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Systematic Required Minimum Distribution Form-TDI 1020

Page 1 of 2 TDAI 3170 REV. 01/22 account OWNER/PARTICIPANT INFORMATIONName (First, Middle Initial, Last): | Social Security Number: Primary Telephone Number: | Date of Birth: PAYMENT DETAILSM Establish new Systematic Required Minimum Distribution instructions* * Only one Systematic Required Minimum Distribution instructions can be established on the Update existing Systematic Required Minimum Distribution instructionsPlease complete my Required Minimum Distribution (RMD) according to the frequency selected below: M Monthly M Quarterly M Semi-Annually M AnnuallyPlease begin these payments on (MM-DD-YYYY) _____. If you do not indicate a date to begin, we will default to the current date of processing. RMD values are subject to change every year. To ensure the necessary updates are made to your request, no distributions can take place after the 28th of each month.

payments will recalculate before each disbursement to ensure your RMD is met annually. The IRS may impose a 50% penalty on all RMD amounts not withdrawn by 12/31. The account holder is responsible for any penalties incurred if we are unable to make the scheduled distribution due to insufficient cash in your account. Please go online at

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