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Automatic Withdrawals — RMD/Life Expectancy

Page 1 of 5 Questions? Go to or call Withdrawals RMD/Life ExpectancyUse this form to request Fidelity to calculate and establish an Automatic required minimum distribution (RMD) or life Expectancy plan for a Traditional, Rollover, Roth, SEP, or SIMPLE IRA on an ongoing basis. Do NOT use this form for Defined Contribution Retirement Plan accounts, Inherited IRAs, or annuities. Not available to nonresident aliens due to tax-withholding requirements. Type on screen or fill in using CAPITAL letters using black ink. If you need more room for information or signatures, make a copy of the relevant to Know It is your responsibility to ensure that your withdrawalscomply with IRS rules and deadlines for RMDs.

4. Distribution Schedule. Distribution payments may be made earlier or later depending on market availability. Examples include payments that are scheduled for a day when the stock market is closed or for a day that doesn’t exist in every month (29th–31st), or payments scheduled close to the begin-ning or end of the year.

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