12/29/2818 18:44 = - 2394321339 MSSB PAGE 81/06 MorganStanley SmithBarney IRA Distribution Form General Instructions RETIREMENT SUPPORT SERVICES Use this form to request cistribution if you are @ Morgen Stanley IRA participant or an inheriting beneficiary with s Tracitional, Rot, SEP, SIMIPLE or SAR-SEP IRA. This form can be used to request: + A singje one-time payment “A series of scheduled periodic cistributions = The ability to call with verbal requests for future distributions (ON-DEMAND Distributions) + Automated Required Minimum Distributions (*RMDs") + IRA plan termination This form will also allow you to rake the Federal and/or State Income Tax Withholding elactions on the distributions) ‘you are requesting. Your withholding election wil remain in effect unt revoked by you in writing by completing 2 new distribution forrn, Please print clearly using CAPITAL letters only. You will need to complete, sign and return this form to your Morgan Stanley Smith Bamey Financial Advisor to request a distribution or to change existing éistribution instructions from your IRA For all distributions complete Sections 1, 2, 3, 4, 5, 9, 10 and 11. You must also complete the following sections, and possibly provide additional documentation, for specific distribution reasons as follows: + 72(0) Substantially Equal Periodic Payment Distributions (also complete Section 6). The Morgan Stanley Smith Barney ‘Complex Administrative Manager (or other Complex Manager designee) will also need to sign Section 12, Please allow at least 15 business days to process your first 72tt) istrbution. You will need to choose one calculation method as follows: (i) Life Expectancy—select either Single Lite or Joint Life (ii) Amortization —enter the interest rate and compounding method (ii) Annitization—enter the interest rate and compounding methoa * Death Benefit—The inheriting beneficiary must also complete Section 7 and attach a certified Deatn Certificate and notarized Affidavit of Domicile and Debt. (NOTE to FA/Branch: See the RSS Coversheet on Forms Gallery for additional documents that may be required.) + Required Minimum Distibution—Use for Traditional, SEP, SIMPLE or SAR-SEP IRA owners age 70% and over. Complete Section & to elect how and when to distribute your annual required minimum distribution ("RMD") + Divorce—Allach a copy of the final divorce decree or court order containing the settlement or agreement * Rollover to Qualified Retirement Plan—For use with Morgan Stanley Smith Barney internal rollovers only. Attach an acceptance letter from the qualified retirement plan * Wire Transfer Request—Complete and attach an Outgoing Wire Transfer Request Form or a Variable Standing Wire Transfer Form + Health Savings Account ("HSA") —Attach the acceptance letter from the HSA Hf you need adaitional information, please contact your Financial Advisor or call the Client Interaction Center at 1-800-844-6119,MorganStanle ‘RA ACCOUNT NUMBER: i SmithBarney 88-GESEOF-eee | (C TRADITIONAL mA. Cl ROTH Ra SePrSAR.SER/SIMPLE IRA INHERITED IRA Zia Omer Ber Shibata EUROEUEHROOOOCO fee) ae Alaa ‘Social Security Namie aan ARESREGOSRESEOLOOO go.eooews |@UUEEGEOOOCOUONOOOOO BA geEoe EE arsavers] O IOOOCOUO | For Single (One-time) Payments: LU incash Specie aszats ink (attach ational sheet wt of assets and share aunt) For Periadie (Scheduled) Payments: a noo I is prec pay check is box Ca pita Section 8 O It this petege payment is or AUTO-RED, check tis tox Cl an ats compete Sex oae orrearPl oa Perec Payment: 1 Monthly] Quartary 0. Semeneuelly Annually 1 incasn 1D Avincome receed nta account CIS fred incre (monthly on) 1D Specie asa iri attach aeitonal sheet wie of assets an share araurt) For ON-DEMAND Payment: Zl Vanevie amour to be determines by the account holder tx each payment | authorize Morgan Staley Sith Bemey to sept verbel requests fr thee] _areunts tat | may make fora tne to time. ON-DEMAND payments 3 processed in cash ony. For Account Termination: Entire balance in cash Entire bataree ini (intuatng any cash n the