One Time Distribution Form
Use this form to take a withdrawal (distribution) from a Merrill:
• Individual Retirement Account (IRA)
(Rollover IRA)
• Roth IRA
• Simplified Employee Pension (SEP) plan, or
• SIMPLE Retirement Account (SRA)
Complete, sign and send this form to the appropriate channel for processing. For clients with a Merrill Lynch Wealth Management Advisor
please contact your branch office directly for the appropriate fax number and address for prompt processing. If forms are sent to the wrong
channel processing is not guaranteed. Please retain a second copy of this form for your records.
Merrill Lynch Wealth Management Clients
Please contact your personal advisor
to obtain your advisor's office fax number or address
for prompt processing.
Merrill Edge Self-Directed and Merrill Guided Investing Clients
• Fax to: 866-994-7807
• Or, you can mail to the following address:
Merrill • P.O. Box 29002, Hot Springs, AR 71903-9002
Ensure cash is available in your account before requesting a
Part 1: Account Owner Information
Your Name (please print)
Date of Birth (month/day/year)
Merrill Retirement Account Number
Phone Number
Part 2: Reason for Withdrawal
Check One*
q (a) Normal distribution (if age 59½ or older)
q (b) Early/premature distribution (if under age 59½)
q (c) Direct rollover to an eligible retirement plan
q (d) Distribution of excess contribution for tax year __________
Note: If the tax year is other than current or prior year,
your distribution will be coded as normal or premature in accordance
with IRS guidelines
q (e) Distribution of SEP/SRA income deferral for tax year __________
If you checked box (d) or (e), please provide contribution and earnings or
losses amounts. You are responsible for computing earnings or losses
attributable to your excess contribution. The amount of contributions
plus attributable earnings (minus attributable losses) indicated
must equal the amount of your distribution in Part 3. If you are
eligible to make a contribution and would like to allocate all or a portion
of the excess to do so, you must include a Letter of Authorization with
your instructions in order for us to process.
Excess Contribution amount $_____________
Earnings (losses) $_____________
Total $_____________ (Use this amount in Part 3)
* As a reminder, you may only process one 60-day rollover between any and all of your IRAs in any rolling 12-month period, regardless of
the number of IRAs you own (IRS Announcement 2014-15). You may, however, continue to make as many transfers between IRAs as you
want. Do not use this form to complete a transfer. If you would like instructions on how to complete a transfer, please contact us using the
appropriate contact channels for your relationship.
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__________ ______________________________________
__________ ______________________________________
__________ ______________________________________
__________ ______________________________________
Part 3: Amount of Distribution
q 1. Part of my account (please check one)
q (a) Cash only $_____________
q (b) Securities in-kind* only (describe at right)
q (c) Cash $_____________ AND securities in-kind*(describe at right)
For Clients Enrolled in the RMD Service:
q Check this box if you want this distribution amount to be subtracted from
the remaining RMD Service calculated amount*
*For Office Use Only: To capture the value of securities in kind, a History File
Adjustment must be submitted.
q 2. My entire account (Your account will be closed and fees may apply)
q (a) Distribute all available cash AND sell all securities and
distribute all cash proceeds as directed in Part 5
q (b) Distribute all available cash AND all eligible securities in-kind*
*If you selected the distribution of securities in-kind, a fee may apply.
Description of Securities: Use descriptions as they appear on your
account statement. If you select more securities than the space
provides, attach a supplemental list of securities to be distributed
in-kind. The securities you’ve selected will not be sold but will
be transferred to your non-retirement account or mailed to you in
certificate or statement form, based on your election within Part 5.
If you do not indicate a quantity for the securities selected, your
distribution may not be processed.
Quantity Security Name or Symbol
Part 4: Withholding Election
Important: Please read the Withholding Notice before completing this section.
