Vanguard Retirement Resource Center IRA Distribution Request Form Instructions 1. Account Owner Information The information you provide in this section should be identical to the registration information on your Vanguard IRA. 2. Reason for IRA Distribution Complete either the traditional IRA / SEP IRA or Roth IRA part of this section. Traditional IRA / SEP IRA. If you are taking a distribution from a traditional IRA or SEP IRA, you must check the box on the form that corresponds to one of the reasons listed below. Normal distribution. You are age 59 1 2 or older. Early (premature) distribution, no IRS exception applies. Choose this option if you are under age 59 1 2 and do not meet any of the IRS exceptions listed below. Early (premature) distribution, IRS exception applies. You are under age 59 1 2 and any of the following applies: You are using the substantially equal periodic payments (SEPPs) exception under IRS rules. You will use your distribution to cover medical expenses exceeding 7.5% of your adjusted gross income. You have received at least 12 consecutive weeks of unemployment compensation during the current or prior tax year and will use the distribution to pay health insurance premiums. You will use your distribution for a first-time home purchase. (The lifetime maximum for this distribution is $10,000.) You will use your distribution for postsecondary educational expenses. Your distribution is due to an IRS levy. Permanent disability. You cannot engage in any substantial gainful activity because of your physical or mental condition. (A physician must certify that the condition has lasted or can be expected to last continuously for 12 months or more, or that the condition can be expected to result in death.) Death of the original traditional IRA or SEP IRA owner. The IRA owner is deceased and you are the beneficiary. (Please call Vanguard if the account has not been reregistered since the original account owner s death.) Return of excess contributions made for tax year. (This option is available only when requesting a single distribution.) You are requesting a distribution from your IRA because you contributed more than $2,000 or 100% of your compensation for the applicable tax year, or made an otherwise ineligible contribution. (Please indicate the applicable tax year.) Roth IRA. If you are taking a distribution from a Roth IRA, you must check the box on the form that corresponds to one of the reasons listed below: Early (premature) distribution, no IRS exception applies. Choose this option if you are under age 59 1 2 and do not meet any IRS exceptions listed above. Note: You should also choose this option if you are distributing after-tax contributions (not earnings or converted assets). Roth IRA distribution, IRS exception applies. Instructions are the same as for a traditional IRA. Permanent disability. Instructions are the same as for a traditional IRA. Death of the original Roth IRA owner. Instructions are the same as for a traditional IRA. Return of excess contributions made for tax year. Instructions are the same as for a traditional IRA. (This option is available only when requesting a single distribution.)
3. Your Method of Distribution Use this section to tell us when to make distributions and how much to distribute. Complete either the installment distributions or single distribution part of this section. Installment distributions. Provide the following information: Start date. Enter the date you wish to begin receiving distributions. End date (optional). Enter the date you wish to end distributions. (You may provide Vanguard this information at a later date.) Frequency. Tell us how often you wish to receive your distributions. Installment type. Select either fixed-dollar, declining-balance, or adjusted installments. If you wish to receive distributions from more than two Vanguard funds, list the additional fund account information on a separate sheet of paper. Single distribution. Select one of the following: Total (lump-sum) payment Partial payment 4. Income Tax Withholding In this section, instruct us whether or not to withhold federal income tax from your IRA distribution. If you want Vanguard to withhold tax, please specify a percentage of 10% or more. 5. Payment Instructions Complete either the standard payment or special payment part of this section. Standard payment instructions Use this space to tell us whether we should deposit your distribution checks in an existing Vanguard nonretirement account registered in your name or mail them to the address of record. Special payment instructions Use this space to tell us to make your distribution check payable to a third party, mail it to an address different from the address of record, deposit it into a Vanguard account registered in a different name, or wire the distribution to another financial institution. If you want us to electronically deposit your installment distributions into your account at another financial institution, please provide a voided check or preprinted deposit slip from that account. Attach it to the IRA Distribution Request form in the space provided in Section 5. (This option is not available when requesting a single distribution.) 6. Your Signature Sign your name on the line provided for the IRA owner and indicate the date. Sign your name exactly as it appears on your Vanguard IRA. 7. Signature Guarantee Provide a signature guarantee only if you made a special payment instruction in Section 5. A signature guarantee is not required if your distribution is deposited into a Vanguard account that you (or you and another person) own jointly (or are joint trustees of) and the address of record for that account is identical to the address of record for your Vanguard IRA. Vanguard wants your payments to be distributed promptly and accurately. If you have any questions about the IRA Distribution Request form or would like a retirement specialist to review it with you, call us at 1-800-205-6189 on business days from 8 a.m. to 10 p.m. and on Saturdays from 9 a.m. to 4 p.m., Eastern time. 2001 The Vanguard Group, Inc. All rights reserved. RRDF 072001
