Valic 403B Rollover Transfer Form PDF Details

The Valic 403B Rollover Transfer Form, also known as the Agreement to Transfer Funds from a Qualified Retirement Plan, is used to transfer funds from one qualified retirement plan to another. This form must be completed and signed by both the retirement plan participant and the receiving plan sponsor in order for the transfer to take place. It's important to understand the tax implications of this transaction before completing the rollover transfer form. Contact your financial advisor or tax accountant if you have any questions.

You will discover information regarding the type of form you intend to fill out in the table. It can show you the amount of time you will need to fill out valic 403b rollover transfer form, what parts you will need to fill in and a few additional specific facts.

QuestionAnswer
Form NameValic 403B Rollover Transfer Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesvalic death claim form vl 995, valic 403 b forms, 2010 valic, valic vl

Form Preview Example

 

 

ROLLOVER/TRANSFER OUT FORM

 

 

 

For All Annuity Plan Accounts Except 403(b)

The Variable Annuity Life Insurance Company (VALIC), Houston, Texas

Original Form Required for Processing

 

 

Mail Completed Forms to:

VALIC Document Control

P.O. Box 15648, Amarillo, TX

79105-5648

Call 1-800-448-2542 for assistance.

1. CLIENT INFORMATION

 

 

 

 

Name: _________________________________________________________________ SSN or Tax ID: _____________________________________

Daytime Phone: (________) _________________________

Date of Birth: _____________________

Group Name/Number: _________________________

2. ROLLOVER/TRANSFER OUT REQUEST

Indicate if you are requesting a Rollover or Transfer by checking one of the boxes below. Do not check either box if you are requesting a Transfer to Purchase Credit (complete information below). See Information pages for more details.

Rollover Distributions:

Transfers to a Like Plan Type:

• Must have met a distributable event (See Information pages)

• Allowed at any time if not restricted by the plan

• Generally not restricted by receiving plan

• Plan may restrict transfers to only certain specified carriers

Not taxable

Generally subject to restrictions of receiving plan

Are reported to IRS

Not taxable and not reported to IRS (except for NQDAs)

If you do not designate this transaction either as a Rollover or a Transfer, and if the plan and the applicable rules permit, we will treat this as a request for a Transfer. Otherwise, we will treat this as a request for a Rollover, subject to applicable plan requirements and restrictions.

Indicate Receiving Plan Type for Rollover/Transfer:

 

 

 403(b)

 401(a)/403(a)

 401(k)

 SEP or Traditional IRA

 457(b) Governmental Deferred Compensation

 Roth IRA

Non-Qualified Deferred Annuity

Non-spousal Inherited IRA

 457(b) Tax-Exempt Deferred Compensation (transfer only)

Transfers to Purchase Service Credit (refer to Information pages for additional information):

Indicate Retirement Date (if known) _____________________

I elect to transfer funds to purchase service credit. REQUIRED: Attach State Defined Benefit Plan Documentation providing the dollar amount of eligibility.

Choose from one of the following distribution types below.

In accounts/contracts containing Multi-Year Terms, distributions made prior to maturity date may be subject to a market value adjustment.

Option A Withdrawal

Optional: You may request we distribute the amount pro-rata against

• Distributes funds as requested and leaves account open. Unless your contract/

all funds or specify an amount or percentage to be taken from each

plan allows otherwise, complete withdrawals will be processed under Option B.

fund for the account(s) listed below. If neither option is specified, the

• Future contributions accepted, if your contract allows

funds will be withdrawn in the following order: Fixed Account (FB001/

• No impact to outstanding loans

FB004/FB009), Short Term Fixed (FP002), Largest Variable Investment

• Withdrawals not allowed from Non-Qualified Deferred Annuities

Option, Second Largest Variable Investment Option, etc., Fixed Account

 

 

Plus Enhanced (FB003) and lastly the Multi-Year Term(s).

