Charles Distribution Form – Fill Out and Use This PDF

www.schwab.com 1-800-435-4000

Important instructions for completing this form

The form you requested follows this page. You can either complete it on your computer and

then print it out, or print it out irst and ill it in by hand.

Follow these easy steps to complete your form:

•You can move among the ields by using your mouse or the “Tab” key.

Please note: Adobe® Reader® does not allow you to save your work. It’s very

important that you print out your form immediately after completing it.

3.When your form is complete, please review, sign and date it, and either:

Bring it into your nearest Schwab branch (Visit schwab.com/branch to ind the one nearest you.)

Be sure to enclose any accompanying materials with your form (such as a check for an initial deposit

to open a new account). Should you have any questions, or need help, just call 1-800-435-4000.

©2011 Charles Schwab & Co., Inc. Member SIPC. CS13854-01 (0111-0580) ELC37185-03 (01/11)

IRA & ESA Distribution Request Form

1. Schwab Account Information

We respect your privacy. Schwab will use the information you provide to process your distribution request or any request to transfer money between your IRA and another inancial institution. Read about Schwab’s privacy policy at www.schwab.com/privacy.

Type of Account:		Traditional/Rollover IRA		Inherited IRA	SEP-IRA/SARSEP-IRA	SIMPLE IRA		Roth IRA	ESA
Account Holder’s Name (First)				(Middle)			(Last)
Schwab IRA or ESA Account Number			Social Security/Tax ID Number				Daytime Telephone Number
Check one:	This is a new distribution request.			This is a change to my recurring distribution request previously established in the amount of $____________.

2.Reason for Distribution Choose only one from Sections A–C below. For a “Withdrawal of Excess Contribution,” skip to Section 3, or for a “Transfer Pursuant to Divorce,” skip to Section 4.

A. From a Traditional IRA, Rollover IRA, Inherited Traditional IRA, SEP-IRA, SARSEP-IRA or SIMPLE IRA Only:

Normal Distribution (Code 7)

Use for any of the following when the taxpayer is age 59½ or older: Normal Distribution, a distribution that will be rolled over to another IRA or an employer plan* within 60 days, an IRA revocation, or a Roth IRA conversion or reconversion.

Early Distribution, no known exception (Code 1)

Use for a distribution when the taxpayer has not reached age 59½ and no known exception under Section 72(t) applies (see Section 9), including a distribution that will be rolled over to another IRA or an employer plan within 60 days when the taxpayer is younger than age 59½, or for an IRA revocation when the taxpayer is younger than age 59½.

Early Distribution, exception applies (Code 2)

Use for a distribution when the taxpayer has not reached age 59½ but an exception under Section 72(t) applies (see Section 9), or for a Roth IRA conversion or reconversion when the taxpayer is younger than age 59½.

Disability Distribution (Code 3)

Use for a distribution due to permanent disability within the meaning of IRS Section 72(m)(7). Consult your tax advisor.

Death Distribution from an Inherited Traditional IRA (Code 4)

Use only for distributions from an Inherited IRA. Note: To request an initial Death Distribution, please use the Inherited IRA Distribution Election Form.

Direct Rollover to an Employer Plan* (Code G)

This option is not available for Inherited IRAs or for IRA-to-IRA movement of money. Use only for a rollover to an employer plan.* Provide the Employer Plan Name and Address in the space below:

*“Employer plan” means a qualiied retirement plan such as a 401(k), 403(b), or 457(b) eligible deferred compensation plan.

Early Distribution from a SIMPLE IRA, no known exception (Code S)

Use for a distribution from a SIMPLE IRA taken within two years of the date the irst contribution was made if the taxpayer has not reached age 59½ and none of the exceptions under Section 72(t) applies (see Section 9).

B.From a Roth IRA or Inherited Roth IRA Only:

Qualiied Distribution from a Roth IRA (Code Q)

Use for a distribution if the ive-year holding period has been completed and the taxpayer has reached age 59½, if the taxpayer is disabled, or for a distribution from an Inherited Roth IRA.

FOR CHARLES SCHWAB USE ONLY:

Branch Ofice and

Account Number

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=01*
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 2 of 8

2.Reason for Distribution (Continued)

Roth IRA Distribution, exception applies (Code T)

Use for a distribution if it is not known if the ive-year holding period has been completed and the taxpayer has reached age 59½, if the taxpayer is disabled, or for a distribution from an Inherited Roth IRA.

Early Distribution from a Roth IRA (Code J)

Use for a distribution from a Roth IRA when Codes Q and T do not apply.

C.From an ESA Only: ESA Distribution

Use for a distribution from an Education Savings Account.

3.Withdrawal of Excess Contribution Complete this section if you want to withdraw an excess contribution from your account.

