

Retirement benefit
choices guide

The information and forms you requested are enclosed.

Your choices
Before making a decision, you may want to consult with your tax advisor.

Description of choices Tax implications

Refer to Your Rollover Options for more tax information

1. IRA with the Principal Financial Group® > You will continue to defer taxes on the taxable amount rolled
over and potential earnings until you elect to take a distribution
You can request to roll over your retirement funds into
from the IRA.
an IRA with Principal®.
> The 20% federal tax withholding doesn’t apply to a rollover until
> If you are not working with an agent or broker, please
distributed.
call 800.247.8000 ext. 753. We can recommend a suitable
product, complete an application over the phone and send > Lets you avoid the 10% additional income tax that applies if
it to you ready for your review and signature by email or you’re younger than 59.5 and left employment before the year
postal mail. in which you turned 55 (see Your Rollover Options).

2. Direct rollover > You will continue to defer taxes on the taxable amount rolled
over and potential earnings until you elect to take a distribution
You can request to have your retirement funds sent directly
from the IRA.
to:
> The 20% federal tax withholding doesn’t apply to a rollover until
> An IRA with another financial institution.
distributed.
> Another eligible retirement plan with the Principal Life
> Lets you avoid the 10% additional income tax that applies if
Insurance Company.
you’re younger than 59.5 and left employment before the year
> Another eligible retirement plan outside Principal Life.
in which you turned 55 (see Your Rollover Options).

3. Cash distribution — paid to you > The amount distributed from the plan will be reported as
income in the year it’s taken.
You choose how much of your retirement funds you want
to receive as a single cash payment. > The 20% federal tax withholding applies.
> The payment may be subject to a 10% additional income tax if
you’re younger than 59.5 and left employment before the year
in which you turned 55 (see Your Rollover Options).
> You may roll over cash distributions within 60 days of issue
to avoid federal tax liability and the 10% additional income tax.
Please refer to the Sixty-Day Rollover Option in Your Rollover
Options.

4. Stay in the plan* > You will continue to defer taxes on the taxable portion of
your account and potential earnings until you elect to take
You leave your retirement funds in your former employer’s
a distribution.
plan and keep your current investment option elections.
If you choose to stay in the plan, you may be able to receive
installment payment.
Installments
You choose the amount and frequency of the payments > You pay taxes each year on the taxable portion you receive.
you want to receive until the vested account balance > Taxes are withheld as if you were married claiming three
equals zero. Your payment amount may be re-determined allowances unless you choose another option on Form W-4P.
each year. You may choose any of the investment options > The 20% federal tax withholding doesn’t apply unless the
available under the plan. annuity is less than 10 years; these distributions are considered
Please call 800.547.7754 for a personal quote an non-periodic payments.
enrollment forms. > The 10% additional income tax may apply (see Your Rollover
Options).

*These options may not be available to all plans,

including plans that are terminating.

RBC12-12 | 03/2019 page 2 of 44

Your choices continued
Before making a choices, consult your tax advisor.

Description of choices Tax implications

(Refer to pages 35-42 for more tax information)

5. Plan annuity options

You can elect to receive guaranteed income based on > You pay taxes each year on the taxable portion you receive.
the options available under your former employer’s plan.1 > 10% additional income tax may apply to fixed period annuities
> Fixed Period Annuity if you are younger than 59.5, and left employment before the
You receive regular income for the number of years you year in which you turned 55.
choose — can’t be more than your life expectancy. If you > If you receive payments for more than 10 years, the payment
die before the period ends, your beneficiary receives either is considered a periodic payment and taxes are withheld as if
regular income for the rest of the fixed period or a single you were married claiming three allowances unless you choose
payment. another option on Form W-4P.
> If you receive payments for less than 10 years, the payment is
considered a non-periodic* payment and is subject to 20% federal
tax withholding.

* May not be available to all plans. * Non-periodic payments can be rolled over to an eligible retirement plan
1
Guarantees are based upon the claims-paying ability of the issuing including an IRA.
insurance company.

Additional information in the guide

Description of choices Purpose

Information about payment of benefits Describes the Qualified Joint and Survivor Annuity form of
payment available to married participants.

Consequences of not deferring Describes the consequences of electing to receive your benefit
before your normal retirement.

Benefit illustration example Provides an example of monthly benefits you and your spouse
might receive under various benefit options.

Your rollover options Gives additional information on how you can continue to defer
federal income tax on the taxable portion of your retirement
savings in the plan.

Questions?
 We’re here to help. Call us at 800.547.7754. Monday through Friday, 7 a.m. - 9 p.m. CT.

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RBC12-12 | 03/2019 page 4 of 44

IRA with the Principal Principal Life Insurance Company
Mailing address: P.O. Box 9394
Des Moines, IA 50306-9394
Fax: 866.704.3481

This form is intended to obtain information required to process your requested rollover and is not intended to offer or market any
of the options mentioned.

Section 1 — Personal information

Please print in upper case capital letters using a black ink pen.

Company name

Contract number Social Security number/Taxpayer ID number

- -

Participant name - first, middle initial, last

Participant street address

Participant city, state, zip code (plus 4-digit)

State of legal residence - for tax purposes Date of birth Sex

- - Male Female

Phone number Email address*

- -
*The email address you provide will be used for services provided by the Principal Financial Group. For more information, see the privacy policy at [Link].

U.S. Person (Includes a resident alien of the United States) Non-U.S. Person
To learn more about how a U.S. Person is defined, please refer to Internal Revenue Service Publications 515 and 519, available on their website at [Link], or you
may request a copy by calling 800.829.3676. Your tax advisor can also provide assistance.

Section 2 — Direct Rollover IRA with Principal

Are you currently working with an agent or broker?

Yes. Please continue filling out the application, Sections 2 through 5.

Broker/agent name - first, last

Broker/agent phone number

- -

No. Do not complete this form.

If you are not working with an agent or broker who has helped you set up your account at the Principal, call us at 800.247.8000, ext. 753. We
can recommend a suitable product, complete an application over the phone and send your forms by email or postal mail that is ready for your
review and signature.
please continue to next page
RBC12-12 | 03/2019 page 5 of 44
IRA with the Principal

Section 2 — Direct Rollover IRA with the Principal (continued)

Direct rollover — This option allows you to keep the retirement funds tax-deferred and avoid the 10% additional income
tax. You must complete 2-A or 2-B. Do not complete both sections.

