A BANK OF AMERICA COMPANY
Part 7: Direct Rollover Third-Party Payee Instructions to Employer-Sponsored
I understand that I am responsible for ensuring that this distribution is eligible for rollover. I have checked with the employer-sponsored plan
to which the monies are being rolled, and they are willing to accept receipt of these monies. Merrill will accommodate distributions to third-
party employer-sponsored retirement plans only in the following instances: (i) direct rollovers to employer-sponsored retirement plans and (ii) removal
of excess rollover being returned to employer-sponsored retirement plans. I understand that for tax purposes, if the direct rollover transaction type is
a type other than Journal Entry or Check, Merrill will report transactions to external institutions as a distribution unless provided with proof that these
funds were deposited into a qualified account.
q Make check payable to: OR
City State Zip Code
q Journal Entry to my Merrill employer-sponsored
retirement plan account number:
Plan Account Type:
q Proﬁt Sharing
q Money Purchase
q Other Qualiﬁed Plan__________
Part 8: Signature
I have read and understand the terms of the Merrill Lynch Custodial Agreement and the Withholding Notice and my instructions comply with the terms
therein. For cash distributions and tax withholding, I understand I must make arrangements to have sufﬁcient cash and/or money accounts available in
my retirement account for this request to be processed. I understand that if the distribution is made payable to a third party payee, I will be responsible
for any taxes that are due as a result of this requested distribution. I have reviewed this form in its entirety, and hereby certify that all information as it
appears is correct and may be relied upon by the custodian.
Note: The rules governing distributions can be complex, and you might be subject to taxes based on your distribution. We urge you to consult your tax
advisor or attorney for further guidance.
This distribution will be processed by Merrill upon receipt of this form unless a future transaction date is inserted here __________________.
(The future transaction date must be within 365 days for cash and 30 days for securities from the date the form is signed)
Signature Date (month/day/year)
/Roth IRA/SEP/SRA Distributions Only
Federal income taxes are required to be withheld (subtracted) from your distribution at a rate of 10% unless you tell us that you do not want any taxes withheld. State income taxes
will be withheld according to requirements of the state in which you reside. You must use this form to instruct us whether you want income taxes withheld from distributions you will
receive from your retirement account. Certain states require that you complete their state form to opt-out of state taxes when your distribution is subject to federal income taxes. To
determine your state’s requirements, please refer to the supplemental State Tax Withholding Rate Document. Even if you elect to not have federal and state taxes withheld from your
distribution, you are liable for payment of federal and state income taxes on the taxable portion of your distribution.
How to choose not to have taxes withheld.
If you do not want any federal taxes withheld from your distributions, check the appropriate boxes in Part 4 (Withholding Election) on the Distribution Form and sign at the bottom.
Your selection will also serve as an election not to have state taxes withheld from your distributions. If you do want state taxes withheld check the appropriate box and indicate the
applicable state withholding rates.
If you do not make an election we will assume you choose to have federal and, if applicable, state income taxes withheld from all distributions.
Estimated Taxes. Under Internal Revenue Service Rules, if you choose not to have federal income taxes withheld, or if the amount withheld from your distribution is not sufficient,
you may be responsible for paying estimated taxes each quarter. When your actual taxes for a year are determined, you could incur IRS penalties if your estimated federal income
tax payments were not sufficient. You may incur similar tax penalties under state law.
Merrill Lynch, Pierce, Fenner & Smith Incorporated (also referred to as "MLPF&S" or "Merrill") makes available certain investment products sponsored,
managed, distributed or provided by companies that are affiliates of Bank of America Corporation ("BofA Corp."). MLPF&S is a registered broker-dealer,
registered investment adviser, Member SIPC and a wholly owned subsidiary of BofA Corp.
Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value
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