I am withdrawing the excess contribution I made on _________________________ for the tax year ____________.

(mm/dd/yyyy)

The amount of the excess was $__________________.

My tax-iling deadline is/was _________________________.

(mm/dd/yyyy)

Choose one:

The amount of earnings I calculated was $_________________________.

Calculate earnings on my excess contribution for me. By checking this box, I accept the calculation method and earnings amount determined by Schwab to be accurate. The earnings are calculated based on a pro rata portion of the total earnings accumulated for the period of time from the original contribution. Schwab will use the IRS-approved calculation method as described in IRS Notice 2000.39 for contributions made for tax year 2003 and the IRS Final Regulations (Treas. Reg. 1.408-11) for contributions made for tax year 2004 and later.

Choose only one from Section A or B below.

A.From an IRA:

This withdrawal is being made prior to the tax-iling deadline (including extensions) for the year in which the excess contribution was made. (Code 8/P)

This withdrawal is being made after the tax-iling deadline (which does not include extensions), and my tax return was iled in a timely manner. A withdrawal of the excess can still be made no later than six (6) months after the due date for iling the tax return, not including extensions. (Code 8/P)

Neither of the two choices above applies.*

*If you are removing an excess amount after your tax-iling deadline, including any extensions you received or could have received automatically, then the distribution must be reported as a Code 1, 7, J or T, and earnings are not distributed.

B.From an ESA:

This withdrawal is being made before June 1 of the taxable year following the taxable year in which the excess contribution was made.

This withdrawal is being made on or after June 1 of the taxable year following the taxable year in which the excess contribution was made.

4.Transfer Pursuant to Divorce Complete this section for transfers of interest from one IRA or ESA account holder spouse to another under a divorce decree or separation instrument. Note: Transfers of interest in an IRA or ESA from one spouse to another under a divorce decree or separation instrument are generally tax-free and are not reported to the IRS.

Please provide the following required information and documents:

(1)Final divorce decree or separation instrument with judge’s signature

(2)Marital property settlement agreement

(3)Letter of Authorization and Instruction signed by both parties agreeing to speciic asset division if settlement agreement is not current or not speciic

(4)Schwab IRA or ESA account number and telephone number for receiving party:

(5)Schwab IRA or ESA Application (if interest is to be transferred to a new IRA or ESA at Schwab)

(6)Contra Transfer of Account (TOA) form (if interest is to be transferred to an IRA or ESA outside of Schwab)

(7)IRA & ESA Distribution Request Form completed and signed by receiving party if recipient would like to take a distribution of the interest that has been transferred to a Schwab IRA or ESA after the divorce transfer has been processed. Note: If a distribution is made, the amount is subject to taxes and may be subject to a penalty. (See Section 9.)

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©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 3 of 8

5.Income Distributions Complete this section to set up ongoing payments of income (dividends, interest and money market account income) from your Schwab IRA to your Schwab Bank account, an account at another inancial institution, or your nonretirement Schwab One® account, or to have payments mailed to you. (Select an Income Option, a Frequency and Start Date, and an Income Distribution Method, then continue to Section 8.)

Income Options Choose “All Income” in Option A below OR up to three income payment options from Option B below. Note: The maximum amount that can be transferred in a single transaction is $500,000.

A. All Income Plan (All dividend, interest and money market account income will be consolidated into a single payment.)

OR
B.	Flexible Income Plan

Dividends (includes capital gains distributions; will be consolidated into a single payment)

Interest (includes ixed income and CD interest; will be consolidated into a single payment)

Money Market (includes Schwab One Interest and Schwab Bank Interest; will be consolidated into a single payment)

Frequency and Start Date Check one frequency only and enter your preferred start date. Note: If frequency and start date are not provided, your account will be set up to begin paying income on the earliest available Last Business Day of the Month.

As Accrued (Your account will be debited on the irst business day after the day on which income is credited to your account. Generally, your outside

bank account will be credited one business day after the debit occurs. Available only for transfers to Schwab Bank or Other Financial Institution.)

OR

	Last Business Day of the Month (Income is aggregated on the last business day of each month, and your account is debited on the irst business day
	of the next month [excluding December]. Generally, your outside bank account will be credited one business day after the debit occurs.)
Preferred Start Date: ______________________________ and continue until notiied otherwise.
	(mm/dd/yyyy)
Income Distribution Method Check (1), (2) or (3) below.
(1)	Distribute income to Schwab Bank or Other Financial Institution:
	Schwab Bank or Other Financial Institution Information (Other Financial Institution must be a United States inancial institution and an Automated
	Clearing House [ACH] member). You may not transfer funds to inancial institutions outside the territorial jurisdiction of the U.S. Enter the
	information requested below for the account into which you want your income distribution payments to be electronically transferred.