2-A. Roll 100% of my balance to a new account (all of the contributions types within my plan will be rolled
to a new account.)

Distribute to: Select product type

Pre-tax IRA Mutual Fund
Roth IRA (Taxes will only be withheld on pre-tax Principal Bank IRA
contributions rolling to a Roth IRA if indicated below.) Fixed annuity IRA
Federal withholding on Roth IRA rollover:
Variable annuity IRA
% Brokerage account (stocks or general securities)

 If you completed Section 2-A, please proceed to Section 3.

2-B. Split Pre-tax, Roth, and/or After-tax contributions to different accounts (complete the section for each
money type that you want distributed differently. Unless otherwise elected below, any remaining
retirement funds below the small amounts provision of the plan will be issued to you as a taxable cash
distribution. Any remaining retirement funds above the small amounts provision will stay in the plan.

Pre-tax portion – I would like a direct rollover of my pre-tax portion to (Represents pre-tax contributions
plus earnings (non-Roth elective deferrals, matching contributions, discretionary contributions, e.g.)
Please see Your Rollover Options for additional information.):

Distribute to: Select product type

Pre-tax IRA Mutual Fund
Principal Bank IRA
% or $
Fixed annuity IRA
Variable annuity IRA
Roth IRA (Taxes will only be withheld on pre-tax earnings Brokerage account (stocks or general securities)
rolling to a Roth IRA if indicated below.)

% or $

Federal withholding on rollover to Roth IRA:

please continue to next page

RBC12-12 | 03/2019 page 6 of 44
IRA with the Principal

Section 2 — Direct Rollover IRA with the Principal (continued)

Roth Portion – I would like a direct IRA rollover of my Roth portion to (represents elective deferrals which
are treated as Designated Roth Contributions plus earnings on those contributions. Please see Your
Rollover Options for additional information.):

Distribute to: Select product type

Roth IRA Mutual Fund

Principal Bank IRA
% or $
Fixed annuity IRA
Variable annuity IRA
Brokerage account (stocks or general securities)

After-Tax Portion – I would like a direct IRA rollover of my after-tax portion to (represents any
contributions which were contributed to the plan on an after-tax basis. Please see Your Rollover
Options for additional information.):

Distribute to: Select product type

Pre-tax IRA Mutual Fund
Principal Bank IRA
% or $
Fixed annuity IRA
Roth IRA Variable annuity IRA
Brokerage account (stocks or general securities)
% or $

Existing Account. If you have an existing account in a product indicated above and you want this distribution directed
to that account, please supply your existing account number.

My existing account number:

Rollovers will not be initiated until confirmation of an IRA account has been provided by the receiving area.

please continue to next page

RBC12-12 | 03/2019 page 7 of 44
IRA with the Principal
Legal Requirement*
This is an important decision. Before signing, be sure you understand what retirement benefits you’ll receive
and what benefits you’ll no longer be eligible to receive.

Section 3 — Participant’s signature

I reviewed the attached Retirement Benefit Choices Guide and understand my benefit choices.

I understand the relationship between my benefit election(s) and income tax withholding and have consulted a tax
advisor, if necessary. I certify the information I provided on this form is accurate and complete. This election cancels
any prior election I made under this plan.

Federal tax law requires a payment cannot be made sooner than 30 days, nor later than 180 days after I receive the
Retirement Benefit Choices Guide. However, my signature below is an affirmative election for the distribution option
chosen on this election form and reduces the 30-day waiting period as allowed by law. I understand if 180 days**
has passed since I received the Retirement Benefit Choices Guide, I am required to receive a new booklet and must
complete and submit another copy of this election form to restart the time limit described above.

Certification: under the penalties of perjury, I certify with my signature below that the information provided in each
completed section of this form is/are true, correct, and complete.

Participant signature X
Print name

Contract/plan I.D. number Date

- -

I certify that I received, either in paper copy or electronic delivery, all pages of the Retirement Benefit Choices Guide
on the date I signed this election form, unless I enter a different date in the following boxes:

Date I received the Retirement Benefit Choices Guide:

- -

* The information and signatures in these sections are required by Internal Revenue Code § 402(f), 411(a)(11).
*** Some plans may require a shorter period of time before a new booklet is required.

Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market
value of your investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account
at [Link].
Revocability of benefit election: You have elected to roll over your retirement funds in the retirement plan. Your election
becomes irrevocable once the request has been processed.

RBC12-12 | 03/2019 page 8 of 44

Direct rollover Principal Life Insurance Company
Mailing address: P.O. Box 9394
Des Moines, IA 50306-9394
Fax: 866.704.3481

Use this form to request a rollover to an Individual Retirement Account (IRA) outside of Principal® or to another eligible
retirement plan.

Section 1 — Personal information

Please print in upper case capital letters using a black ink pen.

Company name
T. U. F T. S M.E. D. I. C. A. L C. E. N. T. E. R

Contract number Social Security number/Taxpayer ID number

8. 6. 3. - 3. 6 - 6. 9. 7. 1

Participant name - first, middle initial, last

W E I. , C. H.E. N

Participant street address

4 4. 5. A. R T. I. S. A. N. W. A. Y

Participant city, state, zip code (plus 4-digit)

S. O. M.E R V I. L. L. E , M A, 0. 2. 1. 4. 5
State of legal residence - for tax purposes Date of birth Sex
M. A 1. 1. - 0. 4. - 1. 9. 9. 1 √ Male Female

Phone number Email address*

2. 0. 3 - 5. 6. 0. - 3. 1. 6. 8 R. O. B W C. H E. N. @ Y. A. H. O. O . C. O. M
*The email address you provide will be used for services provided by the Principal Financial Group. For more information, see the privacy policy at [Link].

U.S. Person (Includes a resident alien of the United States) √ Non-U.S. Person
To learn more about how a U.S. Person is defined, please refer to Internal Revenue Service Publications 515 and 519, available on their website at [Link], or you
may request a copy by calling 800.829.3676. Your tax advisor can also provide assistance.

Section 2 — Rollover instructions

Direct rollover – This option allows you to keep the retirement funds tax-deferred and avoid the 10% additional
income tax.

