Blank E Trade Api Template

E*TRADE Securities LLC

P.O. Box 484

Jersey City, NJ 07303 – 0484

General Fax: 1-866-650-0003

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E*TRADE Securities IRA Account Number

IRA DISTRIBUTION REQUEST FORM

•Trying to take a distribution from a Beneficiary IRA or due to the death of an IRA account holder? Use our Beneficiary Distribution Request Form - IRA instead.

•Did you know you can request common types of distributions online? Please visit www.etrade.com/onlinedistribution. It's easier and faster!

•Need Help? Send us a Secure Message through www.etrade.com or call 1-877-921-2434 from 7AM to 12AM EST, Monday through Friday.

Date of Birth (mm/dd/yyyy)

Social Security Number

Country Code Home Phone Number

Country Code Business Phone Number

1A. Normal Distribution (over age 59½)

1B. Normal Distribution - Roth IRAs (over age 59½) This is a Qualified Distribution

2A. Premature Distribution* (under age 59½)

This option also applies for first time home buyers, medical/ Health Savings Accounts (HSA), or education expenses.

2B. Premature Distribution* - SIMPLE IRAs (under age 59½) This option also applies for first time home buyers, medical/ Health Savings Accounts (HSA), or education expenses.

It has been more than 2 years since my first

SIMPLE IRA contribution

3. Premature with Exception: Substantially Equal Periodic Payments

You must attach a calculation, pursuant to IRC 72(t)(2)(A)(iv).

4. Excess Contribution Removal*

Also complete Section 3: Excess Removal.

*A $25 fee may apply. The fee will be waived if combined E*TRADE Securities brokerage account balances total at least $100,000 or you have placed 30 or more trades in the preceding calendar quarter.

5. Revocation (within 7 days of opening account)

6. Disability

Pursuant to IRC 72(m)(7)

7. Transfer Pursuant to Divorce

Also attach a copy of the full divorce decree.

8. Direct Rollover to Qualified Employer Plan

Also complete the section below.

Employer Plan Name

Employer Plan Account Number

Make Check Payable To

Employer Plan Address (direct rollover check will be mailed to this address)

Refund excess including earnings amount, which may be negative. E*TRADE will calculate the net earnings attributed to the excess amount.

Refund excess only. E*TRADE will not calculate any earnings attributed to the excess amount.

Securities IRA (referenced on page 1)

B. Refund my excess contribution

One Time Payment of $

Requested funds must be available in the account for withdrawal.

Balance of Account (lump sum)

Also mark an option below.

Required Minimum Distribution Over age 70½ Check this box to have your Required Minimum Distribution calculated for you without having to specify an exact amount.

If you are over age 70 ½, your spouse beneficiary is the sole primary beneficiary, and he/she is more than 10 years younger than you, please indicate his/her date of birth:

Transfer Securities In-Kind

You are not required to sell securities before taking distributions. In Section 5 indicate the E*TRADE brokerage account to which you would like to have the securities transferred.

All securities positions

Only the securities & quantities listed below

(MM/DD/YYYY)

Installment Payments of (choose one):

Requested funds must be in the account and available for

withdrawal at the time each installment payment is processed.

Check

Check by Express Mail (additional $20.00 fee)

Deposit to existing E*TRADE Securities brokerage account number:

Deposit to existing E*TRADE Bank account number:

Direct Deposit* to my:

Wire* (additional $25.00 fee)

*Complete the following information if you chose Direct Deposit or Wire

Bank Name

Bank Routing Number (ABA)

(not less than 10 percent) from the amount withdrawn. Withhold additional Federal income tax of $

(in addition to above percentage elected).

State Withholding**

Do not withhold State income tax.

Withhold State income tax from my requested amount in accordance with State requirements.

GENERAL INFORMATION

E*TRADE Financial Corporation and its affiliates do not provide tax advice and you always should consult your own tax adviser regarding your personal circumstances before taking any action that may have tax consequences.