acount) Specie Instruction for examate, reer securities, or sibs cetan sae ini, or sll en cstrbute cosh) Normal ge 89%, and oer) Fit Time Home Purchase Rend of eats entution (fil in below ‘Y Prematurs—No Exception D Medical Expense/Premiums Tax Year oO a ag O 1 biabiy 1 Hie: ison oes raeoa s|_J IUOO0 1 he th face Dest ee) Cl Tafa Han Sonpséoanccsay earns 6) LIL IE) ‘aon space eter fom 1S OD Death Benefit (attach certified Death Certificate and noterized Affidavit of Domicile and Debt) 11 Rellower to Qualified Retirement Plan Ginter rollovers anly—attach acceptance letter frm GRP) siete ret suarely il ate Pye compl Secon 6) Automated Check (21 Cet i» Morgen Stan Lea rh Ok eter pooh) f)e)5)-[) iret Depost vis ACH to my bask or cet union account named below. For checking accounts atach a voided (DO NOT SEND DEPOSIT TICKETS, Page 2 of12/29/2818 18:44 = - 2394321339 MSSB PAGE 83/06 EE BAGEoe-Ooe seen! IOOOGO00000000 =e OO Od-O00 (cor roete I OOOOOO0LOoO0d Account Type (check ore) C] Checking O Svings (1 Fes Fund Wire Transfer (atack Wie Transfer Request For} 7 Mall to Secondary Adress OF bark, include account muir) NOANOABOOOOROOoO0oCONooodooaooIoOd DODOUOOO0G0000O OOOO OOSOoNNooOo0 PLEASE ALLOW AT LEAST 15 BUSINESS DAYS FOR YOUR FIRST 72() DISTRIBUTION TO BE PROCESSED. YOU ARE RESPONSIBLE FOR ‘THE INTEREST RATE AND THE DISTRIBUTION METHOD CHOSEN. NOTE: 72() esttbutons, ence begun, must ronnue unchanged url age SB or fr Tive years whichever i ae. These payments wil continse unt we ceive written aetiizaton to cance them, Psce elect your ditrbution method bol. (0 C1 UFe exPECTANCYREQUIRED MIKIMUM DISTRIBUTION METHOD “Tho sleviousen amount wil be ealulated sorusly and wll he bared ea the arr yearend value, chided by the ie expectancy mat chosen singe ute sont ute It your jon Ie expectancy is chosen, we wil use the Benfciary information curently oa He with u, Te name or change benaficary information, please complete an IRA Designation of Banca orm, (C1 Amorrzamion weTHOD Interest Rate [_]T|[][_][__fe C1 Annuel Compounding Oi Other Compounding: (1 asmumearon wereoo messeae | ]L]L] fe 2 amavcowgandig CI one caren For (il ani) above, the (RS requires that a “eesonable” interes rate be used. "Reasonable”is coined as between BO% and 120% othe federal mid-term rote, 8 annauneed quoter by the IRS under Cede section 1274), fr ether of he two (2) ments pracoding tho month in whieh te dtouton begin. 1 Ronavert soause's (RA Transfer to Inherited IRA to defer IRA owner's 70% requted besnning date (spouse ony) 7 Trarfar to Inherited IRA to pay ovr banefean/> singe ia erpactangy or appieable Ife expectancy 1 Trane t ohare RA to pay out win 3 years of MRA owner's Cast Pao erite 00-00-0000 00-00-0000 IRA ourers date of ceath Berencarys date ct oir SETS 1 AUTO-RMD toutomencaty pays out he eect amount) yu set ALTO-END, tre xg amcunt of your ant RID wil eae x amis. yeu cans his ction, we wil arte yur eine RMD aul te te remaining potion of th sends var. Fer sah eters we wil ale Your RUD ad ett evr teenie year Eased ne feguey (2! a0. Tis election lean afer unt eres vce intr Nam jeu 2 obese 1 Pertis Distt (i rnount exceeds the RD arncun Calculation Election Disclosure (check one option only—if nether is checked, we wit use the Unitrm Table) CF untorn Taste I Joie Lie Expastaney Table. only avaiable when your sale Primary Benen your epeuse who is mare than ton (10) yaar younger than you swmtetcencewee TVOOONT sete 0-00-0000 Page 30612/29/2818 18:44 = - 2394321339 MSSB PAGE 84/06 {RA ACCOUNT NUMBEF EES-OFAeFa-Oeie ET “Tho eietibutone you retve fam an IRA ara subject ta withholding fr federal income tax unase you aac net ts have withholéing apply by checking the appropriate box on tls form, You may also ect to have withholding from your astlbution by checking the approptste box and indicating ether 10%, 2 Gmerent peoartage, or aed doin amour, iro eleeon Is mace, taceal income tx wll be withed from your distizulion at 2 rte of 107% for orwiemand nayments or at he rate of marred wih thre claimed exertions for periodic