Note: Not all financial institutions or eligible retirement plans will accept all types of rollovers. Please check with the
receiving financial institution or plan sponsor to see if your retirement funds can be rolled over before completing and
submitting this form. Any checks that are returned or rejected by the receiving institution will be held by Principal
Life Insurance Company (Principal Life) until we receive further direction from you. Please note the retirement
funds will not be invested during this timeframe.

You must completed 2-A or 2-B. Do not complete both sections

please continue to next page

RBC12-12 | 03/2019 page 9 of 44
Direct rollover

Section 2 — Rollover instructions (continued)

√ 2-A. Roll 100% of my balance to a new account (all of the contributions types within my plan will be
rolled to a new account.)

Distribute to:
Pre-tax IRA Eligible employer sponsored retirement
plan outside of Principal Life

√ Eligible employer sponsored retirement Roth IRA (Taxes will only be withheld on pre-tax
plan with Principal Life contributions rolling to a Roth IRA if indicated below.)
Federal withholding on rollover to Roth IRA:
Plan/contract number
%

 If you completed Section 2-A, please proceed to Section C.

2-B. Split Pre-tax, Roth, and/or After-tax contributions to different accounts (complete the
section for each money type that you want distributed. Any remaining retirement funds below
the small amounts provision of the plan will be issued to you as a taxable cash distribution.
Any remaining retirement funds above the small amounts provision will stay in the plan.

Pre-Tax Portion – I would like a direct rollover of my pre-tax portion to (Represents pre-tax contributions
plus earnings (non-Roth elective deferrals, matching contributions, discretionary contributions, e.g.)
Please see Your Rollover Options for additional information.):

Distribute to:
Pre-tax IRA Eligible employer sponsored retirement
plan outside of Principal Life
% or $
% or $

Eligible employer sponsored retirement Roth IRA (Taxes will only be withheld on pre-tax earnings
plan with Principal Life rolling to a Roth IRA if indicated below.)

Plan/contract number
% or $

Federal withholding on rollover to Roth IRA:

% or $ %

please continue to next page

RBC12-12 | 03/2019 page 10 of 44
Direct rollover

Section 2 — Rollover instructions (continued)

Roth Portion – I would like a direct IRA rollover of my Roth portion to (represents elective deferrals which
are treated as Designated Roth Contributions plus earnings on those contributions. Please see Your
Rollover Options for additional information.):

Distribute to:
Roth IRA Eligible employer sponsored retirement
plan outside of Principal Life
% or $
% or $

Eligible employer sponsored retirement

plan with Principal Life
Plan/contract number

% or $

After-Tax Portion – I would like a direct IRA rollover of my after-tax portion to (represents any
contributions which were contributed to the plan on an after-tax basis. Please see Your Rollover Options
for additional information.):

Distribute to:
After tax IRA Eligible employer sponsored retirement
plan outside of Principal Life
% or $
% or $

Eligible employer sponsored retirement Roth IRA (Taxes will only be withheld on pre-tax earnings
plan with Principal Life rolling to a Roth IRA if indicated below.)

Plan/contract number
% or $

Federal withholding on rollover to Roth IRA:

% or $ %

 If you completed Section 2-B, please proceed to Section C.

RBC12-12 | 03/2019 page 11 of 44

Direct rollover

Section 2 — Rollover instructions (continued)

C. Receiving financial institution information

Name of financial institution, trust account, or trustee

Account number or identification number - optional

Name of agent/broker or contact at financial institution - optional

Mailing address of financial institution - street or P.O. Box

Financial institution city, state, zip code (plus 4-digit)

Additional financial institution information — Only fill out if Roth IRA portion and/or after-tax are being distributed
to a different account.

Name of financial institution, trust account, or trustee

Account number or identification number - optional

Name of agent/broker or contact at financial institution - optional

Mailing address of financial institution - street or P.O. Box

Financial institution city, state, zip code (plus 4-digit)

please continue to next page

RBC12-12 | 03/2019 page 12 of 44
Direct rollover

Section 2 — Rollover instructions (continued)

D. Mailing information

Note: Principal Life will mail only the check(s) to the designated individual or financial institution. If additional
documents must accompany a check to a financial institution, then have the check mailed to you so you can
include the additional documents that are required.

Mail checks to:

The financial institution(s) listed above in Option C.
To me at the address provided in Section 1.
Other – address listed below.
Name

Name of agent/broker or contact at financial institution - optional

Mailing address

City, state, zip code (plus 4-digit)

E. Additional information/comments:

please continue to next page

RBC12-12 | 03/2019 page 13 of 44
Direct rollover
Legal Requirement*
This is an important decision. Before signing, be sure you understand what retirement benefits you’ll receive
and what benefits you’ll no longer be eligible to receive.

Section 3 — Participant’s signature

I reviewed the attached Retirement Benefit Choices Guide and understand my benefit choices.

I understand the relationship between my benefit election(s) and income tax withholding and have consulted a tax
advisor, if necessary. I certify the information I provided on this form is accurate and complete. This election cancels
any prior election I made under this plan.

Federal tax law requires a payment cannot be made sooner than 30 days, nor later than 180 days after I receive the
Retirement Benefit Choices Guide. However, my signature below is an affirmative election for the distribution option
chosen on this election form and reduces the 30-day waiting period as allowed by law. I understand if 180 days**
has passed since I received the Retirement Benefit Choices Guide, I am required to receive a new booklet and must
complete and submit another copy of this election form to restart the time limit described above.

Certification: under the penalties of perjury, I certify with my signature below that the information provided in each
completed section of this form is/are true, correct, and complete.

Participant signature X

Print name
W E. I. C. H. E. N

Contract/plan I.D. number Date

0 9. - 2. 9. - 1. 9. 9. 1

I certify that I received, either in paper copy or electronic delivery, all pages of the Retirement Benefit Choices Guide
on the date I signed this election form, unless I enter a different date in the following boxes:

Date I received the Retirement Benefit Choices Guide:

0. 9 - 2. 5. - 2. 0. 1. 9

* The information and signatures in these sections are required by Internal Revenue Code §402(f), 411(a)(11).
*** Some plans may require a shorter period of time before a new booklet is required.

Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market
value of your investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account
at [Link].
Revocability of benefit election: You have elected to roll over your retirement funds in the retirement plan. Your election
becomes irrevocable once the request has been processed.

