Right of Accumulation Letter of Intent and check the applicable sections. Please note that a Right of Accumulation Letter of Intent may only be used to reduce sales charges and may not be used to satisfy investment minimums to avoid the automatic conversion feature of Invest Class Class A shares. MAINSTAY FUND ACCOUNT NUMBER MAINSTAY FUND ACCOUNT NUMBER Right of Accumulation When buying Invest Class Class A shares of MainStay Funds, you may combine the values of Invest Class, Class A, Class B, and Class C shares (except f noncommissioned shares of MainStay Money Market Fund) already owned by you and members of your immediate family (your spouse and children under age 21), including those held at other Broker/Dealers, to determine your eligibility to pay a reduced sales charge. Documentation may be required if shares are held at another Broker/Dealer. n I would like to use the combined assets in the above MainStay Fund account(s) to qualify f a reduced sales charge. Letter of Intent If you intend to invest a certain amount over a 24-month period in one me MainStay Funds, you may be entitled to a reduced sales charge. Ask your Registered Representative f detailed infmation concerning escrow and default provisions. A Letter of Intent may not be established f a shareholder who invests solely in MainStay Money Market Fund. I plan to invest, over a 24-month period, a total of at least: n $100,000 n $250,000 n $500,000 n $1 million 6 ONE-TIME EXCHANGE (Please attach additional pages as needed.) Exchanges are permitted between MainStay Fund accounts within the same class of shares and identical account registrations. If a new Fund is being established by this exchange, account options will not carry over unless the appropriate sections of this fm are completed. EXCHANGE Dollars $ Shares Percentage % FROM MAINSTAY FUND TO MAINSTAY FUND EXCHANGE FROM MAINSTAY FUND Dollars $ Shares TO MAINSTAY FUND Percentage % EXCHANGE FROM MAINSTAY FUND Dollars $ Shares TO MAINSTAY FUND Percentage % 3

4 7 BANK INFORMATION Complete this section to indicate the bank that you would like to send your distributions to in Section 8. Attach either a pre-printed voided check pre-printed savings deposit slip below. The Participant s name must appear in the bank account registration. If not, a Medallion Signature Guarantee is required in Section DISTRIBUTION DIRECTION (Complete Sections A through E.) A. Reason f Distribution (Check one type of distribution only.) n Early Distribution with Exception (Substantially equal periodic payments. 10% early distribution penalty does not apply. Complete Section B Part II.) n Early Distribution (under age , no exception to 10% early distribution penalty) n Early Distribution (under age , pri to participation in a SIMPLE IRA plan f at least two years; a 25% penalty may apply) n Nmal Distribution (age over) n Disability (attach signed physician s statement) n Death (attach a certified copy of Account Owner s Death Certificate and a completed MainStay Funds Individual Retirement Account Application) n Required Minimum Distribution after age n Withdrawal of employer OR employee (circle one) excess contribution of the tax year (enter either the current year previous year) n Transfer of all a ption of this account to an IRA of a fmer spouse under a decree under a written instrument to such divce (attach court certified documentation and a completed MainStay Funds Individual Retirement Account Application). Medallion Signature Guarantee required in Section 10. n Rollover to a Qualified Plan (Complete Section 8 Part B.I., Section 8 Part D, indicate no withholding in Part E, and sign Section 10.) 4

5 8 DISTRIBUTION DIRECTION (Continued) B. Distribution Frequency (Select one of the three choices below. Complete Part C to list funds to be distributed from.) I. n Single Distribution Indicate amount to be redeemed in Part C and complete Part D and Part E. Unless indicated otherwise, the proceeds will be mailed via check to your address of recd. II. n Periodic Distributions (Choose one) Choose one of the options below and complete Part C, Part D and Part E. Unless indicated otherwise, the proceeds will be mailed via check to your address of recd. The frequency chosen below will apply to all accounts listed in Part C. Beginning: (MM/DD/YYYY) Frequency: (Choose one) l Monthly l Quarterly l Semiannually l Annually l Systematic Withdrawal Plan (F a specified amount) l Required Minimum Distribution After Age Indicate your SIMPLE IRA account balance at the end of the year preceding the year f which the required minimum distribution is to be calculated. You should consult with your tax advis to determine if this amount should be adjusted to reflect certain outstanding rollovers and recharacterizations of Roth IRA conversions. I understand that my Required Minimum Distribution amount will be calculated using the IRS s Unifm Lifetime Table unless I am married and my spouse is the sole designated beneficiary of my SIMPLE IRA and is me than 10 years younger, in which case the amount will be calculated using the IRS s Joint Life and Last Surviv Expectancy Table. (To view these tables, visit and view IRS Publication 590.) Account Value as of December 31 of pri year: $ l Spouse beneficiary who is me than 10 years younger. Spouse s Date of Birth: (MM/DD/YYYY) l Substantially Equal Periodic Payments Calculation Method (Check one box f method) l Life Expectancy Method. Annually recalculate my distribution using the following IRS life expectancy table: (Check one box) l Unifm Lifetime Table l Single Life Expectancy Table l Joint Life and Last Surviv Expectancy Table. Beneficiary s Date of Birth: (MM/DD/YYYY) l Fixed Distribution Method. I have calculated my fixed annual distribution in the amount indicated below using a method f determining substantially equal periodic payments described in IRS Revenue Ruling (which, along with Frequently Asked Questions on the ruling, can be found at Amount to be distributed $ /year III. n Distributions to the beneficiary due to the death of the Account Owner. Based on Single Life Expectancy Table. Must supply Account Owner s Date of Death: (MM/DD/YYYY) 5