You must supply all requested information so that E*TRADE Clearing can do the proper tax reporting. The term "IRA" will be used below to refer to Traditional IRAs, Rollover IRAs, Roth IRAs, SEP-IRAs, and SIMPLE IRAs, unless otherwise specified.

SECTION 2

DISTRIBUTION REASON

You are required to give the reason for taking the withdrawal from the IRA. If more than one reason applies, you must complete a separate IRA Distribution Request Form for each distribution reason. Only one reason may be applied per distribution amount.

SECTION 3

EXCESS REMOVAL

3.Premature with Exception: Substantially Equal Periodic Payments - Provide calculation, pursuant to IRC 72(t)(2)(A)(iv)

If you are under 59 ½ and take “substantially equal periodic payments” (as defined in Internal Revenue Code (IRC) Section 72(t)(2)(A)(iv)) from your IRA, you may qualify for an exception to the early distribution penalty. Once this payment series begins, generally, the payment schedule may not be altered for a period of five years (60 months) or attainment of age 59 ½, whichever is longer. Funds may not be added or subtracted from the account in any way, including contributions, transfers in or out, and distributions from the account other than the calculated payment once the payment period is complete. The account you are requesting this payment schedule for must have sufficient cash funds for the distribution. A missed payment not corrected by year’s end constitutes an alteration of the schedule and will terminate the exception. Please consult with a financial or tax professional before submitting this request.made.

4.Excess Contribution Removal

If you have made an excess contribution to your IRA, you must take the appropriate steps to remove or redesignate the distribution. Depending on when you take the necessary corrective action and the amount of the excess contribution, you may have to pay the IRS either an excess contribution or early distribution penalty tax, or both. Code 1, 7, 8, or P (or a combination of these codes) will be applicable on IRS Form 1099R depending on the timing of the removal.

If you marked Excess Contribution Removal as your distribution reason, you must complete Section 3:

EXCESS REMOVAL.

5.Revocation

If you receive a disclosure statement at the time you establish your IRA or Roth IRA, you have the right to revoke your account within seven (7) calendar days of its establishment. If revoked, you are entitled to a full return of the contribution made.

6.Disability

You may take a distribution due to disability only if the disability renders you unable to engage in any substantial gainful activity and it is medically determined that the condition will last continuously for at least 12 months or lead to your death.

7.Transfer Pursuant to Divorce

A transfer may be made by an IRA holder and a recipient under a transfer due to divorce. The following documents are required to process a divorce transfer: Official Divorce Decree signed by a judge referencing the settlement, IRA Application from receiving party (if the party does not already have an IRA with the same registration) and the IRA Distribution Request Form from the releasing party.

8.Direct Rollover to Qualified Employer Plan

If you qualify, you may rollover taxable IRA assets to your employer’s qualified plan, tax-sheltered annuity (403(b)), or 457 plan. The rules governing rollovers are very complex. You are advised to see a competent tax advisor if you have questions regarding eligibility to complete a rollover.

For Direct Rollovers to a Qualified Employer Plan, E*TRADE Clearing will send assets directly to that plan. Checks are typically be made out to the plan, for the benefit of the IRA holder. If you are unsure to whom the check should be made payable, check with your plan administrator. Checks are mailed to the Employer Plan Address supplied by you, in this section.

If you indicated the reason for your distribution is an excess contribution removal, you must complete this section.

Question 5: If you marked response "A", please note that if the application of earnings to the current tax year will create an excess contribution, the earnings will be disbursed to you by check to the address of record, instead.

Additional Instructions

If you would like to distribute the full balance of your account, including the in-kind distribution of all securities in your portfolio:

1.You may select both the option for "Balance of Account (lump sum)" and "Transfer Securities In-Kind"

2.In Section 5. Payment Instructions, you must then select the option "Deposit to existing E*TRADE Securities brokerage account number." Selection of a different option in Section 5 is not permitted for distribution of securities in-kind.

If you would like to distribute a portion of your account balance, including the in-kind distribution of any securities in your portfolio:

1.You may select both the option for "One Time Payment of $___" and "Transfer Securities In-Kind".