RBC12-12 | 03/2019 page 14 of 44

Cash distribution Principal Life Insurance Company
Mailing address: P.O. Box 9394
Des Moines, IA 50306-9394
Fax: 866.704.3481

Use this form to request a single cash payment from your retirement funds.

Section 1 — Personal information

Please print in upper case capital letters using a black ink pen.

Company name

Contract number Social Security number/Taxpayer ID number

- -

Participant name - first, middle initial, last

Participant street address

Participant city, state, zip code (plus 4-digit)

State of legal residence - for tax purposes Date of birth Sex

- - Male Female

Phone number Email address*

- -
*The email address you provide will be used for services provided by the Principal Financial Group. For more information, see the privacy policy at [Link].

U.S. Person (Includes a resident alien of the United States) Non-U.S. Person
To learn more about how a U.S. Person is defined, please refer to Internal Revenue Service Publications 515 and 519, available on their website at [Link], or you
may request a copy by calling 800.829.3676. Your tax advisor can also provide assistance.

Section 2 — Paid to you

I would like a cash distribution of (choose one):

100% of my retirement funds

I would like a partial payment of $ or %*

My partial payment should be:

Gross distribution (check amount equals specified amount less required taxes).
Net of taxes (check amount equals specified).

please continue to next page

RBC12-12 | 03/2019 page 15 of 44
Cash distribution

Section 2 — Paid to you (continued)

Partial cash distributions will be equally prorated from all investment and contribution types unless
indicated below.
Process my partial cash distribution as follows:

* Partial payments will be treated as a gross distribution unless otherwise elected above. Any remaining retirement funds below the
small amounts provision of the plan will be issued to you as a taxable cash distribution. Any remaining retirement funds above the
small amounts provision will stay in the plan.

Section 3 — Taxation
Please refer to “Your rollover options” for more information.

Federal withholding
Required
Principal Life Insurance Company (Principal Life) is required to withhold 20% for federal taxes on the taxable portion of
distributions that are eligible for rollover but paid in cash from a qualified retirement plan.

Additional (select if you wish to have additional withholding)

10% additional income tax – This applies to early withdrawals of retirement funds. If you are older than 59.5,
disabled, or age 55 when you separated from service, you do not need to pay.
In addition to the required 20% Federal and the 10% additional income tax (if indicated above), I would like to

withhold additional federal taxes of: % or $

State withholding
State income tax withholding may apply to the cash distribution. If the state of legal residence box is not completed
in Section 1, the state given in your address is used to determine whether state taxes apply. If applicable, the state
withholding tax will automatically be withheld. Refer to your state income tax authority to see if your state of residence
is a required withholding state.

In addition to the required state withholding above (if applicable), I would like to withhold additional state

taxes of: % for the state of .

Additional state specific forms may be needed for states that don’t require withholding or permit an election
out of any state withholding. Contact your state income tax authority to obtain this information.

Standard withholding will apply unless this page is returned electing additional federal or state withholding.

Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market value of your
investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account at [Link].

please continue to next page

RBC12-12 | 03/2019 page 16 of 44
Cash distribution

Section 4 — Method for receiving your funds

Choose option A or B below. Please send my benefit payment via:

A. Direct deposit
Financial institution information: Please enclose a voided check (if applicable) and complete the following information.

Financial institution name

Your name as shown on the account (your name must be on the account indicated)

Financial institution address (street number and name, must be located in the U.S.)

Financial institution city, state, zip code (plus 4-digit)

Routing/transit number Your account number Account type

Checking Savings

How to find the routing/transit number:

You can usually find the routing/transit number at the bottom left-hand corner of the checks issued to you by your
financial institution. The numbers are usually 9 digits long.

B. Check
Mail check to (only complete if mailing address is different than Section 1):
Name

Mailing address

City, state, zip code (plus 4-digit)

Section 5 — Additional distribution information/comments

please continue to next page

RBC12-12 | 03/2019 page 17 of 44
Cash distribution
Legal Requirement*
This is an important decision. Before signing, be sure you understand what retirement benefits you’ll receive
and what benefits you’ll no longer be eligible to receive.

Section 6 — Participant’s signature

I reviewed the attached Retirement Benefit Choices Guide and understand my benefit choices.
I understand the relationship between my benefit election(s) and income tax withholding and have consulted a tax
advisor, if necessary. I certify the information I provided on this form is accurate and complete. This election cancels any
prior election I made under this plan.
Federal tax law requires a payment cannot be made sooner than 30 days, nor later than 180 days after I receive the
Retirement Benefit Choices Guide. However, my signature below is an affirmative election for the distribution option
chosen on this election form and reduces the 30-day waiting period as allowed by law. I understand if 180 days***
has passed since I received the Retirement Benefit Choices Guide, I am required to receive a new booklet and must
complete and submit another copy of this election form to restart the time limit described above.
If using Direct Deposit:
I authorize Principal Life to initiate credit entries to my checking or savings account at the financial institution named
within the Method for Receiving Your Funds section, and if necessary, to initiate debit entries and adjustments to
correct any credit entries made in error. I authorize the financial institution to credit and/or debit entries to my checking
or savings account. This authorization applies to any payments that hereafter become due and payable to me under the
provisions of the plan(s) identified by the Social Security Number identified within this distribution form.
The authorization is to remain in full force until I notify Principal Life in writing at its Corporate Center that the
agreement is no longer effective. This election will update any Direct Deposit authorization agreement on file.
Certification: under the penalties of perjury, I certify with my signature below that the information provided in each
completed section of this form is/are true, correct, and complete.

Participant signature X

Print name

Contract/plan I.D. number Date

- -

I certify that I received, either in paper copy or electronic delivery, all pages of the Retirement Benefit Choices Guide
on the date I signed this election form, unless I enter a different date in the following boxes:

Date I received the Retirement Benefit Choices Guide: - -

* The information and signatures in these sections are required by Internal Revenue Code §402(f), 411(a)(11).
*** Some plans may require a shorter period of time before a new booklet is required.

Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market
value of your investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account
at [Link].
Revocability of Benefit Election: You have elected to receive a cash distribution as your form of benefit payment. Your election
becomes irrevocable once the request has been processed.