Account #________________________________

Account #________________________________

Account #________________________________

$_________________ or _____________%

$_________________ or _____________%

$_________________ or _____________%

CHOOSE ONE:

 

 

CHOOSE ONE:

 

 

CHOOSE ONE:

 

 

 Distribute the amount pro-rata against all funds

 Distribute the amount pro-rata against all funds

 Distribute the amount pro-rata against all funds

 Distribute the amount or percentage from each

 Distribute the amount or percentage from each

 Distribute the amount or percentage from each

fund as specified below:

 

fund as specified below:

 

fund as specified below:

 

Fund Code

Amount

 

Fund Code

Amount

 

Fund Code

Amount

 

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

_________ $ ___________

or _________%

Option B Surrender

Automatically closes account

Future contributions will not be accepted

If you have an outstanding loan(s), see below

If you have an outstanding loan(s) and request a surrender of your account, a 100% withdrawal will be processed leaving your account open with no impact to outstanding loans or loan security. However, you may request your account be closed and any outstanding loan(s) terminated by checking the box below under the account number. Termination of a loan(s) may result in a taxable distribution(s). If all regulatory requirements are not met to allow a loan termination, the loan(s) will remain intact.

Account #________________________________

Account # _______________________________

Account #_______________________________

 DO Terminate my Loan

 DO Terminate my Loan

 DO Terminate my Loan

3.ROLLOVER DISTRIBUTION REASON This section is required if you checked “Rollover Distribution” above. 401(a)/(k) or 457(b) governmental Deferred Compensation Plans (See Information pages.):

Separation from Service as of _________________ (date) due to:

Other Distributions:

 Termination

 Early Retirement

Normal Retirement

 

Spousal Beneficiary

 

 

 

 

 

 

 

 

 

 

 

Did you separate from service during or after the year you attained Age 55?

Yes

No

 

Qualified Domestic Relations Order (QDRO) Payment

In-service Withdrawal of available funds other than hardship.

Permanent/Total Disability as of __________ (date). (Does not apply to 457 Plans.) Termination Date: _______________

Attach Doctor’s Statement or Social Security Administration Documentation.

4.SPECIAL INSTRUCTIONS

___________________________________________________________________________________________________________________________

5.PAYEE ROLLOVER/TRANSFER COMPANY MAILING INSTRUCTIONS

___________________________________________________________

_____________________________________________________________

Payee Rollover/Transfer Company Name

 

Receiving Account Number

 

 

_______________________________________ _______________________________________ ______________________ _____ ______________

Attention Line/Internal Mail Code

Address

City

State ZIP

 

VL 18711 VER 5/2010

 

 

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DISBURSMNT

 

 

 

 

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6. SPOUSAL CONSENT

ERISA-covered and certain other employer plans require the client to state his/her marital status and the spouse to consent to this distribution. Please check the appropriate box below:

REQUIRED FOR CLIENT: Client Marital Status

Not Married

Married

Legally Separated: Attach Court Order of Legal Separation (petition not acceptable)

Missing Spouse: I hereby affirm that I have made reasonable attempts to locate my spouse and have not been able to do so.

REQUIRED FOR SPOUSE: Spousal Consent

Under federal law for ERISA plans and the terms of some employer plans, as the spouse of the contract owner, you have the right to receive a survivor benefit of at least 50% of the amount in this contract if your spouse dies before you. As a result, your spouse must have written consent before making withdrawals from this contract. If you consent to the withdrawal, you will not receive a survivor benefit payment from VALIC for the amount withdrawn. If you agree to the withdrawal, please read and sign the statement below and have your signature witnessed.

I agree to the payment of funds from the contract(s) listed in Section 2.

I understand and agree that I am giving up my right to receive a survivor benefit payment from VALIC for the amount being paid and I release VALIC from all liability for making this payment.

Spouse’s Signature _______________________________________ Date _________________

SPOUSE’S SIGNATURE WITNESSED BY NOTARY PUBLIC

This section is only to be used for a Notary Public’s witnessing of the Spousal Consent IN ABSENCE OF THE PLAN ADMINISTRATORS WITNESS. State of _________________ County of _____________ On this _____ day of _________________, year of _______

Before me personally appeared __________________________________ (name of spouse) known to me to be the person

who executed the SPOUSAL CONSENT and he/she acknowledged to me that he/she executed the same.

Notary Public __________________________________________________________

7. VESTING DETERMINATION FOR EMPLOYER CONTRIBUTION SOURCES

Vesting Information: To be completed by the employer sponsoring the plan if VALIC is NOT providing full plan administration services.

Employer Basic Vested ____________%Employer Supplemental/Matching % Vested ____________%

All Employers: Indicate hours worked if Hours of Service is used by your plan to calculate benefits. Indicate months worked if Elapsed Time is used by your plan to calculate benefits. Any month in which an employee was compensated for one hour must be counted as a month worked.