payments, Your election wll be applies to all subsequent lstrbutons ane wil remain in efect unt you revoke tn wring. To charge or revoke your election, contact your Firancll Ase. Hf you elect net te rave withholing apply or # yu donot ave enough withheld, you may ba responsible for payrent of estimated tx. Yau may incur penalties uncer the estates tax ules IF your witnhoing and estimated tx payrents are not suiient evan f you sect no to have federal income tax withelé, you ar able fo payment f fase income tax on your IRA dstibutons. Yox sso may be subject to tox pels under etinated tx payment rules Ifyou payment of your extimatad ox and withholding, any, ae not adequate t cover the income t,t you act to have federal incor tax wid, yo late oF stance may also rage that slate incor lax be wile. I bo et wisholé federal ncame ax ar 7 wrenola Feder ineame tx tom my IRA ctbuton as fotowes CJ 10% of grote eatbution 7 Percentage of ce cictvoson [JL [JL |[ hs CF Fed eater amount $0) A crest cement nan Cl For ON-DEMAND requests cn: 1 same as Pest Oi None USA In certain states, tate income tax can also be withheld fom the dstibutions you receive fram en IRA, Hf federal taxes are being withheld, you may ‘also olect te have the state tax wield a einer a percentage oF goss cstibution or @ percentage of the federal Income tax wihnokding. Certain states reqvie that state income tax be wltaheld from your cstrbution if you have elected to Pave federal income tax withheld. Othe states may allow you to wave wthncleingon the state level ‘and stil witrhold federal income ta] by making tis election on IRS Farm W-4P oe checking the ‘appropriate box on this frm, Your elation wil be applies to all subsequent atrintians and will erin in effect until yous revoke it in writing ‘Since eb states have varying guidelines end minimums for withholing, you should afer to withholding regulations fer your sata and/or consult wth tax zion. Even if you sect nt te have federal incoma tax whe, you are abe fr payment of federal income tse cn your IRA divisions. Vou leo may be ‘subject ta tex pena uncer estmates tax payment ales f your payment of your esmated tx anc wining, ary, are not adequate to caver the income tx. you eect to have federal income tax wield your state of resderce may also require that state income tax be witha, SN C Wok setae ihn Racists: CO Peerometresaevitin () OOD €1 pecateat eteniwitctine IIL Ci reaaeanant SOIL etree D1 Fer ON-DEMAND requests onl: 7 Same as Peeaic 17 Nene By rating and signing this craton, | represent and warrant as follows: + oeruly mat | rave proviaas Morgan Stanley Smith Bary wh coneetIfratlon, and | understand that a astibuton or estrautons wil be made ‘rom my Morgan Stanly IRA bese on thet information end as 2 result ofthis direction + Loetiy that this sbioutan request isn aceotdance wit Ue provisions ofthe RA and safes apical fecal and sat aw requlements + Tundertond tht | am rsponciie fr maintaining suicint each or mareatablecacuie in my aocourt to cupgor theeeditbutons * understand that Merzan Stanley Sith Baray. ts afiates and Morgan Stanley Smith Bary Financial Achisors do not pride tax or legal cbc, and hat Morgen Stanley Smith Baroy and is affiliate etrongly rasermend that | coreult my tax or logs! advice air fe compistng and signing tis frm Page 4 of 612/29/2818 18:44 = - 2394321339 MSSB PAGE 85/06 GIG AeA Foil + [hereby indent ane hol harmless Morgan Stanley Sith Barney LLC and is eflotes for any tax consequences of tis sistution raqust and tre sections mata above + Morgan Stanley Sm Barney may ry on my ertficaton witout futher ivesigaton or inquiry and shel not be Tan for any misrepeseration of act Fes income tx purses, any anal secures @strinues Incna wile values aso the close of business onthe day each ase tibute, Morgan Stanley Sith Bary wil process your request as son as practical, Qecouce the eatin ul nt commncs unl come tine aftr you eign your request, the valve of yeur IRA asses being cistnbutec may vary from tei rent value dueto market ructuatons. These rravket