IRA DISTRIBUTION PACKET

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IRA DISTRIBUTION PACKET 4010 Boy Scout Blvd., Suite 450 Tampa, Florida 33607 Ph: 866.634.5873 Fx: 813.425.9790 www.aspireonline.com

IRA Distribution Packet Complete this form if you wish to request a distribution from your IRA. An IRA Distribution Packet must be completed, signed and returned to ( Aspire ) to request a distribution from your IRA. You must complete a separate form for each account type. Note: If you are the beneficiary of a deceased IRA account holder, DO NOT complete this IRA Distribution Packet. Contact Aspire to obtain applicable forms. STEP 1 ACCOUNT HOLDER INFORMATION Account Number First Name Last Name M.I. Home/Legal Street Address Apartment/Suite City State Zip Contact Number Email Address* Social Security Number Date of Birth (month day year) *By providing your email address, you consent to receiving notifications regarding your transaction via email. If no email address is provided communications will be sent via USPS. STEP 2 IRA TYPE Traditional IRA Roth IRA SEP IRA Simple IRA Inherited Traditional IRA Inherited Roth IRA STEP 3 DISTRIBUTION TYPE Normal (over age 59 ½) Premature (under age 59 ½) Disability RMD (complete Step 5) IRA Rollover/Transfer STEP 4 DISTRIBUTION ELECTION Full Lump Sum Distribution Partial Distribution: $ (gross)* *This dollar amount cannot exceed 95% of account balance IRA Distribution Packet Ph: 866.634.5873 Fx: 813.425.9790 F0023H-0816-01 [2]

STEP 5 REQUIRED MINIMUM DISTRIBUTION Complete Step 5 only if the RMD option was selected in Step 3. If any other option was selected in Step 3, proceed to Step 6. To process the RMD, assets will be liquidated from all available sources and investments unless the plan provisions restrict the sources and/or investments or unless you attach a letter instructing otherwise. You may calculate the amount required to be distributed for your RMD each year, or you can request that Aspire calculate the required amount. OPTION 1 Participant to Calculate Annually The amount of your RMD changes each year based on your account value at the end of the previous year. You are responsible for re-calculating the amount of your RMD each year and for completing and providing a new RMD Packet each time a change is necessary. If the one-time distribution option is elected, you must complete and submit a new RMD Packet each year. If the installment distribution option is elected, the designated amount will continue to be paid to you in the specified frequency until you instruct Aspire otherwise. One-Time Distribution of $ (gross) Installment Distributions: Monthly Installment Distributions of $ (gross) each month, beginning with the month of, 20 Quarterly Installment Distributions of $ (gross) each quarter, beginning: March 20 June 20 September 20 December 20 Annual Installment Distributions of $ (gross) each year, paid in the month of beginning in 20 Installment Distributions are processed on or around the 15th day of applicable months. Quarterly Installment Distributions are processed in March, June, September, and December. Annual Installment Distributions are processed in October if no other month is indicated. OPTION 2 Aspire to Calculate Annually Calculation Method Account holder requests that Aspire calculate the RMD amount using the IRS Uniform Life Table. For information on this table, please visit www.irs.gov. Payment Options Establish RMD installment distributions of proportionate shares of the RMD amount: Monthly, beginning with the month of, 20 Quarterly, beginning: March 20 June 20 September 20 December 20 Annually, paid in the month of beginning in 20 Installment distributions are processed on or around the 15th day of applicable months. Quarterly RMD distributions are processed in March, June, September, and December. Annual RMD distributions are processed in October if no other month is indicated. IRA Distribution Packet Ph: 866.634.5873 Fx: 813.425.9790 F0023H-0816-01 [3]

