Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616) at a glance
What it is: Distribution Request - IRA Beneficiary Claim/Disclaim Form.
Who signs: Sign as the Account Holder: Account Holder Signature, Account Holder Name (print) and Date.
What to bring and attach to Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616)
Documents to submit with this form: Each beneficiary must complete and sign a separate Distribution Request - Beneficiary Claim/Disclaim Form. If there are multiple beneficiaries journaling securities to Beneficiary IRA accounts and the underlying securities cannot be evenly divided, please complete/sign Addendum A. A certified copy of the Death Certificate is required for all claim/disclaim transactions. Additional requirements will be necessary for specific beneficiary types: Estate: Court-certified Letters of Testamentary will be required. Also, the executor must obtain a Tax ID Number/EIN for the estate. The executor will sign this form. Trust: A complete copy of the Trust will be required. Note: if the Tax ID Number for a grantor trust is the same as the deceased grantor's Social Security Number, a new Tax ID Number/EIN must be obtained for the trust (with the exception of co-grantors). The trustee(s) will sign this form (if the Private Trust Company, N.A. acts as the trustee, please contact them directly at 800-877-7210 extension 7990.) Minor or Conservatorship: Letters of Guardianship or Conservatorship will be required. The Guardian or Conservatorship will sign this form. MCorporation/Non-Corporate Entity: A copy of the Corporate/Non-Corporate Resolution reflecting authorized signer(s). The corporate/non-corporate officer(s) will sign this form. Beneficiary No Longer Living: attach a copy of the beneficiary's death certificate.
A filled-in Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616) example: a widow claims her late husband's IRA
How to fill out Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616), box by box
Deceased IRA Owner Information
Under Deceased IRA Owner Information, enter the Name, Delivering Account Number, Social Security Number, Date of Birth and Date of Death.
If you, as beneficiary, are a natural person
Beneficiary Information: Complete A (if you are an individual person) or B (if you are acting on behalf of a trust, estate, or other entity) and C (for all claims/disclaimer).
If you, as beneficiary, are a natural person, complete A: Name, Relationship to Decedent, Social Security Number* and Date of Birth. *Non-Resident Aliens must attach the Internal Revenue Service(IRS) form W-8 BEN and obtain an Individual Taxpayer Identification Number (issued by the IRS).
If you are acting on behalf of a trust, estate, or other entity
If you are acting on behalf of a trust, estate, or other entity as beneficiary, complete B: Name of Trust, Estate, or other Entity, Tax Identification Number (TIN-EIN), Trust Date (if applicable), Name of Trustee(s), Executor, Administrator, Custodian, etc., Social Security Number of Trustee(s), Executor, Administrator, Custodian, etc. and Date of Birth of Trustee(s), Executor, Administrator, Custodian, etc.
Mailing Address
Complete the Mailing Address for ALL claims/disclaimers. If the Mailing Address is a P.O. Box, please provide a street physical address of records.
Option A: Direct Transfer to a Beneficiary IRA
Option A: Direct Transfer to a Beneficiary IRA - This option is for spouse and non-spouse beneficiaries.
Scenario 1: As designated beneficiary under the listed descendent account, I wish my portion to be transferred to a Beneficiary IRA under the name of the descendent, for the benefit of me and my social security number. Transfer the following assets to LPL beneficiary IRA account (enter account number).
Scenario 2: As trustee/executor of the trust/estate, I direct LPL to affect a transfer, in the name of the trust/estate. Scenario 3: As Trustee/Executor of a look-through trust/estate, I direct LPL to affect a transfer in the name of the beneficiary of the trust/estate rather than in the name of the trust/estate. In Scenario 2 and Scenario 3, transfer ____% of the deceased account to the LPL Beneficiary IRA account (enter account number).
Option B: Spousal Transfer
Option B: Spousal Transfer - This option is for spouse beneficiaries only. Non-Spouse beneficiaries should not select this option.