fctuatons wil ‘fect the amount of table ineome yu wil elze as 2 su of tis clstbution. Morgan Stanley Sith Baenay wil not be response for any rarhet fctustion that reel in Kiger or ler nab income to you because of th timing ofthe cetbutian af your sscurtes, + ON-DEMAND Payments: | hereby ratty any teleshone insinctions even curwant to this authorization and agree Morgan Stanley Smith Bamey and ‘Mecgan Steniy & Co. Incarperates wl nat be abla for any lesoerauing rom uravihoriterazactone I flows reascrabe procedures degra! to very the call. 1 understand tat | ar reponsie fr ary consequences resullg fem tis stibolion inctusing tats and penalties oved. | inary and hold Morgan Stanly Sith Bamay LLC and @s afifates harness rom any resting laites. | understand that his authorization wit be eect Lunt wrttenrevcation or modification s received by Megan Staley Sith Barayeiscatinuing this eevee, whienever occurs st + Specific Section 72{t) Representatloné: | understand that i selected a distruton which is intended to bea saris of “substantily equal oeiic ppaymants” ae provide in Section 72() of the Internal Revenve Cote, | will net he subject to 2 10% federal penalty tax provided tht cetan requirements are said, | request thet this dinbibution be 0 reported on any spllale fdarl income tax fos that Morgan Staley Smith Barney, aseustecian ef the IRA, aay be required to make, In paticuar: 11 nave eects te Arctization ot Aanully Factor Metre for @ Section 72) estibuton, | understand and acknowledge, {alone om respanaibe fr selecting a reasonable interact ete vse to caleulte payment | My ehocen Inteostata ray atcoad my IRA account's rte of return and may nt ba cbtainable in cument or future markets, and fees o¢ commissions may decrease my account rebum ifthe intrest rte | have soot i deem! by the IRS rat to be rzearabl, the dstibutons may not qualify 26 “aubatantaly ua periodic payments” and “=n that cose, | alone wil be abe feral rauting pealy teas on interest = In ation, egarstee ofthe Seeton 7200 dietbstion mata Ihave slate, | understand and ackmoatedge =f racy theses of payments before the later of aga 59's ove years afte the ist ofthese amen | wil be subject ta the penaty reided for in Section 7200 In that case the 10% federal ary cistron ese tx penalty wl apply and wil be payable, pls interest, inthe year ofthe madiiatian and ~ State tax penatties may also analy | acerouedge that Ihave received or had made avilable: 2) te Morgan Stanley Smitn Bamey 72() calzlator to provide estimates as to tis Aistrbuton and 0) 2 cop of the Morgan Stanoy Smith Barey "A Guide to Taléne 7200 Disbutens fee Your IRA® brochure | uncerstand that taking regular citrioutons form my IRA before age 8954 may rcutin nefcentaceots to fund futuro retramant nase, “In rwviauing thas ecimatos, and with racpect to anyextmatos my tax avine may have provided re, | understand that) actual mathe erfermance ofthe asats nm IRA wil alec the IRA's vole to the degree appieable), nd negate pevirmence may use mata maintsin my Section 72(teistbutions by ceplebng IA prncial faster tran these estimates may cal fr, 20 | accept thers ot such negetve market pedormance, and wil not hotd Morgan Stanley Smith Barney or its aflilates resonsibe should ths occur 00-00-0000 ‘Sgratre TRA Gorar or Bonetcany RTINICEAL 90-00-0000 ia Prt Ware & CANT or Dangres12/29/2818 18:44 = - 2394321339 MSSB PAGE 86/06 8f-GARAoe-ee GENERAL INFORMATION ‘Seid an nsaret seus be witheaum fom your IRA, or f yu do not uncerstand an ery on yourstatemartor suspect an ec. tis eset that remadataly contact your Fnancil Avior othe ranager cf the off serzng your secourt. Wa wl consider your sztoment comet wale we ecave 2 writen "rq om you abcu Te suspecien eros whi calendar days fern the cay un whi you read your sateen. Itis your resgonsiaty to ree your stetement prompt and to sesk inate clatfcaion sbovt ees tht YOU donot wncerstand or ar incomes. 