6 8 DISTRIBUTION DIRECTION (Continued) C. Accounts to be Distributed from (Use Section 9 if additional space is needed.) MAINSTAY FUND MAINSTAY FUND MAINSTAY FUND MAINSTAY FUND MAINSTAY FUND D. Fward Distribution To (Select one of eight choices below.) n My address of recd via check. n My bank account via the Automated Clearing House (ACH). (F Periodic Distributions and Single Distributions up to $100,000. You must complete Bank Infmation in Section 7.) Medallion Signature Guarantee may be required in Section 10. n My bank account via bank wire. (Available f Single Distributions only. There may be a fee charged to your SIMPLE IRA account and the receiving bank may charge a fee.) You must complete Bank Infmation in Section 7. Medallion Signature Guarantee may be required in Section 10. n SIMPLE IRA of Account Owner s fmer spouse. Medallion Signature Guarantee required in Section 10. n Account Owner s beneficiary entitled to payment by reason of the Account Owner s death. BENEFICIARY NAME BENEFICIARY DATE OF BIRTH (MM/DD/YYYY) BENEFICIARY RELATIONSHIP n SPOUSE n OTHER BENEFICIARY SOCIAL SECURITY/TAX IDENTIFICATION NUMBER n Special Payee (including a Qualified Plan) and Address via check. (Provide name and address below.) Medallion Signature Guarantee required in Section 10. NAME ADDRESS CITY STATE ZIP n A new New Yk Life Retirement Plan Services SIMPLE IRA account (New Yk Life Retirement Plan Services SIMPLE IRA Application attached) n My non-qualified MainStay Fund account FUND NAME ACCOUNT NUMBER 6

7 8 DISTRIBUTION DIRECTION (Continued) E. Choice of Tax Withholding (10% f federal taxes and any applicable state taxes will be withheld if no election is made.) Federal Withholding Under the tax law, federal income taxes must be withheld at a flat rate of 10% from this distribution, unless you tell us you do not want any taxes withheld by marking the appropriate box below. You can change this election at any time by filing a new fm. Even if you elect not to have any federal income taxes withheld, you are liable f payment of taxes on the taxable ption of your distributions. You also may be subject to penalties under the estimated tax payment rules if your payments of estimated tax withholding are not adequate. State Withholding In addition to the federal income tax withholding requirements, some states require withholding of state income taxes. Although state laws differ, those states requiring withholding generally allow you to elect out of withholding, as long as you elect out of federal withholding. The states requiring withholding as of January 1, 2011, are AR, CA, DE, GA, IA, KS, MA, MD. ME, NC, NE, OK, OR, VA, and VT. The state withholding election on this fm relates only to these states. If you are unsure as to whether your state requires withholding, consult your tax advis. n I elect not to have federal and state taxes withheld from this distribution. n I want to only withhold the minimum of 10% f federal taxes. (This option may not be available f residents of the states listed above.) n I want to only withhold % f federal taxes. (This option may not be available f residents of the states listed above.) n I want to only withhold % f federal taxes and the minimum f state taxes. (This option only available f residents of the states listed above.) n I want to only withhold % f federal taxes and % f state taxes. (This option only available f residents of the states listed above.) 9 ADDITIONAL COMMENTS SECTION (F special instructions.) n I have attached an additional sheet with further instructions. 7

8 10 SIGNATURE(S) Complete this signature section unless you are changing your name. SIGNATURE OF PARTICIPANT DAYTIME PHONE NUMBER X DATE (MM/DD/YYYY) Complete this signature section f name change requests only. F ptfolio balances $100,000 me, if a certified name change document is not attached, a Medallion Signature Guarantee is required below. SIGNATURE OF PARTICIPANT (Fmer name.) X SIGNATURE OF PARTICIPANT (New name.) X DAYTIME PHONE NUMBER DATE (MM/DD/YYYY) Medallion Signature Guarantee. A Medallion Signature Guarantee by an eligible guarant institution as defined under the Securities Exchange Act Rules (generally: a bank, broker dealer, municipal securities dealer broker, credit union, national securities exchange, registered securities association, clearing agency, savings association) is required f all signatures. A notary public is not acceptable. Eligible guarant institutions provide Medallion Signature Guarantees that are covered by surety bonds in various amounts. It is your responsibility to ensure the Medallion Signature Guarantee that you acquire is sufficient to cover the total value of your transaction(s). If the surety bond amount is not sufficient to cover the requested transaction(s), the Medallion Signature Guarantee will be rejected. Medallion Signature Guarantee required f: 1. All distributions over $100, Name Changes f ptfolio balances $100,000 me. 3. Different payee and/ address f distributions. 4. Bank Instructions: When the Participant s name does not appear in the Bank Account Registration. 5. Transfer to fmer spouse. 6. All rollovers to Qualified Retirement Plans that are either over $100,000 and/ do not provide a plan spons acceptance fm from the receiving plan. Place Medallion Signature Guarantee in the space below. 8

9 nylim.com/retirement F Assistance: Call Mailing Address: New Yk Life Retirement Plan Services c/o Boston Financial Services/DCS P.O. Box 8070 Boston, MA Overnight Express Address: New Yk Life Retirement Plan Services c/o Boston Financial Services/DCS 30 Dan Road Canton, MA The MainStay Funds are managed by New Yk Life Investment Management LLC and distributed through NYLIFE Distributs LLC, 169 Lackawanna Avenue Parsippany, NJ 07054, a wholly owned subsidiary of New Yk Life Insurance Company. NYLIFE Distributs is a Member FINRA/SIPC. RPSSIMFMC-09/11