Hours Worked ______________ or Months Worked _______________ or $ _______________

8. PLAN ADMINISTRATOR APPROVAL

To be completed where required under your employer’s plan.

I approve this distribution in accordance with current plan provisions and all applicable laws and regulations.

I verify that the information provided on this form for purposes of this distribution is correct to the best of my knowledge.

If applicable, the client has established to my satisfaction that spousal consent is not required.

I affirm that any signature of a client’s spouse in Section 6 of this form has been witnessed either by me or by a Notary Public.

__________________________________________________

___________________________________________________

________________

Plan Administrator’s Name (Print Name)

Plan Administrator’s Signature

Date

9. CLIENT APPROVAL

I authorize the above rollover/transfer and certify that all statements, including marital statements, are complete and accurate to the best of my knowledge and belief.

I certify that the payee is eligible to accept this rollover/transfer on my behalf.

I have read and understood the “Joint and Survivor Annuity and Qualified Annuity Benefit” section of the Special Tax Notice. By signing below I am agreeing to waive any benefit or right described in that section that would have been provided with respect to the amount that I am withdrawing. I also understand that I have the right to revoke any waiver if a distribution has not already been made.

I have read and understand the information provided in the Information pages of this form, including IncomeLOCK Option, if applicable, and acknowledge that distributions may be subject to surrender charges as provided in the contract.

I understand that I will be responsible for providing evidence to the IRS, if required, to verify distribution reason.

If this rollover/transfer will result in a total surrender of my account(s), I have attached my Contract/Certificate to this form, or alternatively, I certify that my Contract/Certificate has been lost or destroyed. If my Contract/Certificate is not attached, I agree to indemnify VALIC against any claims that may be asserted on the basis of the Contract/Certificate being found and presented for payment.

For Section 1035 Exchanges: VALIC is participating in this transaction at your specific request and as an accommodation to you and makes no representations or warranties and has no responsibility or liability for the validity of this transaction or its tax treatment under Section 1035(a) of the Internal Revenue Code or otherwise. If this is a partial exchange, it is subject to applicable tax rules and requirements, including but not limited to IRS Revenue Procedure 2008-24 which requires that the cost basis of the original contract be reduced pro-rata by the amount of the exchange to the new contract. That guidance includes specific rules intended to prevent the use of partial exchanges to avoid tax obligations, and provides that any distribution from either the surrendering or receiving contract involved in a partial exchange within 12 months from the date of the exchange may result in the partial exchange being treated as a taxable withdrawal from the original contract rather than a tax-free exchange. VALIC does not provide tax or legal advice and recommends that you seek the advice of your tax or legal advisor before entering into this transaction.

__________________________________________________

___________________________________________________

________________

Client’s Name (Print Name)

Client’s Signature

Date

10. SIGNATURE GUARANTEE OR FINANCIAL ADVISOR SIGNATURE

For requests of $25,000 or more, either a Signature Guarantee or your financial advisor’s signature is required.

Signature Guarantee:

You may obtain a signature guarantee from an eligible guarantor including a bank, broker, dealer, municipal securities dealer, government securities broker, credit union (if authorized under state law), national securities exchange, registered securities association, clearing agency or savings association.

The Guarantor should be informed of the approximate amount of the distribution and must affix a stamp in the box to the right.

A notarization by a notary public is not acceptable.

___________________________________________________

_____________________

Financial Advisor’s Name (Print Name)

Financial Advisor’s Number

Signature Guarantee (if applicable)

_________________________________________________________

_______________

Financial Advisor’s Signature (Must be appointed with VALIC)

Date

 

 

VL 18711 VER 5/2010

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Information

*PRIVATE TAX-EXEMPT 457(b) DEFERRED COMPENSATION PLANS

Section 457(b) deferred compensation plans sponsored by private tax-exempt employers require participants to make an irrevocable election regarding the distribution of benefits. Commencement of payments cannot be later than April 1st of the year following the year you attain age 70½ unless you are still working for the plan’s sponsor. Please contact your plan administrator for more information.

SPECIAL TAX NOTICE

The information in this notice applies to qualified plans, 403(b) and governmental section 457(b) plans (“Plan”) and IRAs. You are receiving this notice because all or a portion of a payment you are receiving from an employer-sponsored plan or IRA may be eligible to be rolled over to an IRA or an employer plan. This notice is intended to help you decide whether to do such a rollover. You have the right to at least 30 days to consider your alternatives after receiving this notice. You may waive this review period. Your signature on this form will indicate that either you have had this 30-day review or that you have chosen to waive it and you are requesting an immediate distribution. This notice does not describe any State or local income tax rules (including withholding rules).

