Individual Retirement Account () Request for Distributions Form ederated Complete this form to request a one time or systematic distribution from your. This form may also be used to convert your Traditional to a new or existing Roth. Please use blue or black ink and print clearly in CAPITAL LETTERS. More than one form may be required if distributions vary by fund. 1. Investor Information and Mailing Address First Name Middle Initial/Name Last Name Social Security Number Street Address Apt. # Birth Date City State Zip Code Daytime Phone Number 2. Account Allocation Information Please indicate how you want the distribution amount to be allocated from your funds. (s) Fund Number (s) Amount 3. Type and Method of Distribution For a One-Time Distribution, select and complete Section A. For a Systematic Distribution, select and complete Section B. A. One-Time Distribution Select one option and proceed to Section 4 Federal Income Tax Withholding Traditional or SEP Distribution After age 59½ and before age 70½: After you reach age 59½, you can receive distributions without having to pay an IRS 10% additional tax early withdrawal penalty. Even though you can receive distributions after you reach age 59½, distributions are not required until you reach age 70½. Under Age 59½ Exceptions: There are several exceptions to the age 59½ rule. Even if you receive a distribution before you are age 59½, you may not have to pay the IRS 10% additional tax if you are in one of the following situations: You have unreimbursed medical expenses that are more than 7.5% of your adjusted gross income. The distributions are not more than the cost of your medical insurance. You are disabled. You are the beneficiary of a deceased owner. You are receiving distributions in the form of an annuity. The distributions are not more than your qualified higher education expenses. You use the distribution to buy, build, or rebuild a first home. The distribution is due to an IRS levy of the qualified plan. The distribution is a qualified reservist distribution. Please redeem the entire account OR Please redeem I am: at least age 59½ and this is a normal distribution. under age 59½ and this is a premature distribution; I am aware of the IRS 10% penalty. under age 59½ and this is part of a Substantially Equal Periodic Payment under Internal Revenue Code 72(t). under age 59½ and this is a qualified distribution (see Under Age 59½ Exceptions list above). FORM CONTINUES ON NEXT PAGE 1 OF 5
3. Type and Method of Distribution (continued) A. One-Time Distribution Select one option and proceed to Section 4 Federal Income Tax Withholding (continued) Required Minimum Distribution (70½ years of age) Please redeem for my Required Minimum Distribution. Please calculate my Required Minimum Distribution according to the IRS distribution regulations and redeem that amount. Excess Contribution Please remove for tax year, plus or minus earnings on this amount. I have not yet filed my tax return for the contribution year. Please remove for tax year. plus or minus earnings on this amount. I have already filed my tax return for the contribution year. Please remove for tax year, plus or minus earnings on this amount and redeposit into my account referenced in Section 2 as a contribution for the current tax year. SIMPLE Distribution Please redeem the entire account OR Please redeem I am: At least 59½ under age 59½ and the account is more than two years old and I am aware of the 10% IRS penalty. less than two years old and I am aware of the 25% IRS penalty. under age 59½; this premature distribution is exempt from the IRS 10% penalty because: this is part of a Substantially Equal Periodic Payment under Internal Revenue Code 72(t). this is a qualified distribution. Roth Distribution If this is not a qualified distribution, an IRS penalty applies to the earnings portion of your distribution. Please redeem the entire account OR Please redeem Convert my Traditional to a Roth Convert: All shares Dollar Amount Percentage % To: A new Roth (Complete and enclose an New Account Application) My existing Roth 1 1 I understand that commingling conversion assets with other assets is not recommended. Recharacterize my Contribution Recharacterize my contribution of for tax year from my Roth account To: A new Traditional (Complete and enclose an New Account Application) My existing Traditional Recharacterize my Conversion All shares will be recharacterized unless you enter a specific dollar amount below. Recharacterize my Conversion of for tax year To: A new Traditional (Complete and enclose an New Account Application) My existing Traditional FORM CONTINUES ON NEXT PAGE 2 OF 5
3. Type and Method of Distribution (continued) B. Systematic Distributions Whether you provide the amount of your distribution or choose to have the amount calculated, be sure to complete the Frequency of Distributions section below. The minimum amount for all Systematic Agreement programs (including Systematic Investment Program (SIP), Systematic Withdrawal Program (SWP), and Systematic Exchange Program (EXCH)), is 50 per transaction per fund. With respect to the Class B Shares of funds, the minimum Systematic Withdrawal Program (SWP) amount for qualified Class B Share CDSC waivers is 50 per transaction per fund. Systematic distributions continue indefinitely unless you request cancellation. DON'T BECOME A LOST SHAREHOLDER : It is very important that you notify the Fund of any change to your address information, including your email address. If the Fund s communications to you are returned as undeliverable, the Fund will try to reestablish contact with you. If those efforts fail and the Fund reasonably determines that you are a lost shareholder, the Fund may elect to suspend account activity, program elections (including systematic investment, withdrawal or exchange) and mailings. In addition, most States require entities like the Fund to turn over the assets of lost shareholders following a period of time. Your property may also be transferred to the appropriate state if no activity occurs in the account within the time period specified by law. Once shares are escheated to a State, a shareholder will not be able to access the shares through the Fund. To avoid these kinds of problems, we urge you to keep your contact information with the Fund accurate at all times. Set up Systematic Withdrawal for the amount I have determined. Amount These are: Normal Distributions. I am at least 59½. Qualified Distributions Substantially Equal Periodic Payments that are exempt from the IRS 10% penalty under IRS Code 72(t) OR Calculate My Distribution Amount You may wish to consult a tax advisor to review your specific situation to determine your best