RBC12-12 | 03/2019 page 18 of 44

Stay in the plan Principal Life Insurance Company
Mailing address: P.O. Box 9394
Des Moines, IA 50306-9394
Fax: 866.704.3481

Use this form to indicate that you choose to leave your retirement funds in your former employer’s plan.

Section 1 — Personal information

Please print in upper case capital letters using a black ink pen.
Company name

Contract number Social Security number/Taxpayer ID number

- -

Participant name - first, middle initial, last

Participant street address

Participant city, state, zip code (plus 4-digit)

Date of birth Sex

- - Male Female

Phone number Email address*

- -
*The email address you provide will be used for services provided by the Principal Financial Group. For more information, see the privacy policy at [Link].

Legal Requirement*
This is an important decision. Before signing, be sure you understand what retirement benefits you’ll receive and what
benefits you’ll no longer be eligible to receive.

Section 2 — Participant’s signature

I elect to defer my benefit election until a later date. Leave 100 percent of my retirement benefit in the retirement plan.

Participant signature X
Print name

Contract/plan I.D. number Date

- -

* This option may not be available to all plans, including plans that are terminating.
* The information and signature in this section is required by the Internal Revenue Code §402(f), 411(a)(11).
Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market value of your
investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account at [Link].

RBC12-12 | 03/2019 page 19 of 44

 This page intentionally left blank.

RBC12-12 | 03/2019 page 20 of 44

Plan annuity options Principal Life Insurance Company
Mailing address: P.O. Box 9394
Des Moines, IA 50306-9394
Fax: 866.704.3481

Use this form to request regular income based on the annuity options under the plan.

Section 1 — Personal information

Please print in upper case capital letters using a black ink pen.

Company name

Contract number Social Security number/Taxpayer ID number

- -

Participant name - first, middle initial, last

Participant street address

Participant city, state, zip code (plus 4-digit)

State of legal residence - for tax purposes Date of birth Sex

- - Male Female

Phone number Email address*

- -
*The email address you provide will be used for services provided by the Principal Financial Group. For more information, see the privacy policy at [Link].

U.S. Person (Includes a resident alien of the United States) Non-U.S. Person
To learn more about how a U.S. Person is defined, please refer to Internal Revenue Service Publications 515 and 519, available on their website at [Link], or you
may request a copy by calling 800.829.3676. Your tax advisor can also provide assistance.

Section 2 — Payment starting date and distribution information

Payment frequency depends on the annuity amount – usually monthly. Do not use the 29th, 30th or 31st.
I want my first payment to start on:
- -

My payments thereafter will be made on the same day of the month (if receiving monthly payments).

(Example: Monthly payments chosen; payment starting date of 01/12/17. First payment will be made 01/12/17 and
continue on the twelfth of each month thereafter until the annuity ceases).

please continue to next page

RBC12-12 | 03/2019 page 21 of 44
Plan annuity options

Section 3 — Direct deposit

Financial institution information: Please enclose a voided check (if applicable) and complete the following information.

Financial institution name

Your name as shown on the account (your name must be on the account indicated)

Financial institution address (street number and name, must be located in the U.S.)

Financial institution city, state, zip code (plus 4-digit)

Routing/transit number Your account number Account type

Checking Savings

How to find the routing/transit number:

You can usually find the routing/transit number at the bottom left-hand corner of the checks issued to you by your
financial institution. The numbers are usually 9 digits long.

If you would like your payment issued in check form, please call 1.800.547.7754.

Section 4 — Additional distribution information/additional comments

please continue to next page

RBC12-12 | 03/2019 page 22 of 44
Plan annuity options

Section 5 — Plan annuity options

Fixed period annuity

I would like to purchase an annuity of % or $ of the retirement benefit in the

retirement plan.
I want payments to be made for:

5 years 10 years 15 years years (other year if allowed in your plan)

If I don’t live to the end of the period I have chosen, pay any remaining benefits to my beneficiary by:

Continuing payments (must complete Section 7) A single payment (must complete Section 7)

I have chosen an annuity having a period of less than 10 years and would like to make a Direct Rollover
of the payments. Refer to Rollover Election Forms in this guide for completion.

Section 6 — Tax withholding

Federal tax withholding treatment will depend on the annuity option selected. In some cases an additional 10%
additional income tax may apply if you are under 59.5 when you receive your payments. See the “Your Choices”
section.
If you want additional amounts withheld from any payment, check the appropriate box:

Withhold additional federal taxes of $ from each payment.

Withhold additional federal taxes of 10%.

please continue to next page

RBC12-12 | 03/2019 page 23 of 44
Plan annuity options

Section 7 — Beneficiary designation

Note: Complete this section to change or reaffirm a plan beneficiary already chosen. If this section is left blank, the
beneficiary designation on file (if any) will remain in effect.

Pay any amounts payable after my death to the following primary beneficiary(ies):

Primary beneficiary 1:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

Primary beneficiary 2:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

please continue to next page

RBC12-12 | 03/2019 page 24 of 44
Plan annuity options

Section 7 — Beneficiary designation (continued)

Primary beneficiary 3:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

Primary beneficiary 4:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

please continue to next page

RBC12-12 | 03/2019 page 25 of 44
Plan annuity options

Section 7 — Beneficiary designation (continued)

If no primary beneficiary is alive at the time of my death, pay any amounts payable after my death to the following
contingent beneficiary(ies):

Contingent beneficiary 1:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

Contingent beneficiary 2:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

please continue to next page

RBC12-12 | 03/2019 page 26 of 44
Plan annuity options

Section 7 — Beneficiary designation (continued)

Contingent beneficiary 3:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

Contingent beneficiary 4:
Percent

Full name

Social Security number/Taxpayer ID number Date of birth Relationship to me

- - - -

Street address

City, state, zip code (plus 4-digit)

My selection of a beneficiary appears on a separate sheet of paper. I understand if my designation requires more
space, I must check the box and staple additional paper to this form. I also understand any additional page(s) must
be signed and dated by me and my spouse (if married).

please continue to next page

RBC12-12 | 03/2019 page 27 of 44
Plan annuity options
Legal Requirement*
This is an important decision. Before signing, be sure you understand what retirement benefits you’ll receive
and what benefits you’ll no longer be eligible to receive.