Vanguard Retirement Resource Center IRA Distribution Request RRDF Please print in capital letters, preferably in black ink. Complete this form to request a single payment or a series of installment payments from your traditional IRA, SEP IRA, or Roth IRA. If you are age 59 1 2 or older or have inherited an IRA, you may call Vanguard for a single distribution instead of using this form. Do not use this form to authorize a conversion to a Roth IRA. Provide a signature guarantee in Section 7 when requesting a special payment in Section 5. Note about RMDs: Distributions requested on this form will not necessarily satisfy the IRS s required minimum distribution (RMD) rules. Most forms, as well as booklets that provide details on our service options, are available for download from our website at www.vanguard.com/?serviceforms. Or you can call us to order them or for assistance in filling out this form at 1-800-205-6189. Return this completed form and any other required documents in the enclosed postage-paid envelope, or mail to The Vanguard Group, P.O. Box 1110, Valley Forge, PA 19482-1110. For overnight delivery, mail to The Vanguard Group, 455 Devon Park Drive, Wayne, PA 19087-1815. 1. Account Owner Information Social Security Number Birth Date (month, day, year) Name of Account Owner (first, middle initial, last) Street Address or Box Number City State Zip Daytime Telephone Number Evening Telephone Number 2. Reason for IRA Distribution (Complete either the traditional IRA/SEP IRA or Roth IRA part of this section. This information enables us to code your IRS Form 1099-R.) Traditional IRA / SEP IRA Reason for distribution (Check one.) Normal distribution Reason Code 07. You are age 59 1 2 or older. Early (premature) distribution, no IRS exception applies Reason Code 01. You are under age 59 1 2 and have no qualifying reason to avoid the 10% federal penalty tax for early withdrawal. Early (premature) distribution, IRS exception applies Reason Code 02. You meet one of the IRS exceptions listed in the accompanying instructions. Permanent disability Reason Code 03. You cannot engage in any substantial gainful activity because of your physical or mental condition. You must meet the conditions provided in the accompanying instructions. Death of the original traditional IRA or SEP IRA owner Reason Code 04. Additional documentation may be required; call us for more information. Return of excess traditional IRA or SEP IRA contributions made for tax year. (Single distribution request only.) Additional documentation may be required; call us for more information. 1
RRDF-page 2 of 5 Roth IRA Reason for distribution (Check one.) Early (premature) distribution, no IRS exception applies Reason Code J. You are under age 59 1 2 and have no qualifying reason to avoid the 10% federal penalty tax for early withdrawal. Roth IRA distribution, IRS exception applies Reason Code T. You are 59 1 2 or older or you meet one of the IRS exceptions listed in the accompanying instructions. Permanent disability Reason Code T. You cannot engage in any substantial gainful activity because of your physical or mental condition. You must meet the conditions provided in the accompanying instructions. Death of the original Roth IRA owner Reason Code T. Additional documentation may be required; call us for more information. Return of excess Roth IRA contributions made for tax year. (Single distribution request only.) Additional documentation may be required; call us for more information. 3. Your Method of Distribution (Complete either the installment distributions or single distribution part of this section.) Installment distributions (Select a distribution date from the 5th to the 30th of the month. If the day of your distribution falls on a weekend or a holiday or is not a valid date for example, if you select the 30th and the month is February we will process your transaction on the preceding business day.) Start Date End Date (optional) (month, day, year) (month, day, year) Frequency (Check one.) Monthly Quarterly Semiannually Annually Installment type (Select one. To list more than two funds, provide the information on a separate sheet.) Fixed-dollar installments. Provide a fixed payment each period until the account or accounts listed below are depleted or the end date specified above is reached. (Note: If you are taking substantially equal periodic payments (SEPPs) and have calculated the installment amount using the life expectancy method, you must contact Vanguard each year to provide us with the new installment amount.) Fund Name Account Number Amount $,, $,, Declining-balance installments. Deplete the account or accounts listed below over a period of calendar years. I understand that the installment payments will vary from period to period. Fund Name Account Number Adjusted installments. Make payments from the account or accounts listed below that are adjusted yearly according to my life expectancy and Vanguard s projections of the inflation rate and applicable rate of return. I understand that the installment payments will vary from period to period. Fund Name Account Number 2