ELIGIBLE ROLLOVER DISTRIBUTIONS

You will be taxed on a payment from the Plan or IRA if you do not roll it over. If you are under age 59½ and do not do a rollover, you will also have to pay a 10% additional income tax on early distributions (unless an exception applies). However, if you do a rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if those payments are made after you are age 59½ (or if an exception applies).

If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan or IRA is eligible for rollover, except:

Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary)

Required minimum distributions after age 70½ (or after death)

Hardship distributions

Corrective distributions of contributions that exceed tax law limitations

Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends)

Contributions made under special automatic enrollment rules that are withdrawn pursuant to your request within 90 days of enrollment

Amounts paid from certain deferred compensation plans

If a payment is not an eligible rollover distribution, 10% federal income tax withholding will apply unless you indicate differently. The Plan administrator or the payor can tell you what portion of a payment is eligible for rollover.

You may roll over the payment to either an IRA or an employer plan (qualified plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. Check with the administrator of that plan about whether the plan accepts rollovers and, if so, the types of rollover distributions it accepts. See below for rollover rules regarding payments from designated Roth accounts in 401(k) or 403(b) plans. The rules of the IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the IRA or employer plan. For example, the employer plan may restrict distributions or require spousal consent or plan administrator approval for distributions. Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan. If you roll over a payment from a governmental section 457(b) plan to an IRA or

to an employer plan that is not a governmental section 457(b) plan, a later distribution made before age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies).

There are two ways to do a rollover. You can do either a direct rollover or a 60-day rollover.

If you do a direct rollover, the Plan or IRA will make the payment directly to your IRA or an employer plan.

If you do not do a direct rollover, you may still do a rollover by making a deposit into an IRA or eligible employer plan that will accept it. You will have 60 days after you receive the payment to make the deposit. If you do not

VL 18711 VER 5/2010

do a direct rollover of a Plan distribution, the Plan is required to withhold 20% of the payment for federal income taxes. This means that, in order to roll over the entire payment in a 60-day rollover, you must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment, the portion not rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies).

Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. To apply for a waiver, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs).

After-tax Contributions. After-tax contributions included in a payment are not taxed. If a payment is only part of your benefit, an allocable portion of your after-tax contributions is generally included in the payment. If you have pre-1987 after-tax contributions maintained in a separate account, a special rule may apply to determine whether the after-tax contributions are included in a payment.

You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs). If you do a direct rollover of only a portion of the amount paid from the Plan and a portion is paid to you, each of the payments will include an allocable portion of the after-tax contributions. If you do a 60-day rollover to an IRA of only a portion of the payment made to you, the after-tax contributions are treated as rolled over last. For example, assume you are receiving a complete distribution of your benefit which totals $12,000, of which $2,000 is after-tax contributions. In this case, if you roll over $10,000 to an IRA in a 60-day rollover, no amount is taxable because the $2,000 amount not rolled over is treated as being after-tax contributions.

You may roll over to an employer plan all of a payment that includes after-tax contributions, but only through a direct rollover (and only if the receiving plan separately accounts for after-tax contributions and is not a governmental section 457(b) plan). You can do a 60-day rollover to an employer plan of part of a payment that includes after-tax contributions, but only up to the amount of the payment that would be taxable if not rolled over.

ROLLOVERS OF BENEFICIARY/ALTERNATE PAYEE ACCOUNTS

Payments after death of the participant. If you receive a distribution after the participant’s death that you do not roll over, the distribution will generally be taxed in the same manner described elsewhere in this notice. However, the 10% additional income tax on early distributions and the special rules for public safety officers do not apply, and the special rule described under the section, “Special Tax Treatment for Certain Lump Sum Distributions,” applies only if the participant was born on or before January 1, 1936. Note that whether a payment from a designated Roth account (see below) is a qualified distribution generally depends on when the participant first made a contribution to the designated Roth account in the Plan.