STEP 6 INCOME TAX WITHHOLDING Withholding will only apply to the portion of your distribution that is included in your income subject to federal income tax. There will be no withholding on the return of your own roth contributions. If you do not have enough federal income tax withheld from your distributions, you may be responsible for payment of tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. If you do not make an election below, default tax withholding will apply. Federal Tax Withholding This distribution is subject to voluntary federal income tax withholding at a rate of 10%. You may elect to have withholding applied at a higher rate or to not have any amounts withheld for federal income tax. Regardless of which option you select, you are liable for payment of applicable federal taxes on the taxable portion of your distribution. If you have not attained age 59½, you may also be subject to a 10% early withdrawal penalty on the taxable portion of your distribution when you file your taxes. I want to have federal income tax withholding applied at a rate of 10%. (Default) I want to have federal income tax withholding applied at a rate higher than 10%. Rate: % I DO NOT want federal income tax withholding applied to this distribution. State Tax Withholding The taxable portion of this payment may also be subject to state income tax withholding. If you do not make an election below, state income taxes will automatically be withheld if required by your state s law. Note: If state income taxes are not withheld, you are liable for payment of state income tax on this distribution. If your payment of estimated tax withholding is not adequate, the unpaid portion may also be subject to tax penalties under the estimated tax payment rules in certain states. Withhold the following amount withholding.) Do not withhold (Allowed only for states with optional withholding.) % (Amount cannot be less than minimum required by state for states that require These states require mandatory state withholding. You cannot opt out of state income tax withholding for these states: Washington DC (DC), Iowa (IA), Massachusetts (MA), Maine (ME), Nebraska (NE), and Oklahoma (OK). STEP 7 PAYMENT METHOD NOTE: Unless ACH, wire or overnight mail option is selected, checks will be sent via U.S. mail. If overnight mail option is selected, a physical address must be provided. Wire and overnight delivery are not available for installments. Select your preferred method of payment and provide instructions as requested below: OPTION 1: CASH DISTRIBUTION Check (Check will be made payable to Account Holder and sent to address on record) Send check via overnight mail. A fee of $35 applies. ACH Wire (A fee of $35 applies) Bank Name: Bank Address: Bank City/State: Zip Code: Routing / ABA #: Deposit to Account #: Name(s) on Deposit Account*: * Account Holder s name must be on deposit account. Further Credit: Account Type: Checking Savings FBO Account Name: IRA Distribution Packet Ph: 866.634.5873 Fx: 813.425.9790 F0023H-0816-01 [4]

STEP 7 PAYMENT METHOD (CONTINUED) OPTION 2: DIRECT ROLLOVER/TRANSFER TO RETIREMENT PLAN/IRA Check Send check via overnight mail. A fee of $35 applies. IRA or Plan Name: Make Check Payable to: Mail to Address: (Must be physical address if overnight delivery requested.) IRA or Plan Account #: Wire (ACH is not available for direct rollover or transfers) There is a $35 wire fee for this option. IRA or Plan Name: Bank Name: Bank Address: Bank City/State: Zip Code: Routing /ABA #: Deposit to Account #: Names on Deposit Account: Further Credit: FBO Account Name: STEP 8 SIGNATURE & ACCEPTANCE ACCOUNT HOLDER SIGNATURE I understand that, subject to the provisions of applicable agreements, I have full discretion and control over the form of payment or payments of the entire balance of my Account. I shall exercise control by directing such payment(s) be made as described above. and the custodian of my Account shall have no responsibility or liability with respect to the choice of any such form of payment(s). I understand that a distribution fee may apply and that additional fees may apply based on my election. I attest that I am the proper party to receive payment(s) from this IRA and that all information provided by me on this form, including any supplemental material is true and accurate. I certify that no tax advice has been given to me by, the custodian of the Account, or an affiliate of either, and that all decisions regarding this distribution are my own, I expressly assume the responsibility for any adverse consequences which may result from this distribution; and I indemnify and hold harmless Aspire Financial Services, LLC, the custodian of the Account, the affiliates of and the custodian of the Account and the divisions, officers, directors, owners, employees, representatives, agents, successors, and assigns of each. Recurring distributions may be subject to an additional fee. Account Holder Signature Date (month day year) IRA Distribution Packet Ph: 866.634.5873 Fx: 813.425.9790 F0023H-0816-01 [5]

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