Required Minimum Distribution (RMD) Request Form

1 PLEASE DETACHF inancial Advisor Information (if any)()-()-Name of Financial AdvisorPhone NumberFAX number (if any)(Not applicable to Roth IRAs or Coverdell Education Savings Accounts.)PARTICIPANT INFORMATION (Please Print)////Participant s Name Birthdate ( Required )Soc. Sec.#Street Address ( Check here if new address*)CityStateZipAccount Number(s) (The Distribution method you elect below will be applied to all accounts, unless you indicate otherwise.)*Signature Guarantee Required for distributions to new Minimum Distribution (RMD) Request FormIf this is a Profit Sharing or Money Purchase Pension Plan, the Plan Employer must sign the Certification on the reverse OF Distribution Balance of Account Partial Payment of:$_____; _____% of Account; or _____ Shares Periodic Payments: Monthly Quarterly AnnuallyBeginning:/ / 20(Dividends & Capital Gains will automatically reinvest.)

2 Month/Day*/YearChoose one Periodic Payment Option: Period certain: _____ years (not to exceed maximum life expectancy). Fixed amount of $_____ (which must adhere to the Required Minimum Distribution rules). Minimum based on Life Expectancy. If your spouse is your sole primary beneficiary and is more than 10 years younger, please provide thebeneficiary information of Spousal Beneficiary (of record)Date of BirthSocial Security No.*Periodic Payments may be processed on the 1st, 5th, 10th, 15th, 20thor 25th.

3 If no selection is made, payments will be processed on the : The January Distribution may bedelayed if the 1stor 5this chosen. Year-end balances are Required to calculate Required Minimum distributions, and the year-end balances must be posted before the calculation can be ELECTION(Check one)Please make the withholding election below.*1. I elect NOfederal tax withholding on my Distribution . (Applicable to RMD payments or IRA distributions.)2. Withhold based on: Single MarriedAllowances:_____ (Will default to Married with 3 allowances if not indicated.)

4 For IRA and non-periodic RMD amounts, withholding will be at the rate of 10%. To elect a higher percentage for these distributions, indicate percentage:_____%. (May not exceed 90%.)CALIFORNIA RESIDENTS:Please be advised that California state tax must be withheld at the rate of 1/10 of federal tax withholding, unlessyoucheck this box: NOstate tax withholding on my Distribution .*If your retirement plan is a 403(b), Profit Sharing, or Money Purchase Pension Plan, any amount in excess of your RMD is subject to mandatory 20% federal tax withholding (please see the SpecialTax Notice for an explanation).

5 PAYMENT INSTRUCTIONS(Check one) Forward check(s) to me at the address shown above. Invest funds in my personal Franklin Templeton account # Send to Bank Account or Other*:*Please include account number, name, address, and phone number of the bank or other institution. Send to Bank Account Via ACH: ABA Number _____Account Number _____In order to send the Distribution via ACH, a voided check or deposit slip must be CERTIFICATION AUTHORIZATIONI certify under penalty of perjury that all information contained herein is true and correct.

6 I hereby acknowledge that I have received and read theSpecial Tax Notice regarding plan distributions and take full responsibility for meeting my Minimum Distribution requirements. If I have a 403(b),Profit Sharing, or Money Purchase Pension Plan, I understand that I have 30 days to consider my Distribution option, and I elect to waive this right ifsuch 30-day period has not yet elapsed. If I am in a Money Purchase Pension Plan, I have elected to receive my Distribution other than in the form ofa Qualified Joint Survivor Annuity (QJSA), to which my spouse has consented on the reverse side (if applicable).

7 I further certify that I am a person(including a Resident alien). (Nonresident aliens should cross out the preceding sentence, and if claiming treaty benefits, attach a completed FormW-8 BEN with a tax identification number provided by the Internal Revenue Service.)X//Signature of ParticipantDate()-()-Daytime Phone NumberEvening Phone NumberSIGNATURE GUARANTEE**Your signature must be guaranteed if your Distribution is over $100,000 or if your funds are to be sent to an address other thanthe address of record, to a new address, orpayable to a third party.

8 Signatures may be guaranteed by one of the following: (1) national or state banks, savings associations, savings and loan associations, trust companies,savings banks, industrial loan companies, and credit unions; (2) national securities exchanges, registered securities associations, and clearing agencies; (3) securitiesbroker/dealers which are members of a national securities exchange or clearing agency, or which have Minimum net capital of $100,000; or (4) institutions that participatein the Securities Transfer Agent Medallion Program ( STAMP ).

9 A notarized signature will not be sufficient for the Request to be in proper To:FRANKLIN TEMPLETON BANK & TRUSTc/o Retirement ServicesP. O. Box 9971531-800 Box 33033 Sacramento, CA 95899-9974orSt. Petersburg, FL 33733-8033If you have previously made withdrawals from the above-listed account(s), please indicate the total of those withdrawals:$_____ in 2002;$_____ in 2003IF THIS IS A PROFIT SHARING OR MONEY PURCHASE PENSION PLAN, THE PLAN EMPLOYER MUST SIGN THE CERTIFICATION EMPLOYER S CERTIFICATION( Required to be completed by the Plan Employer.)

10 I certify that the Participant named on this Distribution Request is fully vested and is entitled to Plan distributions. If this distributionrequest pertains to a Money Purchase Pension Plan and the Spousal Consent section (below) has not been completed, I further certify,as Plan Administrator, that the spousal consent requirement does not apply to the certify that I have formally adopted the 2002 restated version of the Franklin Templeton Business Retirement Plan ( Required to ensurecompliance with recent tax law changes).