Nationwide Form Withdrawal PDF Details

The nationwide suspension of classes is an unprecedented decision made by education authorities amidst the COVID-19 pandemic. This calls for a new way to manage and conduct education at various levels. Schools, colleges, universities and other institutions are facing tough times as they reposition themselves in order to facilitate learning from a distance. One important step towards this goal is the withdrawal of physical forms used for registration or application processes in favor of digital solutions. Such reforms can help manage administrative workloads more effectively while safeguarding student information against loss or changes due to natural calamities as well as human mismanagement. In this blog post, we will discuss the ‘Nationwide Form Withdrawal’ and understand what it entails for students, schools and society on a whole.

QuestionAnswer
Form NameNationwide Form Withdrawal
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesnationwide form withdrawal, nationwide form contract withdrawal, withdrawal nationwide annuity form, nationwide contract owner withdrawal form

Form Preview Example

Take a long-term view …

As you know, your annuity is designed to help you invest for retirement. And there are ways it can ofer you income without completely surrendering your contract.

If you’re considering replacing your Nationwide® annuity with another investment —  please remember:

Moving to another annuity provider often brings with it a new surrender charge period that would begin all over again, potentially locking up your money for seven years or more

Don’t forget all the good things your Nationwide annuity brings you, lik e a guaranteed death benefit for your family that isn’t subject to market downturns or interest rate changes

If you’re concerned about the volatility of your annuity’s current investment op tions, you can transfer among many other underlying investment options within your annuity — free of charge and with no tax consequences

You can let your annuity continue to grow tax deferred for y our retirement — while normal contract fees and expenses will still apply, your annuity will no longer have sales charges and your money becomes more accessible

If you need access to your money now, consider these options:

Take income from other investments you may have that don’t carry surrender charge s, fees or adverse tax consequences

You may also have penalty-free withdrawals available to you each year, depend ing on your contract and its features; call us for specific details

If your need is longer term, turn your annuity into a guaranteed stream of income by an nuitizing your contract (ask your investment professional for more details)

Of course, there are always rules.

We want to make sure you know what they are. Please keep these things in mind:

A withdrawal will be subject to ordinary income taxes and, if you’re not yet 59½ years old, a 10% federal income tax penalty may also apply

Withdrawals can reduce the features that come with your annuity, like your death benefi t or optional riders

Depending on when you bought your annuity and how long it’s been since you made a purc hase payment, contingent deferred sales charges (CDSC) may also apply to withdrawals or surrenders

Consult with your investment professional today for the options that may be right for you. And feel free to contact us with any questions. We’re available Monday through Friday from 8 a.m. to 8 p.m. Eastern time by calling 1-800-848-6331.

All guarantees and protections, where available, are subject to the claims-paying ability of Nationwide Life Insurance Company. Investments are subject to market risk, including the possible loss of principal.

Annuities and life insurance are issued by Nationwide Life Insurance Company or Nationwide Life and Annuity Insurance Company, Columbus, Ohio. The general distributor for variable products is Nationwide Investment Services Corporation, member FINRA. In MI only: Nationwide Investment Svcs. Corporation.

Nationwide, the Nationwide framemark and On Your Side are service marks of Nationwide Mutual Insurance Company.

©2006 – 2009 Nationwide Financial Services, Inc. All rights reserved. VAM-1529AO (10/09)

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Contract Owner Withdrawal Form

Mail to: Nationwide Financial®*, Individual Annuities, PO Box 182021, Columbus, Ohio, 43218-2021, 1-800-848-6331

Fax to: 1-888-634-4472 Page 1 of 3

1. General Information

Please print.

1a. Owner Information

Existing Contract Number

(Required)

Contract Owner First/Last Name

Telephone

Number

()

2.Type of Withdrawal (Please check only one.)

Partial Withdrawal:

 

Important Note for Non-Qualiied annuity contracts: If

!

your contract was issued as part of a partial 1035 exchange

Amount

$

 

 

after June 30, 2008, and a distribution or surrender is made

 

 

 

 

 

 

 

from either contract within 12 months after the exchange,

Amount after taxes and charges

 

 

all or a portion of the amount transferred from the original

Amount before taxes and charges (Default)

 

 

contract may be treated as a taxable distribution, subject

Total Withdrawal

 

to both income taxation and the 10% early distribution

 

penalty, unless, the distribution or surrender meets certain

 

 

 

 

Hardship Withdrawal (401 and 403(b) only)

 

deined exceptions. Please consult your prospectus for more

Penalty Free/Age Base Withdrawal (Calculated by Nationwide)

information and discuss any tax consequences concerning

any contemplated transactions with a professional tax advisor.

3.Method of Payment (Please check only one.)

Direct Deposit (A voided check or a letter from your inancial institution is required. Deposit slips, starter checks, money market, or brokerage accounts are not acceptable.)

Check to Contract Owner

Check to Alternate Payee** (Please ill out the following ields.)

Check payable to/Name

Address

City/State/ZIP

Overnight: If carrier name and billing number are not included, a $25 fee is required for this service. The fee will be taken from the contract proceeds and classiied as a taxable event. This option excludes transfers and withdrawals taken during the “Right to Examine and Cancel” period, processed as non-taxable events. Please note option is not available for P.O. Box addresses. Street address is required for overnight option. Weekend delivery is not available.

Carrier Name and Billing#:

4.Tax Withholding (Please check only one.)

!

If this section is

 

Do not withhold taxes

 

Withhold federal taxes

 

%

 

 

Withhold state taxes

%

blank, we will

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

default to

For state withholding, please list your state of residence:

 

 

 

 

 

 

withholding

 

 

 

 

 

taxes.

Note: If state income tax is withheld, as required by speciic states and their regulations, Nationwide will round the dollar amount up to the next whole dollar.