2.In Section 5. Payment Instructions, you must then select the option "Deposit to existing E*TRADE Securities brokerage account number." Selection of a different option in Section 5 is not permitted for distribution of securities in-kind.

If you would like an in-kind distribution of securities, only, from your account.

1.Select the option for "Transfer Securities In-Kind".

2.In Section 5. Payment Instructions, you must then select the option "Deposit to existing E*TRADE Securities brokerage account number." Selection of a different option in Section 5 is not permitted for distribution of securities in-kind.

If you would like recurring distributions to occur at regular intervals from your account.

1.Select the option for "Installment Payments of (choose one)"

2.Specify if you would like a fixed dollar amount to be distributed, or the sum of all dividends & interest that posted to your account during the cycle. Make only one selection per distribution form.

3.Indicate the frequency and starting date of the installment payments.

4.Please remember requested funds much be available for withdrawal from the account at the time each installment payment is processed. E*TRADE will not liquidate positions in order to free up cash for the purpose of distribution.

SECTION 5

PAYMENT INSTRUCTIONS

SECTION 6

WITHHOLDING ELECTION

Complete this section to indicate where your distribution cash and/or in-kind securities should be directed. In- kind security transfers may only be directed to an E*TRADE Securities brokerage account.

Complete this section to indicate if you would like Federal and/or State income tax withholding from the value of your distribution.

Form W-4P/OMB No. 1545-0074

Purpose of Form W-4P

Unless you elect otherwise, federal income tax will be withheld from payments from Individual Retirement Accounts (IRAs). You can use Form W-4P, or a substitute form, such as that contained on this form, furnished by E*TRADE Clearing, to instruct E*TRADE Clearing to withhold no tax from your IRA payments (or to revoke this election).

Nonperiodic Payments

Payments from IRAs that are payable upon demand are treated as nonperiodic payments for federal income-tax purposes. Generally, nonperiodic payments must have income tax withheld at a rate of not less than 10 percent. You can elect to have no income tax withheld from a nonperiodic payment (IRA payment) by filing Form W-4P or a substitute form with E*TRADE Clearing and checking the appropriate box on that form. Your election will remain in effect for any subsequent distribution unless you change or revoke it. For more information please see Publication 505, Tax Withholding and Estimated Tax, available from most IRS offices.

State Withholding

Unless you elect otherwise, State income tax will be withheld as follows:

SECTION 7

SIGNATURES

Michigan residents born on, or after 01/01/1946, are subject to a mandatory MI state tax withholding, regardless of their federal tax withholding election. The mandatory state tax withholding does not apply to Roth IRA account types. If you are a resident of Michigan, born on or after 01/01/1946, and select the option "Do not withhold State income tax" in section 6, you must also provide a completed form MI W-4P with this distribution request form. Failure to provide form MI W-4P will result in the processing of this distribution request with the mandatory state tax withholding.

The election to not have income tax withheld does not apply to any payments that are delivered outside the U.S. or its possessions to a U.S. citizen or resident alien. Other recipients who have these payments delivered outside the U.S. or its possessions may choose not to have income tax withheld only if an individual completes Form W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding, or satisfies the documentation requirements as provided under the regulations

Caution: Remember that there are penalties for not paying enough tax during the year, through either withholding or estimated tax payments. New retirees should see Publication 505. It explains the estimated tax requirements and penalties in detail. You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your IRA using Form W-4P.

Revoking the Exemption from Withholding

If you want to revoke your previously filed exemption from withholding, file another Form W-4P with E*TRADE Clearing and check the appropriate box on that form.

Statement of Income Tax Withheld from Your IRA

By January 31 of next year, you will receive a statement from E*TRADE Clearing showing the total amount of your IRA payments and the total federal income tax withheld during the year. Copies of Form W-4P will not be sent to the IRS by E*TRADE Clearing.

Your signature is required to certify that the information you have provided is true and correct and that you are aware of all the circumstances affecting this IRA withdrawal. Your printed name and the date are also required.