If you are a surviving spouse. If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to a traditional or Roth IRA, you may treat the IRA as an inherited IRA or as your own. If you treat the IRA (either traditional or Roth) as an inherited IRA, payments from the IRA will not be subject to the 10% additional income tax on early distributions. However, if the participant had started taking required minimum distributions, you will have to receive required minimum distributions from the inherited IRA. If the participant had not started taking required minimum distributions from the Plan, you will not have to start receiving required minimum distributions from the inherited IRA until the year the participant would have been age 70½. A traditional IRA you treat as your own is treated like any other traditional IRA of yours, so that payments made to you before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies) and required minimum distributions from your traditional IRA do not have to start until after you are age 70½. A Roth IRA you treat as your own is

Information (continued)

treated like any other Roth IRA of yours, so that you will not have to receive any required minimum distributions during your lifetime and earnings paid to you in a nonqualified distribution before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies).

If you are a surviving beneficiary other than a spouse. If you receive a payment from the Plan because of the participant’s death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited traditional or Roth IRA. Payments from the inherited IRA (even if a nonqualified distribution from a Roth IRA) will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited traditional or Roth IRA.

Payments under a qualified domestic relations order. If you are the spouse or former spouse of the participant who receives a payment from the Plan under a qualified domestic relations order (QDRO), you generally have the same options the participant would have (for example, you may roll over the payment to your own IRA or an eligible employer plan that will accept it). Payments under the QDRO will not be subject to the 10% additional income tax on early distributions.

10% PENALTY

If you are under age 59½, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan or IRA (including amounts withheld for income tax) (or, for payment from a Roth IRA, for the earnings paid) that you do not roll over, unless one of the exceptions listed below applies (or, for payment from a Roth IRA, is a qualified distribution). This tax is in addition to the regular income tax on the payment not rolled over.

The 10% additional income tax does not apply to the following payments from the Plan or IRA:

Payments made after you separate from service if you will be at least age 55 in the year of the separation (not applicable to IRA)

Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary) (exception applies to IRA without regard to separation from service)

Payments from a governmental defined benefit pension plan made after you separate from service if you are a public safety employee and you are at least age 50 in the year of the separation

Payments made due to disability

Payments after your death

Payments from a governmental 457(b) plan, unless the payment is from a separate account holding rollover contributions that were made to the Plan from a qualified plan, a section 403(b) plan, or an IRA

Corrective distributions of contributions that exceed tax law limitations

Payments made directly to the government to satisfy a federal tax levy

Payments made under a qualified domestic relations order (QDRO) (not applicable to IRA; special rule applies for IRAs under which, as part of a divorce or separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse)

Payments up to the amount of your deductible medical expenses

Certain payments made while you are on active duty if you were a member of a reserve component called to duty after September 11, 2001 for more than 179 days

Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution.

IRA Only: (1) payments for qualified higher education expenses,

(2) payments up to $10,000 used in a qualified first-time home purchase, and (3) payments after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self-employed status).

Note: Eligible rollovers into a governmental 457(b) plan that were previously subject to the 10% additional income tax will continue to be subject to that penalty at the time of withdrawal unless you are over age 59½ or some other exception applies.

VL 18711 VER 5/2010

DESIGNATED ROTH ACCOUNTS AND ROTH IRAS

Contributions to designated Roth accounts and Roth IRAs are not deductible and therefore are distributed tax-free at any time. Earnings which accumulate in a designated Roth account or Roth IRA are not taxed currently and are not taxed upon a qualified distribution described below. Rollovers or conversions to a Roth IRA from a traditional IRA or pre-tax contributions to an employer plan are taxable in the year of the distribution.

After-tax contributions included in a payment from a designated Roth account are not taxed, but earnings might be taxed. The tax treatment of earnings included in the payment depends on whether the payment is a qualified distribution. If a payment is only part of your designated Roth account, the payment will include an allocable portion of the earnings in your designated Roth account. If the payment from the Plan is not a qualified distribution and you do not do a rollover to a Roth IRA or a designated Roth account in an employer plan, you will be taxed on the earnings in the payment. For payments from the Plan during 2010 that are rolled over to a Roth IRA, the taxable amount can be spread over a 2-year period starting

in 2011. If you are under age 59½, a 10% additional income tax on early distributions will also apply to the earnings (unless an exception applies). This tax is in addition to the regular income tax on the earnings not rolled over. However, if you do a rollover, you will not have to pay taxes currently on the earnings and you will not have to pay taxes later on payments that are qualified distributions. If the payment from the Plan is a qualified distribution, you will not be taxed on any part of the payment even if you do not do a rollover. If you do a rollover, you will not be taxed on the amount you roll over and any earnings on the amount you roll over will not be taxed if paid later in a qualified distribution.