RRDF-page 3 of 5 Single distribution (Select one of the methods listed below. To list more than two funds, provide the information on a separate sheet.) Total (lump-sum) payment. I hereby instruct Vanguard to distribute all of my assets from my Vanguard IRA fund account or accounts listed below. Partial payment. I hereby instruct Vanguard to distribute a single partial payment from my Vanguard IRA fund account or accounts in the amount or amounts specified below. (Note: If this payment is one in a series of substantially equal periodic payments (SEPPs), you must contact Vanguard each year to request a payment for that year.) Fund Name Account Number Amount (for partial payment only) $,, $,, 4. Income Tax Withholding (Complete either the traditional IRA / SEP IRA or Roth IRA part of this section.) Traditional IRA / SEP IRA (Check one.) Distributions from your Vanguard traditional IRA are subject to federal income tax withholding at a rate of at least 10% unless you elect not to have withholding apply. To change this withholding election, check the appropriate box below. (If you do not check either box below, Vanguard will withhold 10% of your distribution.) Do not withhold federal income tax from my traditional IRA distribution. Withhold at a rate of % (at least 10%). Note: If you elect not to have tax withheld on your traditional IRA, you will remain liable for payment of federal income tax on the taxable portion of your withdrawals. You may also be subject to tax penalties if your payments of estimated tax or the tax withheld are insufficient under IRS rules. Roth IRA (optional) Although your Vanguard Roth IRA is not subject to federal income tax withholding, you will remain liable for payment of federal income tax on the taxable portion, if any, of your withdrawals. You may also be subject to tax penalties if your payments of estimated tax or the tax withheld are insufficient under IRS rules. (Please fill in the space below only if you wish Vanguard to withhold federal income tax from your distribution.) Withhold at a rate of % (at least 10%). 5. Payment Instructions (Complete either the standard payment or special payment part of this section. Attach an additional sheet if listing more than two funds.) Standard payment instructions (Select one of the options below.) Deposit my distribution check into the following Vanguard nonretirement account or accounts that list me as a sole or joint account owner. Fund Name Account Number Mail my distribution check to the name and address on record. 3
RRDF-page 4 of 5 Special payment instructions (Select any of the options below. Note: For any of the special payment options, you must provide a signature guarantee in Section 7 of this form. Failure to do so will delay your transaction.) Make my check payable to the following third party: Mail my check to a different address. Street Address or Box Number City State Zip Deposit my distribution check into the following Vanguard nonretirement account or accounts registered in a different name. Name on Account Fund Name Account Number Electronically deposit my installment payment into the account held at the financial institution named below.* I have attached a voided check or preprinted deposit slip in the space provided. (Note: A signature guarantee is not required for this service if the bank account is registered exactly as your Vanguard account is registered.) (This service is not available for a single distribution.) Name of Bank / Credit Union / Savings and Loan Account Type Bank Telephone Number (Check one.) Checking Savings Bank Account Number Bank Routing Number (located in the bottom left corner of your checks) J. A. Sample 101 123 Street Anywhere, USA 12345 DATE: PAY TO THE ORDER OF $ DOLLARS Tape your voided check or preprinted deposit slip here. Please do not use staples to attach it. MEMO SIGNED VOID 1:23456789:0123456789012 12 3456789: = = *Vanguard transfers your assets two business days before the date on which you want them credited to your bank account. On the first day, we initiate a withdrawal from your Vanguard account. On the second day, we instruct First Union (Vanguard s bank) to transfer the appropriate assets to the Automated Clearing House (ACH). The ACH then transfers the assets to your bank. On the third day, the assets are credited to your bank account. 4
RRDF-page 5 of 5 6. Your Signature REQUIRED (To act on your instructions, Vanguard requires your signature.) S I G N A T U R E Your Signature Date (month, day, year) 7. Signature Guarantee IF APPLICABLE Vanguard requires a signature guarantee only if you selected a special payment option in Section 5 of this form. You can obtain a signature guarantee from an authorized officer of an eligible guarantor institution, such as a bank that is a member of the Federal Deposit Insurance Corporation (FDIC), a trust company, or a member of a domestic stock exchange. A notary public cannot provide a signature guarantee. S I G N A T U R E Guarantor s Signature Authorized Officer to Place Stamp Here Title Date (month, day, year) 5
2001 The Vanguard Group, Inc. All rights reserved. RRDF 072001