“I certify that I was the sole beneficiary of the deceased IRA or if the deceased IRA has multiple beneficiaries as of September 30 of the year following the IRA owner's death, the beneficiaries have been separated into separate accounts by December 31 of the year following the year of the IRA owner's death in order for me to treat the IRA as my own.”
Select the scenario that best applies to your situation. Scenario 1: As spouse beneficiary, I elect to treat the decedent IRA as my own. Scenario 2: As spouse beneficiary of a look-through trust that is named beneficiary, the spouse is a first-level beneficiary of the trust, and the trust allows for a distribution to the spouse, the trustee may direct LPL to affect a transfer in the name of the spouse rather than in the name of the trust. In Scenario 1 and Scenario 2, transfer all assets to my own LPL IRA account (enter account number).
Option C: Beneficiary Disclaimer
Option C: Beneficiary Disclaimer - Qualified disclaimers are governed by Internal Revenue Code and the applicable state probate code. The model qualified language satisfies the Internal Revenue Code, but may not meet all the requirements of state law. Therefore, LPL recommends the disclaimant seek competent legal advice to ensure that all of the state's requirements have been met.
General Requirements: The disclaimant is a beneficiary who was specifically designated by the deceased, or a beneficiary determined under the custodial agreement's default beneficiary provisions.
The disclaimant must have not expressly or implicitly accepted the benefit before making the disclaimer.
The disclaimer is irrevocable once made.
The disclaimer must be made and delivered to the custodian within nine (9) months of the deceased date of death.
Scenario 1: As a designated beneficiary, in accordance with the provisions of Section 2518 of the Internal Revenue Code, hereby irrevocably disclaim my interest of the above listed descendent account (listed in Section 1) in the following manner: Any and all Property.
If you are selecting Scenario 1 of Option C, please go directly to and complete, the following section: 5. Your Signature(s).
Scenario 2: Partial percentage of Property _____% (list percentage to disclaim). If you are selecting Scenario 2 of Option C, complete Option A or B of this section for your remaining designated share.
Signature
Your signature indicates that you have received and read the Beneficiary Information Guide for beneficiaries.
“I certify that if the beneficiary is for an Estate, Charity, Corporation, LLC, or Trust, that I have the authorization to complete and sign this form.”
If a distribution is selected, I certify that I am the proper party to receive payment(s) form this account and the information is true and accurate.
I have reviewed and accept the statement: (A) All parties to this agreement are giving up the right to sue each other in court, including the right to a trial by jury, except as provided by the rules of the arbitration forum in which a claim is filed.
If selecting Option B, please go directly to and complete the following sections: 4. Your Signature(s). If selecting Option A, please go directly to and complete, the following sections: 4. Your Signature(s).
More rules for Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616)
The Internal Revenue Code imposes requirements as to the amount and timing of distributions from this account including Required Minimum Distributions.
Common questions about Distribution Request - IRA Beneficiary Claim/Disclaim Form (CM107-CTD Revised 0616)
Can you disclaim an IRA?
If you find that you do not need or want your inherited assets, you may choose to disclaim or refuse to inherit all or part of your inherited assets.
Where do I file it?
Mail the completed form to LPL Financial Attn: Trade Direct, P.O. Box 509049 San Diego, CA 92150-9049 or fax to (858) 202-8500.
When is this form not the right one?
Instructions: Use this form if you are a beneficiary and would like to claim or disclaim your benefit from a LPL Financial LLC (“LPL”) sponsored IRA account with a deceased owner. If you choose to claim your benefit as beneficiary, you can treat assets as your own IRA (spouse only), or transfer to a beneficiary IRA. Do not use this form for a Qualified Retirement Plan (QRP) or 403(b) 7 account. Please note: If you are a non-resident alien, you must open a Beneficiary IRA in order to claim your benefit, select Option A, Scenario 1.
Sources
[1] Distribution Request - IRA Beneficiary Claim/Disclaim Form, CM107-CTD Revised 0616, LPL Financial LLC (no issuer file found; the form as served on FormsPal) (the Official source link on this page).
