Systematic And Partial Withdrawal

2y ago
9 Views
2 Downloads
773.88 KB
5 Pages
Last View : 23d ago
Last Download : 2m ago
Upload by : Hayden Brunner
Transcription

Systematic and Partial WithdrawalForethought Life Insurance CompanyUse this form to request a systematic withdrawal or partial withdrawal for Annuity contract/certificates, hereinafter referred toas “Contract(s)”.No Index Credits are provided for any amount withdrawn or deducted from an Indexed Strategy prior to the end of aStrategy Term.Section A: Owner InformationPlease provide all information requested in this section. It is important that you provide your telephone number in theevent we require additional information to clarify your instructions.Contract NumberTelephone NumberBest Time To Call:Owner’s Full Name (First, Middle, Last or Trust/Entity)Owner’s Date of BirthAMJoint Owner’s Full Name (if applicable; First, Middle, Last)Joint Owner’s Date of BirthOwner’s Residential AddressCity/TownStateZip CodeOwner’s Mailing Address (if different from above)City/TownStateZip CodePMOwner’s Email AddressSection B: Type of RequestSelect one:Systematic Withdrawal ( 100 minimum) (Complete Section A, C, E, F, G)Partial Withdrawal ( 1,000 minimum) (Complete Section A, D, E, G)Section C: Systematic WithdrawalImportant Notes1Systematic withdrawals may be subject to withdrawal charges and interest adjustments. Funds will be withdrawnproportionately from all account strategies in which they are currently invested. For more information, please refer to yourContract.Please choose one:Withdraw Withdraw % of total Contract Value (please use whole percentage)Choose a in my payments:ImmediatelyAs of this date (mm/dd/yyyy)1Any withdrawal charges or interest adjustments will be deducted from the remaining Contract Value.FA5104-04-BSC (11-16)Page 1 of 5

Systematic and Partial WithdrawalForethought Life Insurance CompanyContract Number:Section D: Partial WithdrawalImportant Notes1Partial withdrawals may be subject to withdrawal charges and interest adjustments. Funds will be withdrawnproportionately from applicable account strategies. If the withdrawal reduces the Contract Value below the amount of theminimum Contract Value we may treat the request as a withdrawal of the entire Contract Value. For more information,please refer to your Contract.Please choose one:Free withdrawal amount only % of contract value1Any withdrawal charges or interest adjustments will be deducted from the remaining Contract Value.Section E: Tax WithholdingPlease Note: This section is not applicable for custodial owned contracts.E1: Federal Income Tax WithholdingFederal tax law requires us to withhold 10% of the taxable amount of your distribution unless you tell us not to. Even ifyou tell us not to withhold taxes, you may have to pay federal and state income taxes on the taxable portion of yourwithdrawal. You may also have to pay tax penalties if your estimated tax withholdings are not adequate. Your signatureon this form acknowledges that you have read this information about income tax withholding and that the Social Securityor Taxpayer Identification Number you wrote on this form is correct.If you are a non-resident alien and you are requesting a reduced tax withholding rate, you must give us your IndividualTaxpayer Identification Number (ITIN). You must also send us a completed IRS form W-8BEN to certify your foreignstatus. We will withhold 30% federal income tax from the taxable amount of your withdrawal if you are claiming reducedwithholding under a tax treaty and there is no applicable tax treaty, or you do not provide us with an ITIN.Please choose one:Do not withholdWithhold 10%Withhold the following amount: Withhold the following percent:distribution.)% (Must be a whole percentage. Cannot exceed 90% of the taxablePlease Note: If no option is selected, federal tax law requires us to withhold 10% of the taxable distribution (non-residentaliens may be subject to a higher percentage as explained above).FA5104-04-BSC (11-16)Page 2 of 5

Systematic and Partial WithdrawalForethought Life Insurance CompanyContract Number:Section E: Tax Withholding (continued)E2: State Income Tax WithholdingMandatory WithholdingArkansas, California, Georgia, North Carolina, and Oregon If you reside in one of these states, you may opt out of the mandatory state withholding by electing 'Do notwithhold’ below.Delaware, Iowa, Kansas, Maine, Massachusetts, Nebraska, Oklahoma, Vermont, and Virginia If you reside in one of these states and federal income tax is withheld, state income tax withholding will apply.You may not opt out of the mandatory state withholding.District of Columbia Full distributions from IRAs and qualified plans: If you reside in the District of Columbia and federal incometax is withheld, state income tax withholding will apply. You may not opt out of the mandatory state withholding. All other applicable distributions: These distributions can be treated as voluntary withholding.Michigan If you reside in Michigan, state income tax withholding will apply regardless of whether federal income tax iswithheld. Withholding will be generally taken at the default rate. Please refer to and complete the Michigan withholding certificate, the MI W-4P.Voluntary WithholdingAlabama, Arizona, Colorado, Connecticut, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana,Maryland, Minnesota, Mississippi, Missouri, Montana, New Jersey, New Mexico, New York, North Dakota, Ohio,Pennsylvania, Rhode Island, South Carolina, Utah, West Virginia, and Wisconsin If you reside in one of these states, you may voluntarily elect state income tax withholding below. If no option isselected state income tax will not be withheld.Please choose one:Do not withholdWithhold the following amount: Withhold the following percent:% (Must be a whole percentage.)Please Note: If you elect state withholding but fail to provide a dollar amount or percentage to be withheld, we will withhold the“default” amount prescribed by your state. If you reside in a state that does not provide a “default” amount such as Delaware, Kansas or Massachusetts, wewill automatically withhold at a rate of 5%.Section F: Distribution InstructionsF1: U.S. MailPlease mail check(s) to the Owner’s address of record.FA5104-04-BSC (11-16)Page 3 of 5