5. Taxpayer ID Certiication

I certify that under penalties of perjury that: 1) The Taxpayer Identiication Number or Social Security Number listed on this form is my correct taxpayer identiication number. 2) I am not subject to backup withholding because:

(a)I have not been notiied that I am subject to backup withholding as a result of a failure to report all interest or dividends, or

(b)The Internal Revenue Service has notiied me that I am no longer subject to backup withholding, or that I am exempt from backup withholding, and

3) I am a U.S. person (including a U.S. resident alien)

You must cross out item (2) if you have been notiied by the IRS that you are currently subject to backup withholding because of failure to report interest or dividends on your tax return.

The Internal Revenue Service does not require your consent to any provision of this document other than the certiications required to avoid backup withholding.

*Nationwide Financial annuities are issued by Nationwide Life Insurance Company and Nationwide Life and Annuity Insurance Company.

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Contract Owner Withdrawal Form

Page 2 of 3

6.Disclosure and General Information

A voided check or letter from your bank/inancial institution must be included for the direct deposit option. If no voided check or letter from your inancial institution is included a check will be mailed to the contract owner’s address of record. The deposit to your

checking or savings account will normally occur two (2) business days after the date of the withdrawal from the annuity contract. Please note that deposit slips are not acceptable

You may be liable for federal and state income tax on the taxable amount of the withdrawal. These may include both federal and state income taxes, underestimated tax withholding penalty, and 10% early withdrawal penalty if under 59 1/2 (including withdraw-

als under Capital Preservation Plus Lifetime Income (CPPLI) Option or the Nationwide Lifetime Income Rider (L.Inc) Option)

For Qualiied Plans (401(a), 401(k), 403(b), etc., Nationwide may be required to withhold 20%. A 20% mandatory withholding will occur for all taxable distributions eligible to be rolled into an IRA or other Qualiied Plan that are not done as a “direct rollover or trustee to trustee transfer. Distributions made from a Qualiied Plan to a non-spouse beneiciary (that are not a “direct rollover” to an

Inherited-IRA) will have a mandatory 20% withheld

For all other taxable distributions (including from a non-qualiied contract) the default of 10% withholding will be used unless the contract owner indicates a diferent amount

If you elected an Extra Value Option in your existing annuity, the credited amount may be recaptured in accordance with the terms of the Extra Value Option

Contracts with CPPLI or L.Inc: Additional withdrawals over your allowable annual amount will reduce your current beneit base and

may reduce the annual lifetime income withdrawals in future years

Withdrawals in excess of the guaranteed withdrawal amount, called “excess withdrawals”, may result in a permanent reduction in future guaranteed withdrawal amounts. Please refer to your product prospectus for additional information. If you would like to make an excess withdrawal and are uncertain how an excess withdrawal will reduce your future withdrawal amounts, you may contact Nationwide prior to requesting the withdrawal to obtain a personalized, transaction-speciic calculation showing the efect of the excess withdrawal

It is hereby expressly represented that no person, irm, or corporation other than the undersigned has any interest in this contract, and that no proceedings in insolvency or bankruptcy have been instituted or are pending against the undersigned.

If this withdrawal is from a tax sheltered or tax deferred program, the undersigned expressly represents a personal knowledge of applicable program restrictions and hereby acknowledges that this speciic withdrawal transaction is in conformity with and is not prohibited by the terms of that program. Nationwide makes no warranties regarding the tax consequences of this transaction. Please consult your tax advisors for details.

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Contract Owner Withdrawal Form

Page 3 of 3

6. Disclosure and General Information (Continued.)

IMPORTANT - Additional Charges May Apply - Please acknowledge the following:

I understand that charges, fees, and beneit losses may apply to any withdrawal, 1035 Exchange, Trustee to Trustee Transfer, or Direct

Rollover I request. I also understand that as of ____/_____/______, I will forfeit charges totaling approximately $, which

includes one or more of the following charges: Contingent Deferred Sales Charges, Excess Withdrawal Charges and /or Extra Value beneits forfeited. In addition, I understand that any market value adjustment may be deducted from my distributions as outlined in

the prospectus. (Initials)

STOP

 

To obtain these current charges or potential lost beneits, or to learn about options available to you, please contact our Service Center at 1-800-848-6331.

7.Signature (Must complete signatures and provide Social Security Number (SSN) or Tax ID Number (TIN).) I certify that all of the information I have provided in this form is accurate and true.

Contract Owner/Custodian Name:

Contract Owner/Custodian Signature:

Joint Owner Name: (If applicable.)

Joint Owner Signature:

X

X

SSN or TIN:

Date:

Date:

Want a transaction status? Provide an E-mail address and a status will be sent upon processing.

E-mail Address:

**Please note: If the gross amount of your withdrawal request is greater than or equal to $50,000 and you choose to have your withdrawal made out to a third party or have your withdrawal sent to an address other than your address of re- cord, or a bank account other than your own bank account, you must have your signature guaranteed by a participating Medallion STAMP (Securities Transfer Agents Medallion Program) program member. A Medallion STAMP signature guarantee is an authentication of a signature in the form of a stamp or seal by a bank, a stock exchange member or another acceptable guarantor. A notary’s stamp or seal is not a Medallion STAMP; therefore a notarized signature will not be accepted. You can obtain a Medallion STAMP signature guarantee from a commercial bank, savings bank, credit union, or broker dealer authorized to provide Medallion STAMP signature guarantees. Medallion STAMP signature guarantees will not be accepted by fax.

! Important

Medallion Stamp/Signature Guarantee:

(Required As Described**)

If any information contained on this form is unclear or incomplete, Nationwide will correspond directly with the contract owner via regular mail.

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