A qualified distribution from a designated Roth account or Roth IRA is a payment made after you are age 59½, after your death or disability, or as a qualified first-time homebuyer distribution of up to $10,000 (not applicable to designated Roth accounts) and after you have had the designated Roth account in the Plan or Roth IRA for at least 5 years. In applying this 5-year rule, you count from January 1st of the year for which your first contribution was made to a designated Roth account or Roth IRA. However, if you did a direct rollover to a designated Roth account in the Plan from a designated Roth account in another employer plan, your participation will count from January 1st of the year your first contribution was made to the designated Roth account in the Plan or, if earlier, to the designated Roth account in the other employer plan.

You may roll over the designated Roth account payment to either a Roth IRA or a designated Roth account in an employer plan (qualified plan or section 403(b) plan) that will accept the rollover. The rules of the Roth IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the Roth IRA or employer plan. Further, the amount rolled over will become subject to the tax rules that apply to the Roth IRA or the designated Roth account in the employer plan. In general, these tax rules are similar to those described elsewhere in this notice, but differences include:

If you do a rollover to a Roth IRA, all of your Roth IRAs will be considered for purposes of determining whether you have satisfied the 5-year rule (counting from January 1st of the year for which your first contribution was made to any of your Roth IRAs).

If you do a rollover to a Roth IRA, you will not be required to take a distribution from the Roth IRA during your lifetime and you must keep track of the aggregate amount of the after-tax contributions in all of your Roth IRAs (in order to determine your taxable income for later Roth IRA payments that are not qualified distributions).

Eligible rollover distributions from a Roth IRA can only be rolled over to another Roth IRA.

There are two ways to do a rollover. You can do a direct rollover (Plan will make payment directly) to a Roth IRA or designated Roth account in an employer plan. If you do not do a direct rollover, you may still do a rollover by making a deposit within 60 days into a Roth IRA, whether the payment is a qualified or nonqualified distribution. In addition, you can do a rollover by making a deposit within 60 days into a designated Roth account in an employer plan if the payment is a nonqualified distribution and the rollover

Information (continued)

does not exceed the amount of the earnings in the payment. You cannot do a 60-day rollover to an employer plan of any part of a qualified distribution. If you receive a distribution that is a nonqualified distribution and you

do not roll over an amount at least equal to the earnings allocable to the distribution, you will be taxed on the amount of those earnings not rolled over, including the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies).

If you do a direct rollover of only a portion of the amount paid from the Plan and a portion is paid to you, each of the payments will include an allocable portion of the earnings in your designated Roth account.

If you do not do a direct rollover and the payment is not a qualified distribution, the Plan is required to withhold 20% of the earnings for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover to a Roth IRA, you must use other funds to make up for the 20% withheld.

If you roll over the payment to a designated Roth account or Roth IRA, later payments from the designated Roth account or Roth IRA that are qualified distributions will not be taxed (including earnings after the rollover). Payments from the designated Roth account or Roth IRA that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). You do not have to take required minimum distributions from a Roth IRA during your lifetime. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs).

LOANS

If you request a total surrender of your Plan account and you have an outstanding loan, the account balance will be reduced by the outstanding loan balance and outstanding loan security will be returned to the account. The loan offset amount is treated as a distribution to you at the time of the offset and will be taxed (including the 10% additional income tax on early distributions, unless an exception applies) (in the case of a nonqualified distribution from a designated Roth account, only to the extent of the earnings in the loan offset) unless you do a 60-day rollover in the amount of the

loan offset to an IRA or employer plan (or in the amount of the nonqualified distribution earnings to a Roth IRA or designated Roth account in any employer plan). You may also choose to pay off the outstanding loan balance prior to the surrender by submitting payment in full to the Loan Department.

SPECIAL TAX TREATMENT FOR CERTAIN LUMP-SUM DISTRIBUTIONS

If you were born on or before January 1, 1936 and receive a lump sum distribution (including a nonqualified distribution from a designated Roth account) that you do not roll over, special rules for calculating the amount of the tax on the payment (or the earnings in the payment for a nonqualified distribution) might apply to you (not applicable to governmental 457(b) plan distributions). For more information, see IRS Publication 575, Pension and Annuity Income.