1 there ae ineflon gud unde in your 1A to enue the On Damand sitbutien, the ditrbvto wil at be procetted Ifthe cash dstiction payment lavesan inser balance inthe IRA, the IRA account wil automaticaly terminate. The required IRA balances re determined by the flowin + Fr IRA astrotions where the JRA termination ee appias, a minimum belance equal to the anourt of he rent trina fee ms ein nthe ‘scount ta auc termination (eg, lens win cstintons fr reason cer than ceat or sab). + For citoutone wher no termination fe apie, 2 minimum Solana equal tothe amount of the curant anual fee must remain inthe aconurt to (ai termination “The automatic termination wil apa testable patie payments, ON-DEMAND ryments and new dsbibuion requests that pay down the RA ‘oles than the reir balance REASON FOR WITHDRAWAL—DEFINITIONS. Do nat use this form for an ACATS or non-ACATS transferor rect rover to a retirement account at another fim. Norma!—Any IRA distrbution taken ator ater attainment of age SS Premature—No Exception Any withdrawal mada pir to attainment of age 59% unles the withdrawal made for one ofthe folowing reasons: death, cleaailiy, madieal expanses, mecca insurance preiums afer unemployment, parle payments pais over the Iiftie ote axeectancy af tha IRA oumer, est ime Pama rurenace, higher education capansas or alever to Qualied Retirament Pan Disabilty—Any withdrawal prior to atinment of aga £9%4 whore the IRA owner cannot do any substantial gainful activity bezause of a physical or mental condition. Death Distbution—Ary IRA cisioution ten by a Deneiary after the IRA overs deceased, Rellver to Qualified Retirement Plan—Any withdrawal fom one retirement plan to 2 qualifies empleyersrerement plan, # 403°) plan or govemmental £57 plan. Quaified plas may, but are not require tn, accep such rollovers. Refund of Excess Contitution Ary wltnrawal mace 25a resi of a contribution that ether exceeded the amount the paricigant was eligible te cantinute or wes due to ineomect rollover information. Divorce —Any witarawval tat Is made unde a jxdgment, decree, or order Issue In connection with a eiarce (Qualiied First-Time Heme Purchase. ny withrawal made prior to age 59H for a cuaifiad Frsttine home purchase, not exceecing litime lime of $10,000, Medical ExpensesPremiums—Any withdrawal pir to atainment of age 50% which wil be either used to pay macical expenses in excess of 7.5% OF AGI, of paid to IRA owner efter seperation from employment (or within 60 days of reaaployment) inthe same of rextsuccaeding taxable year or after the IRA owner has received (or would have received but for sa-employment) Federal or State unemployment compensation for at least 12 Consecutive weeks 2s a ret af such unemployment proves te IRA dsicution is used to pay rerum fer healthoare coverage curing such paved of unerplayment Education Experses—Any withdrawal mace pcr to age 89% which wil be uses to pay quali’ higher education expense, Section 721)—Ary witrdrawel made pir to ape 58 which wil be paid in substataly equal peregie payments over the lfeime cre exnactency Of the IRA comer or jin ies or fe expectancies of the IRA camer ens his or her beri. Transfer to Health Savings Account *HSA")—cne-ime per taxpayer relloer of IRA assets to an HSA” in an amount rot t exceed the ennual maximum “HSA” contribition DISTRIBUTION METHOD/TYPE Direct Deposit via ACH—The Direc Deposit via ACH enrcimentarecess may tke up to ten business days for the financial Isttutlor to vary anc sstablish new insuction. On-Damand cleans cannot be presses dung that tens (One-time payment—ary IRA dsinuton requested as 2 single payment wil be treated as a one-time event, Each single payment alsribiton requires you to sign 2 new IRA D'strbution Recuest Form, Petia payment—Any perce IRA dieibution requested on 2 enthiy, quarterly, semiznrual or annual basi, Changes to the type, amount e880n, method or withholding of the periodic cistrbuton wil require 2 new signed IRA Distribution Request Form. (ON-DEMAND Payment Authorization to accent vertal stitution intactions for varabe amaunts {© 2010 Megan Staley Smith Baray LLC, Member SIPC, MorganStanley SmithBarney Page 6 of 6 covnossa seust¥9 5001