IRA DISTRIBUTION REQUEST

Transcription

1 IRA DISTRIBUTION REQUEST Additional Copies or Assistance If you need additional copies of this application, or would like assistance completing it, please call Nuveen Investments at or go to Mail this form to: Nuveen Investor Services P.O. Box 8530 Boston, MA Overnight this form to: Nuveen Investor Services 30 Dan Road Canton, MA Tips for completing the application You may use this form to effect a direct transfer from an IRA to an IRA (either Traditional IRA to Traditional IRA or Roth IRA to Roth IRA) with another Custodian; a direct rollover from a Qualified Plan, 403(b) or 457(b) to a Traditional IRA or Roth IRA (with respect to designated Roth contributions); or a conversion rollover from a Traditional IRA to a Roth IRA. The assets may be from another fund family or within Nuveen Investments. Make sure you attach a copy of your existing account statement, any other forms required by your current custodian/trustee, and an IRA Adoption and New Account Agreement form if you do not have an existing IRA of the type necessary to receive the assets. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions, including mutual funds, to obtain, verify and record information that identifies each person who opens an account. What this means: When an individual opens an account, we will ask for name, address, date of birth, and other information that will allow us to identify the person. We may also ask for other identifying documents or information. Please print clearly in all CAPITAL LETTERS using black ink. 1. IRA REGISTRATION Type of IRA: Traditional IRA Roth IRA SIMPLE IRA SEP IRA First name (IRA account holder), Middle initial, Last name: Date of Birth: Social Security No.: Address*: Daytime Phone: Evening Phone: *If address noted on form is changing from the address presently on the account a Signature Medallion Guarantee is required in Section 8 if redeeming to the new address. (Continued on page 2) Page 1 of 5

2 (Continued from page 1) 2. REASON FOR REQUEST Please check one of the boxes listed below. Original request Change of request Change of withholding election only 3. TYPE OF DISTRIBUTION Please check one of the boxes listed below. Normal (age 59½ or older) Premature (under age 59½) Required Minimum Distribution (RMD) Rollover (see section 8 for rollover rules. For a direct rollover, attach successor plan trustee/custodian acceptance letter form.) Transfer (transfer funds directly to): Name of trustee/custodian: Address: Excess: withdraw $ (plus earnings, if applicable) for tax year 20 Revocation (must be within seven days of establishing plan) Divorce (attach copy of divorce decree) Death Spousal beneficiary Transfer to new IRA (IRA Account Application/ Adoption Agreement required) Transfer to my existing IRA. Account number Fund number Non Spouse Beneficiary Transfer to new beneficiary IRA (IRA Account Application /Adoption Agreement required) For Immediate liquidation (Complete beneficiary information below. Signature Medallion Guarantee is required in Section 8.) Beneficiary Information (This must match the beneficiary information we currently have on file for the account owner.) Name of Beneficiary: Date of Birth: Social Security No.: Address: Relationship to IRA Holder U.S. Citizen Resident Alien or Nonresident Alien Medical expenses** Qualified higher education expenses** Qualified first time home buyer expenses** Qualified Reservist Distribution** Qualified Charitable Distribution (attach information identifying the charity and distribution instructions)** Disability** Other** **(See disclosure statement or IRS Publication 590 for explanation) (Continued on page 3) Page 2 of 5

3 (Continued from page 2) 4. METHOD OF DISTRIBUTION Please check one of the boxes listed below. If distribution amount exceeds $50,000 by check, Signature Medallion Guarantee is required in Section 8. Full distribution: To close my IRA account Partial distribution: In the amount of $ Recurring distribution/required Minimum Distribution (RMD) (complete section 5) Please indicate which distribution method you would prefer ACH Wire Check 5. METHOD OF PAYMENT Complete this section only if requesting a recurring distribution. Normal and Early Distribution Scheduled payments over a period of years. Beginning date: Payment frequency: Monthly Quarterly Annually Dividend Income and Capital Gains only $ per period Installment payments, which will close my plan within year(s) Required Minimum Distribution (RMD) Uniform Lifetime Table (Standard IRS Method) Installment payments payable over the joint life expectancy of myself and my spouse who is more than 10 years younger than myself calculated annually. (Spouse s birth date / / ) (Future distributions will be made in the same manner.) Note: If you fail to designate a periodic payment period, distributions will be made payable over Uniform Table calculated annually. If you wish to receive a recurring distribution with payment via ACH or check, you must attach a voided check for the bank account you wish to use or a pre-printed deposit slip. Any change in these instructions must be made in writing to Nuveen Investments and must be signature guaranteed Please indicate if you would like an ACH: Yes No (Continued on page 4) Page 3 of 5