ELIGIBLE RETIRED PUBLIC SAFETY OFFICER

If the Plan is a governmental plan, you retired as a public safety officer, and your retirement was by reason of disability or was after normal retirement age, you can exclude from your taxable income plan payments (including nonqualified distributions from designated Roth accounts) paid directly

as premiums to an accident or health plan (or a qualified long-term care insurance contract) that your employer maintains for you, your spouse, or your dependents, up to a maximum of $3,000 annually. For this purpose, a public safety officer is a law enforcement officer, firefighter, chaplain, or member of a rescue squad or ambulance crew.

NONRESIDENT ALIEN

If you are a nonresident alien and you do not do a direct rollover to a U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is generally required to withhold 30% of the payment for federal income taxes. If the amount withheld exceeds the amount of tax you owe (as

VL 18711 VER 5/2010

may happen if you do a 60-day rollover), you may request an income tax refund by filing Form 1040NR and attaching your Form 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced rate of withholding under an income tax treaty. For more information, see also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.

OTHER SPECIAL RULES

If a payment is one in a series of payments for less than 10 years, your choice whether to make a direct rollover will apply to all later payments in the series (unless you make a different choice for later payments).

If your payments for the year are less than $200, the Plan is not required to allow you to do a direct rollover and is not required to withhold for federal income taxes. However, you may do a 60-day rollover.

Unless you elect otherwise, a mandatory cashout of more than $1,000 will be directly rolled over to an IRA chosen by the Plan administrator. A mandatory cashout is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant’s benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan).

You may have special rollover rights if you recently served in the U.S. Armed Forces. For more information, see IRS Publication 3, Armed Forces’ Tax Guide.

FOR MORE INFORMATION

You may wish to consult with the Plan administrator or a professional tax advisor, before taking a payment from the Plan or IRA. Also, you can find more detailed information on the federal tax treatment of payments from employer plans and IRAs in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590, Individual Retirement Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local IRS office, on the web at www.irs.gov or by calling 1-800-TAX-FORM.

DISTRIBUTABLE EVENT

Generally a distributable event includes attainment of age 59½ (age 70½ for governmental 457(b) plans), separation from service, disability or death. However, the employer’s plan may place additional restrictions that must also be met prior to a distribution. If you have met a distributable event, you may request a rollover of funds to any eligible plan type or a transfer to a like plan type. If you wish to move funds from your VALIC 403(b) account to another 403(b) account via a rollover distribution, and have made contributions prior to 01-01-87, those amounts may lose a grandfathered status that can impact future required distributions. However, movement of funds from your VALIC 403(b) account to another 403(b) account via a transfer distribution may retain the status. For more information, please call 1-800-448-2542.

TRANSFERS

Transfers to a like plan will not be taxed or reported to the IRS. Generally, transfers are allowed regardless of employment status. However, your employer’s plan may restrict you to authorized carriers. Transferred amounts generally become subject to the requirements of the plan receiving the transfer as though originally contributed to that plan.

INCOMELOCK OPTION

If you have chosen the IncomeLOCK living benefit option, withdrawals from the contract will reduce the account value and all benefits of the IncomeLOCK living-benefit option. Withdrawals exceeding the Maximum Annual Withdrawal Amount may reduce future Maximum Annual Withdrawal Amounts. Minimum distribution amounts calculated for each year will include the value of the IncomeLOCK benefit. One year’s required minimum distribution based solely on the value of each individual account will not be treated as an excess withdrawal, but may reduce the Maximum Withdrawal Period. See your contract endorsement.

Information (continued)

PURCHASE OF SERVICE CREDIT

If allowed by both your State law and your State Defined Benefit Plan, you may request a withdrawal or surrender to purchase service credit*. VALIC will waive any applicable surrender charge if the following requirements are met:

1.VALIC has received all required paperwork in good order.

2.You are no more than 180 days from your specified retirement date.

3.You are age 55 or older.

4.Your account has been in effect for 5 years or longer.

Additionally, VALIC will waive the 20% Fixed Account Plus withdrawal restriction if you meet requirements 1 and 2 above.

*Withdrawals are allowed from 403(a), 403(b), 401(a), 401(k), governmental 457(b) and 408(a) plans.

QUALIFIED JOINT AND SURVIVOR ANNUITY AND QUALIFIED ANNUITY BENEFIT: FOR ERISA PLANS ONLY

This notice should be provided to you at least 30 days, but no more than 180 days, before your proposed distribution date.