Type of Account (check one)

Personal Checking Account Personal Savings Account

Account Owner(s)

Attach an original preprinted, voided check (required).

Name must be preprinted and unaltered.

Dana Jones

123 Main Street

Anytown, NY 12345

REQUIRED

Tape your voided check here.

(Use a preprinted deposit slip for savings accounts.)

ABA Transit Routing Number

Account Number

Alternative acceptable documentation for accounts without checks:

•Preprinted deposit slip, which includes account title, account number, account type and ABA Transit Routing Number; or

•A letter from your Other Financial Institution, on its letterhead and signed by an oficer, which includes account title, account number, account type and ABA Transit Routing Number.

FOR CHARLES SCHWAB USE ONLY:

Branch Ofice and

Account Number

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=03*
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 5 of 8

7. Distribution Method Check only one.

A.	Mail my distribution (a check and/or securities):
		To the address listed on my Schwab IRA or ESA.
		To an address that is different from the address listed on my Schwab account (please provide address below).
		Street Address	City	State	Zip
		To a third party, made payable to: _________________________________________________________. Mail the check to the following address:
		Street Address	City	State	Zip

Optional:

Overnight delivery (Fees apply. Call 1-800-435-4000 for details.)

B. Transfer my distribution assets (listed in Section 6) to my non-retirement Schwab One® account number: _________________________.

C. Convert my Traditional IRA assets (listed in Section 6) to my Schwab Roth IRA number: _________________________.

D. Distribute, in certiicate form, speciic shares of securities listed in Section 6. Note: Schwab charges a per-certiicate fee for all requests to order physical certiicates from Schwab accounts. Some securities cannot be delivered in certiicate form. Please call 1-800-435-4000 for more information.

E. Electronic transfer with Schwab MoneyLink®.(This option is not available for one-time distributions from IRA accounts enrolled in Schwab

Managed Account Services™ [MAS] or Schwab Managed Portfolios™ [SMP].)

•By enrolling in Schwab MoneyLink, you are establishing a standing authorization to request electronic funds transfers from your Schwab IRA to an account at another U.S. inancial institution speciied below (collectively, the “MoneyLink Service”). You may not use Schwab MoneyLink to transfer funds to inancial institutions outside the territorial jurisdiction of the U.S.

•Required: Attach an original preprinted, voided check (no photocopies) to ensure proper routing.

Other acceptable documentation for accounts without checks:

• Preprinted deposit slip for savings accounts

• A letter from your Other Financial Institution, on its letterhead and signed by an oficer, which includes account title, account number, account type, and ABA Transit Routing Number

ABA Transit	Account Number
Routing Number

•Allow three weeks for Schwab to receive your request and enroll your account before you request your irst transfer. Once Schwab enrolls your account, you will receive written notiication in the mail. You will also receive a copy of the MoneyLink Terms and Conditions that govern your use of, and provide additional information about, the MoneyLink Service.

•The maximum amount you can transfer in a single transaction is $100,000.

U.S. bank/Other Financial Institution information

Type of Account (check one)

Personal Checking Account Personal Savings Account

All registered owners on the U.S. bank/Other Financial Institution account must sign in Section 10.

FOR CHARLES SCHWAB USE ONLY:

Branch Ofice and

Account Number

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=05*
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 6 of 8

7. Distribution Method (Continued)

F. Wire funds.* (This method is not available for recurring distributions, income distributions or IRA account transfers [e.g., Traditional IRA to Traditional IRA] to another inancial institution.)

One-Time Request

Standing Instructions (Allows you to conveniently deliver future wire requests by telephone)

To give us time to process your request for a wire, we must receive your request prior to 11:00 a.m. PT (2:00 p.m. ET) on the date of the proposed wire. Fax your wire request to 1-877-553-7692.

Bank Name	ABA Routing Number	Bank Phone
		(	)
Bank Account Number	Bank Account Registration
Name of Final Beneiciary		Further Credit Account Number (if applicable)
Final Beneiciary Street Address	City		State	Zip Code

*Fees apply. Call 1-800-435-4000 for details.

8.Tax Withholding Election (This section is not applicable for withdrawals from an Education Savings Account, or if you are not a U.S. citizen or a legal resident of the U.S.—skip to next section.)

Distributions from your IRA (excluding distributions from Roth IRAs) are generally subject to federal (and possibly state) income tax. Even if you elect in writing not to have federal and/or state income tax withheld, you are liable for payment of federal tax and state income taxes, if applicable, on the taxable portion of your distribution. You may also be subject to tax penalties under the estimated tax payment rules if your withholding and payment of estimated tax, if any, are not adequate.

Your tax withholding election will remain in effect on all distributions from this IRA until you change or revoke it. You may change or revoke your tax withholding election at any time by submitting your request to Schwab.

