SEP IRA Removal of Excess Form Please read the information outlined below before completing this form. The information provided is not intended as tax or legal advice nor should it be considered as such. This form is provided for use when your annual contribution limit, as defined by the Internal Revenue Service, has been exceeded in your SEP IRA. IMPORTANT CONSIDERATIONS u We encourage you to consult your tax advisor for assistance regarding removal of excess contributions or to review IRS Publication 590 or 560. u Do not complete this form if you are removing the excess after tax-filing deadline, plus extension. Instead, consider these options: u Removing the excess amount as a distribution by completing an IRA Distribution Request Form. The amount is subject to a 6% excise tax for each year it remains in the account. u Carrying over the amount in excess for subsequent years as a Traditional IRA contribution. You avoid the IRS 6% excise tax. No form is required. u If you have made Traditional IRA contributions into your SEP IRA account(s) and need to remove this excess, complete the Traditional IRA Excess Removal Form. Employee-Initiated Removal of Excess Employer Contributions u In order to be initiated by you, your excess must be removed timely by tax-filing deadline, plus extensions, of the year contributions were made to your account. u The excess plus earnings will be returned to you. u Your employer must adjust your W-2 to include the excess amount in your income. u The excess amount plus earnings will be taxable to you as earned income in the year it is distributed from your SEP account(s). u Earnings are subject to a 10% early distribution penalty, if under age 59½. u You avoid the IRS 6% excise tax by removing timely. Employer-Initiated Removal of Excess Employer Contributions u The excess amount plus earnings will be sent to your employer. u Both you, the employee, and your employer must sign in Section 5. u Your employer must use the Employee Plan Compliance Resolutions System (EPCRS) voluntary compliance procedures to correct the excess. u Your employer is required to provide OppenheimerFunds with a copy of the IRS resolution letter as a result of the EPCRS filing. u The excess will be reportable to you on IRS Form 1099-R but is not taxable to you.
SEP IRA Removal of Excess Form Before completing this form, please read the cover information sheet. Please complete all sections and sign this form. Please call 800.835.7305 with questions. Return completed form to OppenheimerFunds Services Regular mail: P.O. Box 5270 Denver, CO 80217-5270 Overnight mail: 6803 S. Tucson Way Centennial, CO 80112-3924 Fax: 303.768.1500 (We cannot accept a fax if a Signature Guarantee is required.) Please print clearly in all CAPITAL LETTERS using black ink. Color in circles completely. For example: not x not 1 Personal information *Asterisked fields are required. *Name (First, Middle, Last) *Social Security number n*date of birth (mm/dd/yyyy) *Contact (select one): Myself My financial advisor Either ( ) *Contact phone number RE1000.030.1113 Page 1 of 4
2 Excess removal instructions A. Please indicate the removal option. I am removing my excess, plus earnings, on or before my tax-filing deadline plus extensions. Complete Section B. My employer is utilizing the Employee Plan Compliance Resolutions System s (EPCRS) voluntary compliance procedures to correct the excess. Your employer must sign in Section 5. B. Please select only one (1) option. 1. I want to remove the excess and apply or 100% of the proceeds as a Traditional IRA/ Roth IRA contribution for the current taxable year. Note: If the excess amount is greater than the annual limitation, OppenheimerFunds will automatically distribute a check to you at your address of record for the amount over the limit. Please include a Traditional IRA/Roth IRA Account Application if establishing a new account OR Provide an existing Account Number: 2. I want to remove the excess and apply the proceeds to a non-retirement account. Please include a Non-Retirement Account Application if establishing a new account. Please see fund prospectus for our Minimum Balance policies and other important information. OR Provide an existing Account Number: 3. I want to remove the excess and receive the proceeds as follows: Electronically deposit the money into my checking account* Electronically deposit the money into my savings account* Mail the check to the address listed on my account Mail the check made payable to me at a different address. Please indicate the alternative address below: (In accordance with the funds prospectus, if you choose this option your signature must be guaranteed.) Address City State Zip *Important: If OppenheimerFunds does not have your bank information on file, you must include a voided preprinted check or deposit slip from your checking account or savings account. (If the bank registration does not match the registration on your OppenheimerFunds account, your signature must be guaranteed.) Page 2 of 4 RE1000.030.1113
3 Account(s) to remove excess from Please indicate the excess amount(s), the date OppenheimerFunds received the excess contribution, and to which tax year the excess contribution is applicable. Amount of Excess Date Excess Contribution Was Received Tax Year Contribution Was Deferred Please indicate the account(s) to withdraw the excess amount(s) from. If you wish to withdraw the excess from more than one account, please indicate the percentage of excess to be removed from each account. Note: Percentages must equal 100%. If additional space is needed, please supply a separate sheet. 4 Federal withholding election Please indicate your tax withholding election. Important: If no withholding is chosen, OppenheimerFunds is required to withhold a minimum of 10% federal income tax from the taxable portion of your distribution. We do not withhold state taxes. I do not want federal income taxes withheld. Please withhold federal income tax at the rate of % from each account (percentage listed cannot be less that 10%). RE1000.030.1113 Page 3 of 4
5 Signature I certify that I have read the information in the instructions on this form and completed the appropriate sections to the best of my knowledge. I certify that I have consulted with my tax advisor, or that I otherwise fully understand the tax and other legal consequences of my request. I understand that I am responsible for knowing whether this request complies with applicable tax laws, and that I am responsible for reporting and paying any applicable taxes or penalties related to this distribution or reallocation request. I understand and agree that neither the trustee, Shareholder Services Inc., OppenheimerFunds Distributor, Inc. or the Funds shall be responsible for any tax due because of this request, or for any tax or other penalties I may incur as a result of this request for any distributions from my SEP IRA account(s). The correction (removal) of excess is considered by the IRS to be a reportable distribution on IRS Form 1099-R, which is mailed in January of the year following the calendar year in which the distribution is made. Signature of Account Owner Date The undersigned employer hereby requests the distribution through Employee Plans Compliance Resolution System s (EPCRS) voluntary compliance procedures to correct excess. Employer signature is required. Your employer is required to supply OppenheimerFunds with a copy of the IRS resolution letter as a result of the EPCRS filing. I am including a copy of the IRS resolution letter. *Signature of Employer *Date Signature Guarantee required for the following transactions: u Distribution(s) in excess of 100,000 per account. u ALL distributions not being sent to the address listed on your account or to the address listed in our records for your employer, if applicable. u If address on your account has changed within the past 15 days. Signature Guaranteed By: RE1000.030.1113 March 4, 2014 Page 4 of 4