If you are married, your retirement plan distributions will be paid to you in the form of a Qualified Joint and Survivor Annuity (“QJSA”) unless you elect a different form of distribution. Under your QJSA, if your spouse survives you, the plan will pay him or her at least 50% of the amount the plan had been paying to you, on the same frequency as the payments to you. If you are not married, your benefit will be paid monthly over your life and will end upon your death unless you elect a different form of distribution. This benefit is referred to as a Qualified Annuity Benefit (“QAB”).

The plan may satisfy the QJSA or QAB by using your vested account balance to purchase an annuity contract from an insurance company. The actual monthly payments made under the annuity contract will depend on the value of your account balance, annuity purchase rates used by the insurance company, your age, and if you are married, your spouse’s age at the time the distribution begins.

The following table reflects the relative values of monthly payments from a Joint and Survivor Annuity and a Life Annuity, assuming a vested account balance of $5,000 and an interest rate of 6%. This table is based on the Annuity 2000 Mortality tables. The table is hypothetical and does not reflect the value of your individual benefit or the actual payments you or your beneficiaries would receive. Please note that as the ages change, the payment amount will change. If none of the examples closely approximates your situation, you may obtain a more accurate value specific to your situation from your plan administrator or from your financial advisor.

Age at Benefit Starting Date

Annuitant

70

65

60

55

50

45

40

35

Spouse

65

70

55

60

45

50

35

40

 

 

 

 

 

 

 

 

Monthly Payment

 

 

 

 

 

 

 

Annuitant Life

 

 

 

 

 

 

 

 

Only

39.62

35.35

32.38

30.27

28.75

27.61

26.76

26.13

Joint and

 

 

 

 

 

 

 

 

50% Survivor

35.47

33.65

30.21

29.26

27.53

26.99

26.07

25.76

 

 

 

 

 

 

 

 

 

Joint and

 

 

 

 

 

 

 

 

75% Survivor

33.71

32.86

29.23

28.78

26.95

26.70

25.73

25.58

 

 

 

 

 

 

 

 

 

This QJSA or QAB requirement may not apply to smaller account balances (generally below $5,000) and will not apply if you have elected another form of benefit. A partial withdrawal would be considered another form of benefit for this purpose. Other alternate forms of benefits that may be available under your employer’s plan and under your plan investments may include:

Annuity

An annuity can provide you with payments for your life or for your life and that of your beneficiary; payments for a specified period; payments for your lifetime with a minimum guaranteed period; or a continuation of payments

VL 18711 VER 5/2010

to your surviving spouse that is different from the plan’s percentage of the payments made to you. Generally, the more that the form of payment guarantees, such as a minimum period of payments, or payments to your surviving spouse or to another beneficiary, the more that specified benefit amount will cost. There are IRS rules that may limit the period during which payments may be made.

Lump Sum Distribution

If you elect a lump sum distribution, your benefit will be paid to you in one payment. The amount of your benefit is the vested portion of your account balance as of the valuation date used to calculate your distribution.

Installments

If you elect to receive your benefits in installments, you may specify the dollar amount and frequency of your payments. The period of time over which you receive these installments cannot be greater than your life expectancy or the joint life and last survivor expectancy of you and your designated beneficiary. There are other IRS rules that may further limit the period over which you receive payments.

In order to elect one of these alternative forms of benefits you must waive your right to the QJSA or QAB, and if you are married, your spouse must also consent in writing. In addition, this written consent must be witnessed by a Notary Public or by your Plan Administrator. You are entitled to 30 days (but no more than 180 days) within which to make this decision. Although you have at least 30 days to make this decision, under some circumstances, you may waive this minimum 30-day period, and if you submit a waiver of the QJSA or QAB less than 30 days after it is signed we will assume that you are waiving this notice period. Unless a waiver

of the QJSA or QAB is made irrevocably, you have the right to revoke the waiver and execute another waiver at a later time, up to the time when the benefit payments have started. You also have the right to defer receiving a distribution, subject to the terms of your employer’s plan as well as legal requirements that generally require distributions to commence upon the later of attainment of age 70½ or retirement.

The investment options available to you, the right to change investment options, and the fees imposed under the investment options will not be affected by your decision to defer distributions.

Please send completed forms to:

VALIC Document Control

P.O. Box 15648

Amarillo, TX 79105-5648

Call 1-800-448-2542 for assistance.

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