course of action. Please calculate Substantially Equal Periodic Payments. I am under age 59½ and these premature distributions are exempt under Internal Revenue Code 72(t). Base the calculations on: my life expectancy per the IRS Uniform Lifetime Table; or my single life expectancy per the IRS Single Life Expectancy Table. my life expectancy per the IRS Joint Life and Last Survivor Expectancy Table. Please calculate my Required Minimum Distribution according to the IRS distribution regulations and begin systematic withdrawals. Frequency of Distributions Distributions will occur on the 15th day of the month unless you specify a different day of month below. If the day of distribution falls on a non-business day, the distribution will occur on the business day immediately prior to the 15th (or the day of the month you specify). Day of Month: Begin my distributions on (date): Check the following boxes to indicate when you want to take your distribution(s): Frequency: All Months Other (Check months below) January April July October February May August November March June September December 4. Federal Income Tax Withholding Substitute Form W-4P Generally, Federal income tax withholding of 10% applies to distributions; however, there are three withholding options available. Please select one of the following boxes to indicate your withholding option. With the exception of Roth s, if you do not choose an option, 10% withholding will apply. I elect to withhold 10% from each distribution; I elect to withhold this percentage from each distribution: % (amount must be in excess of 10%); or I elect not to have income tax withheld from my distributions. I understand that I may be responsible for payment of estimated tax and may incur penalties if estimated payments are insufficient. 5. State Income Tax Withholding Certain states require withholding from retirement distributions. If you are a resident of one of the mandatory withholding states and elect to have Federal income tax withheld, the Custodian will automatically withhold the required amount of state tax. Other states allow voluntary withholding from retirement distributions. To elect voluntary withholding, check this box and indicate the amount you want withheld. Please withhold this dollar amount from each distribution and apply it to my state tax: NOTE: You may waive Federal income tax withholding and still elect state income tax withholding. FORM CONTINUES ON NEXT PAGE 3 OF 5
6. Payee Instructions By Check: Choose All that Apply To the address of record. Payable to someone other than the account owner (Indicate payee below)** Make payable to: To an address other than the one on the account (Provide address below)** Street Address City State Zip Code Invest in Another Federated Account Purchase shares of a new individual, non-retirement account. (Complete and attach a New Account Application.) Purchase shares of a new account where I am not the sole owner.** (Complete and attach a New Account Application.) Purchase shares for my existing individual account referenced below. Purchase shares of an existing account referenced below where I am not the sole owner.** (s) Fund Number (s) Send to My Bank Send distributions to my bank by Automated Clearing House (ACH) based on the: ACH instructions already established for my OR New Bank Account Information** Wire Transfer my One-Time Distribution (not available for Systematic Distributions) to my bank based on the: bank instructions already established for my OR New Bank Account Information** ** An original Medallion guarantee is required; see Section 7 Investor Signature and Medallion Guarantee for details. Bank Account Information I authorize the Custodian to withdraw money from my mutual fund and deposit it to my bank account. I understand this privilege will be effective after the verification process. Please select one of the following: Attach a voided check for your bank account. Please tape your check here; do not staple. OR Enter your Bank Account information below: VOID Name of Bank Branch ABA Routing Number Bank Phone Number Name(s) on Account New Bank Account Number Account Type: Checking Savings FORM CONTINUES ON NEXT PAGE 4 OF 5
7. Investor Signature and Medallion Guarantee By signing below, you: Authorize the Custodian to make distributions according to the instructions given on this form. Assume full responsibility for all tax consequences of your elections. Understand that Systematic Distributions continue indefinitely until you request cancellation, or are deemed a lost shareholder. Agree that UMB Bank n.a., Federated, the funds, their affiliates and agents will not be responsible for any losses, claims, expenses and liabilities that result from accepting these instructions. Please sign exactly as your name appears in the account registration. Investor Signature Date An original STAMP2000 Medallion guarantee is required when: the address of record has changed within the last 30 days; distribution checks are payable to someone other than the registered owner; distribution checks are mailed to an address other than the one on the account; distributions are sent to your bank account by Automated Clearing House to ACH instructions that are not on file; a One-Time Distribution is wire transferred to your bank account instructions that are not on file; or distributions are purchased into another Federated account where you are not the sole owner. An original STAMP2000 Medallion guarantee is required. This form must be signed in the presence of the authorized guarantor, who should be contacted in advance to confirm the documentation required and that the amount of the proposed transaction can be insured. A Medallion guarantee is designed to protect the account from fraud and may be obtained from any of the following institutions participating in one of the Medallion guarantee programs. bank or trust company; savings association; credit union; or broker, dealer, or securities exchange member. MEDALLION GUARANTEE Notarization by a notary public is not a Medallion guarantee and is not an acceptable substitute. The Signature Validation Program Stamp may be used for non-financial transactions. Please contact your Federated Client Service team or see your financial institution for more information. 8. Mailing Instructions Regular Mail: Overnight Delivery: The Federated Funds The Federated Funds PO Box 8600 30 Dan Road Boston MA 02266-8600 Canton MA 02021-2809 ederated Federated Client Services 1-800-341-7400 For more information, visit our website at FederatedInvestors.com G02505-01 (6/17) Federated Securities Corp., Distributor Federated is a registered trademark of Federated Investors, Inc. 2017 Federated Investors, Inc. 5 OF 5