Bank Of America Beneficiary Form – Fill Out and Use This PDF

1. DECEASED DEPOSITOR INFORMATION

Bank of America, like all financial institutions, is required by the USA PATRIOT ACT to obtain, verify, and record information that identifies each beneficiary of an IRA account with us. When you are a beneficiary of an IRA account with us, we will ask you for your name, address and other information that will allow us to identify you. The information we gather is for your protection and the country’s against terrorist activity and illegal money laundering schemes.

3. DISTRIBUTION INSTRUCTIONS

BANK OF AMERICA RECOMMENDS YOU CONTACT YOUR TAX ADVISOR BEFORE MAKING YOUR ELECTION

A beneficiary of an IRA Plan should elect how to receive the proceeds of the IRA Plan no later than 09/30 of the year following the year of the IRA Plan Depositor’s death. Any separate beneficiary accounts must be established by 12/31 of the year following the IRA Plan Depositor’s death. Available options depend on the age of the IRA Plan Depositor, the relationship of the beneficiary to the IRA Depositor, and the type of IRA Plan.

SELECT ONLY ONE OF THE PAYMENT OPTIONS BELOW.

Lump Sum Distribution I elect to receive my entire portion of the IRA Plan in a single lump sum payment.

NOTE: Under both options, additional amounts may be withdrawn at any time.

4. RMD PAYMENT INSTRUCTIONS

You are responsible for taking your annual Required Minimum Distribution (RMD) from the IRA Plan. The Bank will not distribute your RMD unless you give the Bank timely written distribution instructions. The Specific Start Date is limited to any date between January 7th and December 28th. If date selected is a non-business day, the distribution will be processed on the first business day following the date.

Form 00-59-1289NSBW–Version 051712

5. TAX WITHHOLDING ELECTION

Notice of Withholding Election: Distributions you receive from your Individual Retirement Account are subject to Federal income tax withholding and may be subject to State income tax withholding and/or Local income tax withholding based on your state and municipality of residence unless you elect not to have withholding apply.

You are liable for Federal, and applicable State and Local income taxes on the taxable portion of your distribution. If you elect not to have withholding apply to your distribution, or if you do not have enough tax withheld from your distribution, you may be responsible for payment of estimated taxes. You may also incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient.

Withholding Election: You MUST indicate your withholding election below.

Complete if you are providing a U.S. Address:

Federal Withholding:

Important: Please note that if you do not make a withholding election, federal income tax will be automatically withheld from your distribution at a rate of 10%.

Do not withhold federal income tax from my distribution.

Withhold federal income tax from my distribution (check one):

State Withholding:

Important: State withholding may also be required in certain states when you elect federal income tax withholding. North Carolina residents are required to use form NC-4P (Withholding Certificate for Pension or Annuity Payments) for all North Carolina state withholding elections.

Local Withholding:

Important: Local withholding may also be required in certain states.

Complete if you are providing a Foreign Address:

Important: If you are a U.S. citizen or a Resident Alien with a foreign address, you may not waive the Federal withholding requirement and you must complete Form W-9. If you are a Non-Resident Alien, all IRA distributions are subject to a tax treaty rate or 30% tax withholding and you must complete Form W-8BEN.

I am a U.S. Citizen or Resident Alien living abroad (check one)

6. BENEFICIARY’S ACKNOWLEDGMENT

I acknowledge that I have read and completed this Form. I further acknowledge that neither the Bank nor its agents or employees have made any representations to me regarding tax or any other effects of my elections/instructions on this Form, and the Bank has advised me to speak to my tax advisor regarding my elections/instructions. I direct the Bank to effect the elections/instructions I have made on this Form and agree that the Bank and its agents and employees have no liability for any action or inaction taken by them in reliance upon such elections/instructions.

Form 00-59-1289NSBW – Version 042412

Informational Sheet

BANK OF AMERICA RECOMMENDS YOU CONTACT YOUR TAX ADVISOR BEFORE MAKING YOUR ELECTION

A beneficiary of an IRA Plan should elect how to receive the proceeds of the IRA Plan no later than 09/30 of the year following the year of the IRA Plan Depositor’s death. Any separate beneficiary accounts must be established by 12/31 of the year following the IRA Plan Depositor’s death. Available options depend on the age of the IRA Plan Depositor, the relationship of the beneficiary to the IRA Depositor, and the type of IRA Plan.

Complete, sign and send the distribution form:

To your Local Bank of America Banking Center

Or, mail to the following address:

Bank of America, N.A.

Mail code: TX2-979-02-14

P.O. Box 619040

Dallas, TX 75261-9943

1. DECEASED DEPOSITOR INFORMATION

Depositor’s Name — Enter the deceased person’s name

Social Security Number — Enter the deceased person’s social security number

Date of Birth — Enter the deceased person’s Date of Birth

Plan Number — Enter the deceased person’s Plan Number that is being processed

Date of Death — Enter the date of death for the account owner (deceased person

Plan type — Select the plan type of the deceased account holder

2. BENEFICIARY INFORMATION

Bank of America, like all financial institutions, is required by the USA PATRIOT ACT to obtain, verify, and record information that identifies each beneficiary of an IRA account with us. When you are a beneficiary of an IRA account with us, we will ask you for your name, address and other information that will allow us to identify you. The information we gather is for your protection and the country’s against terrorist activity and illegal money laundering schemes.

Beneficiary Name — Enter the name of the beneficiary for the plan identified in the Plan Number section

Social Security Number — Enter the Social Security Number for the beneficiary listed in the Beneficiary Name section. If the beneficiary is an entity, enter the Employer Identification Number (EIN)

Daytime Telephone Number — Enter the best contact number that you can be reach at during the day

Date of Birth — Date of birth for the person listed in the Beneficiary Name section. If the beneficiary is an Entity, please list the Date of Birth for the decedent

Relationship to the Depositor — Example, Daughter, Mother, or Father. If the beneficiary is an Entity please leave this field blank

Physical Street Address, City, State, Zip — Enter the street address for the beneficiary listed in the Beneficiary Name section. Please note: This must be a physical address to comply with the USA Patriot ACT.

Source of Income — Select the appropriate option from the list provided. If the beneficiary is an Entity, please select Inheritance.

Mailing Address — Complete only if different from the Physical Address listed.

Employer Name — List the beneficiary’s current employer

Country of Citizenship — Enter the Country that the Beneficiary is a citizen

Country of Residency — Enter the Country the Beneficiary resides in

Occupation — Enter the Beneficiary’s current occupation or job ONLY if employment was selected as Source of Income

Non U. S. Citizen Required Information

of Days Present in the U.S. This Year — Enter the number of days that the beneficiary has been present in the U. S. for the current year

of Days Present in the U.S. Last Year — Enter the number of days that the beneficiary was in the U.S. during the last calendar year

of Days Present in the U.S. Prior to the Last Year — Enter the number of days that the beneficiary was in the U.S. Prior to the last full calendar year

Senior Political Figure and Politically Exposed Person

Indicate if you should be identified as a senior political figure or politically exposed person. Provide details on the position held or relationship.