Section 8 — Participant’s signature

I reviewed the attached Retirement Benefit Choices Guide and understand my benefit choices.
I understand the relationship between my benefit election(s) and income tax withholding and have consulted a tax
advisor, if necessary. I certify the information I provided on this form is accurate and complete. This election cancels
any prior election I made under this plan.
Federal tax law requires a payment cannot be made sooner than 30 days, nor later than 180 days after I receive the
Retirement Benefit Choices Guide. However, my signature below is an affirmative election for the distribution option
chosen on this election form and reduces the 30-day waiting period as allowed by law. I understand if 180 days***
has passed since I received the Retirement Benefit Choices Guide, I am required to receive a new booklet and must
complete and submit another copy of this election form to restart the time limit described above.
If using Direct Deposit:
I authorize Principal Life Insurance Company (Principal Life) to initiate credit entries to my checking or savings
account at the financial institution named above, and if necessary, to initiate debit entries and adjustments to correct
any credit entries made in error. I authorize the financial institution to credit and/or debit entries to my checking or
savings account. This authorization applies to any payments that hereafter become due and payable to me under the
provisions of the plan(s) identified by the Social Security Number identified within this distribution form.
The authorization is to remain in full force until I notify Principal Life in writing at its Corporate Center that the
agreement is no longer effective. This election will update any Direct Deposit authorization agreement on file.

I’m Married Single Legally separated (attach copy of court order)

Note: If Single or Legally Separated box is checked, spousal consent is not necessary. Spousal consent is only needed if
someone other than your spouse is named as beneficiary in Section 7.
Certification: under the penalties of perjury, I certify with my signature below that the information provided in each
completed section of this form is/are true, correct, and complete.

Participant signature X
Print name

Contract/plan I.D. number Date

- -

I certify that I received, either in paper copy or electronic delivery, all pages of the Retirement Benefit Choices Guide
on the date I signed this election form, unless I enter a different date in the following boxes:

Date I received the Retirement Benefit Choices Guide: - -

* The information and signatures in these sections are required by Internal Revenue Code §402(f), 411(a)(11).
*** Some plans may require a shorter period of time before a new booklet is required.

Your balance, and thus the amount of your final payout, changes daily due to a number of factors, including the current market value of your
investments.
Redemption fees may apply on certain transactions. For further information on redemption fees, please login to your account at [Link].
Revocability of benefit election: You have elected to receive an annuity as your form of payment. Your election becomes irrevocable on the selected
annuity start date.

please continue to next page

RBC12-12 | 03/2019 page 28 of 44
Plan annuity options
Section 9 — Spouse’s signature
I, (name of the spouse of the plan participant)

am the spouse of (name of plan participant)

I agree that the beneficiary named on this election form (if one is named) may receive all or part of the survivor benefits from the
plan after my spouse dies. I agree that my spouse may change the beneficiary shown on this election form, or if none shown on this
form, my spouse may add a beneficiary without my consent unless I mark the appropriate box below.
I agree the benefits paid under this plan will be paid as selected on this Election Form.
I understand I do not have to sign this agreement. I am signing this agreement voluntarily. If I do not sign this agreement, the plan
may require that I be named the beneficiary.
Spouse’s signature must be witnessed by a Plan Representative or notarized by a Notary.

Spouse Signature: The signature dates for both the spouse and the notary or plan representative must match.
My consent is only for the: form of benefit chosen on this election form beneficiary chosen on this election form.
Date

Spouse signature X - -
Name of spouse

Notary Public: The person signing as spouse appeared before me and signed the above consent.

Sworn to and subscribed before me this day of , 20 , in the State of

, County of .
Notary expires on:

Notary signature X - -
Name of Notary

The person who signed as spouse is personally known to me, or Type of identification
The person who signed as spouse produced identification.

If your state has specific notary acknowledgment requirements then the notary will need the include any additional acknowledgment
and attach it to this distribution form.

Plan Representative: The spouse appeared before me and signed this consent. Date

Plan Representative signature X - -

Plan Representative name

If spouse cannot be located:

Plan Representative: It has been established to my satisfaction the spouse cannot be located. Date

Plan Representative signature X - -

Plan Representative name

* The information and signatures in these sections are required by Internal Revenue Code §402(f), 411(a)(11).

RBC12-12 | 03/2019 page 29 of 44

 This page intentionally left blank.

RBC12-12 | 03/2019 page 30 of 44


Retirement benefit
choices guide
Important information about payment of benefits

You and your spouse* (if you’re married) should read this • In what form to receive your retirement funds (if you are
section carefully before deciding how you want to receive given a choice) and you elect a distribution;
benefit payments. • Whether to roll over distributed amounts to another plan
or IRA to keep the retirement funds tax-deferred;
Guaranteed interest account
• If you elect a rollover, to what investment options will you
Upon your termination of employment, retirement or disability direct the retirement funds?
you will have sixty days to make your benefit choice. After
These decisions can impact the amount of retirement funds
sixty days, money withdrawn from the guaranteed interest
you are ultimately able to accumulate as well as the amount
account may be subject to a surrender charge. We will honor
and timing of the tax liability associated with the receipt of
our current Guaranteed Interest Rates until date of maturity.
these funds.
Contact us at 1.800.547.7754 for information regarding
surrender charges and when they apply. Some things to consider:
In general, if you do not elect an annuity option which provides
Consent to change
lifetime income, or such option is not available through your
You can waive the QJSA form of payment and choose another employer’s retirement plan, the earlier you start receiving
benefit option. You can change the form of benefit payment payments and the larger the payments, the lower the
any time before payments begin. After benefit payments probability that your retirement funds will last throughout
begin, your election will become irrevocable and cannot be your lifetime.
changed.
If you take your retirement funds now, you give up the
possibility of future tax deferred accumulation in the
What happens if there is a divorce or separation?
retirement plan. If you do not roll the funds over to another
Divorce or legal separation may end a spouse’s right to plan or IRA, you give up the advantage of tax-deferred growth.
survivor benefits from the plan. However, a spouse may be
If you take your retirement funds now and do not roll funds
able to get a Qualified Domestic Relations Order (QDRO) that
over into another plan or IRA, you will be subject to current
would grant him or her rights to receive the survivor benefits
income taxation on the amounts includible in gross income–
even if a waiver giving up these rights were signed.
see Your Rollover Options.