Systematic and Partial WithdrawalForethought Life Insurance CompanyContract Number:Section F: Distribution Instructions (continued)F2: Electronic Funds TransferImportant Notes Following our receipt of this form, your first distribution may be in the form of a physical check sent directly to thecurrent address of record. Electronic settlement of funds into your account may take up to three (3) business days after the effective date ofyour withdrawal. Please attach a voided check/deposit slip below. No temporary checks or temporary deposit slips will beaccepted.Please choose one:Please direct deposit my distribution to my checking account listed below.Please direct deposit my distribution to my savings account listed below.Bank Account NumberFull Name of BankBranch Location9 Digit Routing NumberContact Person (if any)Branch Telephone No.Attach voided check or deposit slip here. Please use tape instead of staples.REQUIRED CERTIFICATION AND SIGNATURE(S) ON NEXT PAGEFA5104-04-BSC (11-16)Page 4 of 5

Systematic and Partial WithdrawalForethought Life Insurance CompanyContract Number:Section G: Certification and Signature(s)CERTIFICATION:Taxpayer Identification Number (must be completed)Owner’s Social Security No./Taxpayer I.D.REQUIRED Joint Owner’s Social Security No.CertificationUnder penalties of perjury, I certify that:1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to beissued to me), and2. I am not subject to backup withholding because:a) I am exempt from backup withholding; orb) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result ofa failure to report all interest or dividends; orc) the IRS has notified me that I am no longer subject to backup withholding.InstructionsYou must cross out item 2 of the above certification if you have been notified by the IRS that you are currently subject tobackup withholding because you have failed to report all interest and dividends on your tax return.The Internal Revenue Service does not require your consent to any provisions of this document other than thecertifications required to avoid back-up withholding.Owner/POA/Custodian/Trustee SignatureTitle (if applicable)Date (mm/dd/yyyy)Joint Owner/POA/Co-Trustee Signature (if applicable)Title (if applicable)Date (mm/dd/yyyy)Spouse’s Signature (Required in the following community property states: AZ, CA, ID,LA, NM, NV, TX, WA, WI) or check here if applicableNot MarriedDate (mm/dd/yyyy)This Systematic and Partial Withdrawal form can be submitted as follows:U.S. MailForethought Life Insurance CompanyP.O. Box 246Batesville, IN 47006Private Express CarrierForethought Life Insurance CompanyOne Forethought CenterBatesville, IN 47006Via FaxPlease fax to (877) 554-2413Via EmailPlease email to annuitypolicyservice@gafg.comQuestions? Please Call: (877) 244-7526FA5104-04-BSC (11-16)Page 5 of 5

Forethought Life Insurance Company P.O. Box 246 Batesville, IN 47006 Forethought Life Insurance Company One Forethought Center Batesville, IN 47006 Via Fax Via Email Please fax to (877) 554-2413 Please email to annuitypoli

Related Documents:

Skyward Withdrawal Guide Last updated: 07/26/2021 TABLE OF CONTENTS . WITHDRAWAL GUIDELINES 2 To key a withdrawal in Skyward: 3 PRINTING THE WITHDRAWL FORM 6 To Delete a Withdrawal 10 COMPLETENESS OF DOCUMENTATION 12 SIGNATURES OF DOCUMENTATION 12 WRITTEN STATEMENTS PARENTS/QUALIFIED STUDENTS. 13 NO-SHOW STUDENTS 13 SUMMER WITHDRAWAL 15

The Truth About Marijuana Withdrawal The simple concept that quitting weed can trigger withdrawal symptoms is relatively new There was basically no research or information on withdrawal 20 years ago. When I quit smoking weed, I was one of the first people to write about marijuana withdrawal online and to study the symptoms and solutions.

Detox and Withdrawal Protocols . Alcohol Withdrawal: Key Points: 1. Alcohol withdrawal can be lethal. 2. Anyone experiencing severe withdrawal symptoms should be sent to the hospital immediately. This includes: hallucinations, agitation, loss of consciousness, seizures, tremors that are not being relieved by medication. 3.

6 Withdrawal of Candidacy If a withdrawal form is not filed with ODA by 5:00 p.m. on August 30, 2022, the candidate's name will appear on the ballot. A candidate must file a completed Withdrawal of Candidacy form with ODA and include a reason for the withdrawal. The Withdrawal of Candidacy form is included in Section 2 of this packet.

Payments before completing this form. If you are under 59½, your withdrawal may be subject to a 10% federal income tax penalty. Your withdrawal may also incur withdrawal charges. Withdrawal or surrender requests in which the money has already been received in your bank a

2219 In-Service Withdrawal JK61748 (rev. 10/28/21) Page 1 of 8 IN-SERVICE WITHDRAWAL REQUEST Is this form for me? You should complete this form when: Plan Sponsor Requesting an in-service withdrawal (other than hardship withdrawal). Do not use this form to request a direct rollover to an IRA or an eligible retirement plan.

Name of Life Assured NRIC/FIN/ Passport No. Ful Full Surrender Termination Par Partial Withdrawal What You Need To Know About Early Withdrawal or Surrender Of Your Insurance Policy (Investment-Linked Policy - ILP & Traditional) 1. An insurance p

withdrawal symptoms. By taking advantage of alpha- and beta- agonists and antagonist, clincians can provide faster tapers and less withdrawal symptoms—without adding a new medication to patients polytherapy. Symptoms of Opioid Withdrawal Opioid receptor activation is mediated by 3 different opioid receptors: delta, kappa, and mu. Symptoms of .