4 (Continued from page 3) 6. Bank Information Please complete this section if you wish to transfer funds electronically to your bank account. Bank Name: Bank Routing Number: Street Address: City, State, Zip Code: Telephone Number: Signature of Registered Holder Date Signature of Registered Holder Date Account Type ( ) Checking account (Please attach a voided check.) Savings account (Please attach a personalized deposit slip.) If you do not have a check or a personalized deposit slip, please call Nuveen Investments at Please tape your voided check or a personalized deposit slip here. Note: If you are adding a new bank to your account and/or are requesting a systematic distribution to the bank, a Signature Validation Stamp is required in section WITHHOLDING ELECTION No Do not withhold federal income tax from my payments Yes Please withhold 10% of my distribution(s) for federal income tax I also wish to have an additional $ / % withheld from my payment(s). (Please circle one above) If no box is checked, the default is 10%. If you are completing this form to begin required minimum distributions (required beginning for the calendar year that you attain age 70½ (for Traditional and SEP IRAs) or if you are the beneficiary of a deceased account holder s IRA) note the required minimum distribution rules are complicated. For more information about these rules call Nuveen Investments at the number listed on page 1 or contact your tax advisor. Page 4 of 5

5 (Continued from previous page) 8. SIGNATURE & CERTIFICATION I understand that certain types of distributions may be subject to tax and/or penalties under the Internal Revenue Code and regulations and certify that I will obtain any necessary tax and legal advice to make this determination. I also may be subject to charges for early redemptions in which my IRA funds are invested (applicable to Class B shares only). Rollover Rules I am aware that if my IRA has had rollover activity in the last 12 months, this distribution may be subject to additional taxes. The funds must be made payable and given to me directly. Withholding Notice If you are receiving a distribution from an IRA and elect to have taxes withheld (or do not make an election), federal income taxes will automatically be withheld from your distribution at the rate of 10%. If you want to increase the amount being withheld, you may specify a dollar amount on the election form in addition to the 10%. You have the right to make or revoke an election anytime prior to the distribution. If you are receiving distribution outside the United States or its possessions, the withholding requirement cannot be waived unless you certify that you are neither a United States citizen nor a resident alien. If you elect not to have withholding apply to your payments or if you do not have enough federal income taxes withheld from your payments, you may be responsible for payments of estimated tax. You may incur penalties under the estimated tax rules, if your withholding and estimated tax payments are not sufficient. This notice of withholding of federal income taxes and election form is a substitute for the current IRS Form WP-4P, OMB No , and it includes all information required by the IRS. Substitute Form W-9 I certify, under penalty of perjury, that: (1) The social security or employer identification number shown on this form is my correct Taxpayer Identification Number. (2) I am not subject to backup withholding because I am exempt from backup withholding OR I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividend OR, The Internal Revenue Service has notified me that I am no longer subject to backup withholding. (Strike out this item (2) if you have been notified that you are subject to backup withholding.) (3) I am a U.S. person (including Resident Alien). The Internal Revenue Service does not require your consent to any provision of this document other than certifications required to avoid backup withholding. Signature of IRA Account Holder or Beneficiary Date If signed by a Beneficiary, please indicate Beneficiary's social security number If not signed by the IRA holder or beneficiary, please indicate in what capacity Place Signature Validation Stamp/ Signature Medallion Guarantee here. Note: A Medallion Signature Guarantee and SVP stamp may be obtained from a domestic bank or trust company, broker, dealer, clearing agency, savings association or other financial institution which participates in a medallion program recognized by the Securities Transfer Association. A Signature Medallion Guarantee is required if: Check mailed to an address other than that currently on your account. Check request is over $50,000. A one-time distribution to a new bank within 30 days of being added to your account. Transfer due to death of spousal beneficiary or new beneficiary IRA. Signature guarantees can be obtained from a bank or brokerage firm, or other financial intermediary that is a member of an Approved Medallion Guarantee Program, or that is otherwise approved by the fund. Just take your unsigned form to one of these institutions and request that an officer guarantee your signature. The officer may require a driver s license and/or other identification, and should stamp and sign this application in the space provided. MAP-IRADI-0515P Page 5 of 5