Benefit chosen affects payment amounts If you have not reached age 59.5 when you take retirement
funds, and you do not roll funds over into another plan or IRA,
The type of benefit you choose will affect the payment you may be subject to an additional 10% penalty tax (see Your
amounts you and your spouse will receive. The table on the Rollover Options). Delaying distribution until a later time may
Benefit Illustration Option explains how your choice will affect avoid this tax.
your income and your spouse’s income.
If you have not reached age 59.5 and have terminated
employment during or after the year you reached age 55,
All participants’ rights to defer payments
the retirement funds you receive from the plan would not be
You also have the right to keep the account held for you in the subject to the additional 10% penalty tax. If, however, you roll
retirement plan until age 62 or your normal retirement age, amounts to an IRA and then take distributions from the IRA,
whichever comes later. If your plan allows, you may elect to you would again be subject to the 10% penalty tax while under
defer payments until the later of April 1 of the year after you age 59.5 unless another exception applies.
reach age 70.5 or retire (doesn’t apply if you’re at least a 5
You should be aware that some investment options currently
percent owner in the company sponsoring the plan).
available in the plan may not be generally available outside the
*Spouse is defined according to applicable law. plan. You should also refer to the Summary Plan Descriptions
for this plan, and any other employer plans under which you
Consequences of not deferring payments are covered, for information which might materially affect
At the time you become eligible to receive a distribution from your decision to defer payments. The fees and expenses
a retirement plan you have several decisions to make. You may associated with investment options can reduce the amount of
need to decide: retirement funds you can otherwise accumulate. The fees and
expenses (including administrative or investment related fees)
• Whether to take retirement funds from the plan now or outside the plan may be different form fees and expenses that
leave the funds in the plan and take at a later date; apply to the account held for you under your employer’s plan.

RBC12-12 | 03/2019 page 32 of 44

If you elect to roll over funds to another qualified plan or IRA, The Principal takes these payments into consideration
you should compare the expenses and fees in the underlying when determining plan administrative services fees for the
investment options of the qualified plan or IRA with those retirement plan.
you are currently subject to under your employer’s retirement While this communication may be used to promote or market
plan. The underlying investment options available to you a transaction or an idea that is discussed in the publication, it
under your employer’s plan are detailed on your benefit is intended to provide general information about the subject
statement, and can be accessed online at [Link]. matter covered and is provided with the understanding
These underlying investment options have expense charges. that The Principal is not rendering legal, accounting, or tax
For these expense ratios, see your prospectus or other advice. It is not a marketed opinion and may not be used to
investment material at [Link]. Your plan sponsor avoid penalties under the Internal Revenue Code. You should
may be paying for a portion of plan expenses. Contact your consult with appropriate counsel or other advisors on all
plan sponsor for details. You may find your plan contact matters pertaining to legal, tax or accounting obligations and
information in your Summary Plan Description. The Principal requirements.
may receive payments from investment option providers
in connection with the investments offered under the plan. *Spouse is defined according to applicable law.

RBC12-12 | 03/2019 page 33 of 44

Benefit illustration sample

The following chart provides an example of monthly benefits you and your spouse might receive under various
benefit options.

Assumptions:
› $25,000 vested account when payments begin
› Age is shown in the example

Option Monthly income

Starting at Starting at Starting at
age 65 age 55 age 45
Fixed Period Annuities

5 years $ 448.83 $ 448.83 $ 448.83

10 years $ 253.94 $ 253.94 $ 253.94

15 years $ 191.83 $ 191.83 $ 191.83

Installments * * *

Cash Distribution $25,000 $ 0.00 $ 0.00 $ 0.00

Note: This chart is for illustration only. It is not intended to project exact monthly benefits for you and your spouse. All amounts
are calculated assuming no commissions payable. Income could vary depending on state of residence at time of purchase to
reflect premium tax.
If you want a more specific projection of the benefits under the different options available in your retirement plan, call
1.800.547.7754, 7 a.m. – 9 p.m. (Monday–Friday) Central Time to request your own personalized Benefit Illustration.

* Varies based on benefit selected.

RBC12-12 | 03/2019 page 34 of 44

Your rollover options

You are receiving this notice because all or a portion of a payment This means that, in order to roll over the entire payment in a 60-day
you are receiving from the plan may be eligible to be rolled over to rollover, you must use other funds to make up for the 20% withheld.
an IRA or an employer plan. This notice is intended to help you decide If you do not roll over the entire amount of the payment, the portion
whether to do such a rollover. not rolled over will be taxed and will be subject to the 10% additional
income tax on early distributions if you are under age 59.5 (unless an
If you received this notice electronically, you may request a paper
exception applies).
copy at no additional charge by calling us at 1.800.547.7754,
7 a.m. – 9 p.m. Monday – Friday (Central Time). How much may I roll over?
This notice describes the rollover rules that apply to any payments If you wish to do a rollover, you may roll over all or part of the amount
from the plan that are not from a designated Roth account (a type eligible for rollover. Any payment from the plan is eligible for rollover,
of account with special rules in some employer plans). If you also except:
receive a payment from a designated Roth account in the plan, • Certain payments spread over a period of at least 10 years or over
please refer to the later “Your Rollover Options” section with your life or life expectancy (or the lives or joint life expectancy of
respect to that payment. you and your beneficiary);
Rules that apply to most payments from a plan are described in the • Required minimum distributions after age 70.5 (or after death);
“General Information About Rollovers” section. Special rules that only
• Hardship distributions;
apply in certain circumstances are described in the “Special Rules and
Options” section. • ESOP dividends;
• Corrective distributions of contributions that exceed tax law
General information about rollovers limitations;
• Loans treated as deemed distributions (for example, loans in default
How can a rollover affect my taxes?
due to missed payments before your employment ends);
You will be taxed on a payment from the plan if you do not roll it over. • Cost of life insurance paid by the plan;
If you are under age 59.5 and do not do a rollover, you will also have
to pay a 10% additional income tax on early distributions (generally, • Payments of certain automatic enrollment contributions requested
distributions made before age 59.5) unless an exception applies. to be withdrawn within 90 days of the first contribution; and
However, if you do a rollover, you will not have to pay tax until you • Amounts treated as distributed because of a prohibited allocation
receive payments later and the 10% additional income tax will not of S corporation stock under an ESOP (also, there will generally be
apply if those payments are made after you are age 59.5 (or if an adverse tax consequences if you roll over a distribution of
exception applies). S corporation stock to an IRA).
What types of retirement accounts and plans may accept Call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time) to
a rollover? find out what portion of a payment is eligible for rollover.
You may roll over the payment to either an IRA (an individual If I don’t do a rollover, will I have to pay the 10% additional
retirement account or individual retirement annuity) or an employer income tax on early distributions?
plan (a tax-qualified plan, section 403(b) plan, or governmental section
If you are under age 59.5 you will have to pay the 10% additional
457(b) plan) that will accept the rollover. The rules of the IRA or
income tax on early distributions for any payment from the plan
employer plan that holds the rollover will determine your investment
(including amounts withheld for income tax) that you do not roll over,
options, fees, and rights to payment from the IRA or employer plan
unless one of the exceptions listed below applies. This tax applies to
(for example, no spousal consent rules apply to IRAs and IRAs may not
the part of the distribution that you must include in income and is in
provide loans). Further, the amount rolled over will become subject to
addition to the regular income tax on the payment not rolled over.
the tax rules that apply to the IRA or employer plan.
The 10% additional income tax does not apply to the following
How do I do a rollover?
payments from the plan:
There are two ways to do a rollover. You can do either a direct rollover
• Payments made after you separate from service if you will be
or a 60-day rollover.
at least age 55 in the year of the separation;
If you do a direct rollover, the plan will make the payment directly to
• Payments that start after you separate from service if paid at
your IRA or an employer plan. You should contact the IRA sponsor or
least annually in equal or close to equal amounts over your life
the administrator of the employer plan for information on how to do
or life expectancy (or the lives or joint life expectancy of you
a direct rollover.
and your beneficiary);
If you do not do a direct rollover, you may still rollover by making • Payments from a governmental plan made after you separate from
a deposit into an IRA or eligible employer plan that will accept it. service if you are a qualified public safety employee and you are at
Generally, you will have 60 days after you receive the payment to least age 50 in the year of the separation;
make the deposit. If you do not do a direct rollover, the plan is required
to withhold 20% of the payment for federal income taxes (up to the • Payments made due to disability;
amount of cash and property received other than employer stock). • Payments after your death;