Complete if you are providing a U.S. Address:
Federal Withholding:
Please note that if you do not make a withholding election, federal income tax will be automatically withheld from your distribution at a
rate of 10%.
q Do not withhold federal income tax from my distribution.
q Withhold federal income tax from my distribution (check one):
q At a rate of 10% q At a rate of _________% (must be greater than 10%)
q At $____________(dollar amount must be greater than 10% of the total distribution value)
State Withholding:
State withholding may also be required in certain states. CA and VT state tax withholding is a percentage of the federal tax withholding.*
To determine your state's withholding requirements refer to the supplemental State Tax Withholding Rate Document.
The minimum required for the state of _________________________ is___________________.
q Do not withhold state income tax from my distribution.
q Withhold state income tax for the state of _________ from my distribution (check one):
q *At a rate of _________% q At $_________
Local Withholding:
Local withholding may be applicable for the states of Indiana and New York.
Complete if you are providing a Foreign Address:
If you are a U.S. citizen with a foreign address, you may not waive the Federal withholding requirement. If you are a Non-Resident Alien,
all distributions are subject to a tax treaty rate or 30% tax withholding and you must complete Form W-8BEN. A valid Form W-8BEN
expires after 3 years.
q I am a U.S. Citizen living abroad (check one)
Withhold: q At a rate of 10% q At a rate of ________% (must be greater than 10%)
q At $____________(dollar amount must be greater than 10% of the total distribution value)
q I am a Non-Resident Alien (check one)
Withhold: q At a rate of 30% q Tax Treaty rate of ____________% Country _________________________
q At a rate of ________% (must be greater than 30%)
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______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
Part 5: Distribution Instructions
Check One and fill in the Third Party Instructions for distributions going to
an alternate payee
o (a) Distribute to a Merrill Non-Retirement Acct.
Or, a Bank of America Non-Retirement Acct.
o (b) Federal Funds Wire Transfer (Please complete the
Wire Transfer Instructions in Part 6. Please note that
Merrill charges a transaction fee for this service.)
o (c) Direct Rollover (Please complete the Direct Rollover
Instructions in Part 7.)
o (d) Mail check/securities to the mailing address on file
o (e) Pick up check at Merrill
Wire Call ________________________
(For office use only)
o (f) Mail check to alternate address noted below:
o Check here if this is your new mailing address to be
updated on our records.
Alternate Address:
*This information will not be displayed in the envelope window.
Third Party Instructions (This section must be completed if
distributing to an alternate payee)
By making an election to pay to a third party, I understand that I will be
responsible for any taxes that are due as a result of this distribution.
Please indicate the alternate payee's name, relationship to you and reason
for the distribution.
Alternate Payee Name: ______________________________________
Reason for Distribution: _____________________________________
Part 6: Federal Funds Wire Transfer Instructions
If you checked Fed Fund Wire Transfer in Part 5, please provide the below information. Please note that Merrill charges a transaction fee for
this service. Please note that an election to wire funds is a distribution, not a transfer.
(Please speak to your Merrill Lynch Wealth Management Advisor or the Merrill Advisory Center for details.)
This box only needs to be completed if intermediary bank instructions are required
Bank Name For Further Credit (if applicable)
ABA Number
(ABA numbers for fed wires differ from the ABA on a checking
account. Please check with your financial institution for the correct ABA.)
For Credit To
Name on Account
Account Number
Name on Account
Account Number
Miscellaneous Bank Instructions (if any)
For international transfers only:
Non-Fed Member/International Bank SWIFT CODE
If the wire transfer is being made to an alternate payee, indicate the final recipient's city and country of residence below.
(Third Party Instructions in Part 5 must be completed)
City of Residence Country of Residence
Relationship Reason for Distribution
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Part 7: Direct Rollover Third-Party Payee Instructions to Employer-Sponsored
Retirement Plans
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
Plan name
Client Name
Street address
City State Zip Code
q Journal Entry to my Merrill employer-sponsored
retirement plan account number:
Plan Account Type:
q 457(b)
q Profit Sharing
q 403(b)
q Money Purchase
q 401k
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)
X_____________________________________________________ _________________
Signature Date (month/day/year)
Withholding Notice
/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.
Investment products:
Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value
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Code 10187 EZ (05/20)
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