A.Federal Income Tax Withholding You may elect not to have withholding apply, or you may elect to increase the rate of withholding. If you do not make an election on this form and you do not have a previous election request on ile, Schwab is required to withhold 10% of your gross distribution for payment of federal income tax. If you do not make an election on this form and have previously submitted an election request, Schwab will default to that election request for this distribution and all future distributions until you change or revoke your request by entering a different withholding amount using this form.

Choose one:

I do not want federal income tax withheld.

I want federal income tax withheld at the rate of _______%. (Federal income tax withholding must be at least 10%, and not more than 99% when combined with state income tax withholding.)

B.State Income Tax Withholding State income tax withholding may be required from your distribution. In some cases, you may elect not to have withholding apply, or you may elect to increase the rate of withholding. In other cases, state income tax withholding is not available. Refer to the State Income Tax Withholding Information sheet for speciic information concerning your state’s withholding rates. While Schwab makes every effort to obtain information about state tax laws from sources believed to be reliable, Schwab cannot guarantee the accuracy or timeliness of state tax withholding information because state tax laws are subject to constant change and interpretation. We recommend that you contact your tax advisor regarding your tax withholding elections and to answer any questions that you may have regarding your state’s withholding laws. If you do not make an election, Schwab will apply withholding (if required) at the minimum rate based on the laws for your state of residency as determined by your legal address of record on your account.

Choose one:

I do not want state income tax withheld.

I want state income tax withheld at the rate of _______%. (State income tax withholding must be at least your state’s minimum tax rate, and not more than 99% when combined with federal income tax withholding.)

Note: If you move between states with differing withholding laws, Schwab will apply withholding (if required) at the rate you provided above or at the minimum rate based on the laws for your new state of residency, whichever is greater.

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=06*
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 7 of 8

9. Important Information About Your Distribution

FOR CHARLES SCHWAB USE ONLY:

Branch Ofice and

Account Number

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=07*
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.

Page 8 of 8

10. Signature

Note: Signature is required below for the Schwab IRA account holder. If establishing MoneyLink, signatures are required below for all Other Financial Institution account holders and the Schwab IRA account holder.

A.By signing below, I acknowledge that I have read and understand the information in Section 9 of this form. Please distribute cash and/or securities from my IRA or ESA in the manner and for the reasons stated on this form. I certify that the information on this form is correct. Schwab may rely on my certiication without further investigation or inquiry.

B.Schwab MoneyLink® Authorization—Terms for Schwab Account Holders. By signing this Agreement, I am signing up for the Schwab MoneyLink Service (the “Service”). Terms and Conditions for the Service will be sent to me when this form is processed. Those Terms and Conditions will govern all transactions initiated under the Service, and my use of such Service will conirm that I have received, reviewed, and agreed to be bound by the

Terms and Conditions, including, without limit, any amendments, until I cancel the Service as described in the Terms and Conditions. If this is a Custodial IRA account, I represent and warrant that all one-time and recurring withdrawals from the Custodial IRA account will be in accordance with the authority granted under the applicable enactment of the Uniform Gifts to Minors Act or the Uniform Transfers to Minors Act, and will be for the beneit of the minor.

C.Schwab MoneyLink Authorization—Terms Relating to the Other Financial Institution Account. My signature below authorizes Schwab to (i) initiate credit entries to my account indicated on this form (the “Other Account”) and credit that account; (ii) initiate debit entries to the Other Account and debit that account; and (iii) initiate reversals to the Other Account of erroneous or duplicate credit or debit entries and credit or debit such account as appropriate. This authorization will remain in full force and effect until Schwab receives written or verbal notiication from me (or any of us) of its termination. If you notify us verbally, we may request conirmation in writing. Schwab must receive this notiication in a time and manner so as to give

Schwab and the Other Financial Institution a reasonable opportunity to act on it.

This authorization may be terminated by any of the parties at any time by calling 1-800-435-4000.

If I am the account holder on the Schwab IRA account, my signature below constitutes my agreement with the terms set forth in Sections 10A and, if applicable, 10B. If I am an account holder on the Other Financial Institution account, my signature below constitutes my agreement with the terms set forth in Section 10C.

Signature(s) and Date(s) Required

X

Schwab Account Holder/Other Financial Institution Account Holder SignaturePrint NameDate

X

Schwab Account Holder/Other Financial Institution Account Holder SignaturePrint NameDate

X

Schwab Account Holder/Other Financial Institution Account Holder SignaturePrint NameDate

X

Schwab Account Holder/Other Financial Institution Account Holder Signature

Print Name

Date

CS16889-02 (0712-4588) APP13430-15 (07/12)	*APP13430-15=08*
Printed on recycled paper.
WB
©2012 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.