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 page 35 of 44

• Payments of ESOP dividends; have pre-1987 after-tax contributions maintained in a separate
• Corrective distributions of contributions that exceed tax law account, a special rule may apply to determine whether the after-tax
limitations; contributions are included in a payment. In addition, special rules
apply when you do a rollover, as described below.
• Cost of life insurance paid by the plan;
You may roll over to an IRA a payment that includes after-tax
• Payments made directly to the government to satisfy a federal tax contributions through either a direct rollover or a 60-day rollover.
levy; You must keep track of the aggregate amount of the after-tax
• Payments made under a qualified domestic relations order (QDRO); contributions in all of your IRAs (in order to determine your taxable
• Payments up to the amount of your deductible medical expenses income for later payments from the IRAs). If you do a direct rollover
(without regard to whether you itemize deductions for the taxable of only a portion of the amounts paid from the plan, and at the same
year); time the rest is paid to you, the portion directly rolled over consists
first of the amount that would be taxable if not rolled over. For
• Certain payments made while you are on active duty if you were example, assume you are receiving a distribution of $12,000, of which
a member of a reserve component called to active duty after $2,000 is after-tax contributions. In this case, if you directly roll over
September 11, 2001 for more than 179 days; $10,000 to an IRA that is not a Roth IRA, no amount is taxable because
• Payments of certain automatic enrollment contributions requested the $2,000 amount not directly rolled over is treated as being after-tax
to be withdrawn within 90 days of the first contribution; contributions. If you do a direct rollover of the entire amount paid
• Payments for certain distributions relating to certain federally from the plan to two or more destinations at the same time, you can
declared disasters; and choose which destination receives the after-tax contributions.

• Phased retirement payments made to federal employees. If you do a 60-day rollover to an IRA of only a portion of a payment
made to you, the after-tax contributions are treated as rolled over last.
If I do a rollover to an IRA, will the 10% additional income tax For example, assume you are receiving a distribution of $12,000, of
apply to early distributions from my IRA? which $2,000 is after-tax contributions, and no part of the distribution
If you receive a payment from an IRA when you are under age is directly rolled over. In this case, if you roll over $10,000 to an
59.5, you will have to pay the 10% additional income tax on early IRA that is not a Roth IRA in a 60-day rollover, no amount is taxable
distributions on the part of the distribution that you must include because the $2,000 amount not rolled over is treated as being after-
in income, unless an exception applies. In general, the exceptions to tax contributions.
the 10% additional income tax for early distributions from an IRA are
You may roll over to an employer plan all of a payment that includes
the same as the exceptions listed above for early distributions from a
after-tax contributions, but only through a direct rollover (and only if
plan. However, there are a few differences for payments from an IRA,
the receiving plan separately accounts for the after-tax contributions
including:
and is not a governmental section 457(b) plan). You can do a 60-day
• The exception for payments made after you separate from service rollover to an employer plan of part of a payment that includes after-
if you will be at least age 55 in the year of separation (or age 50 for tax contributions, but only up to the amount of the payment that
qualified public safety employees) does not apply. would be taxable if not rolled over.
• The exception for qualified domestic relations orders (QDROs) If you miss the 60-day rollover deadline
does not apply (although a special rule applies under which, as part
Generally, the 60-day rollover deadline cannot be extended. However,
of a divorce or separation agreement, a tax-free transfer may be
the IRS has the limited authority to waive the deadline under certain
made directly to an IRA of a spouse or former spouse).
extraordinary circumstances, such as when external events prevented
• The exception for payments made at least annually in equal or close you from completing the rollover by the 60-day rollover deadline.
to equal amounts over a specified period applies without regard to Under certain circumstances, you may claim eligibility for a waiver
whether you have had a separation from service. of the 60-day rollover deadline by making a written self-certification.
• There are additional exceptions for (1) payments for qualified Otherwise, to apply for a waiver from the IRS, you must file a private
higher education expenses, (2) payments up to $10,000 used letter ruling request with the IRS. Private letter ruling requests require
in a qualified first-time home purchase, (3) payments for health the payment of a nonrefundable user fee. For more information,
insurance premiums after you have received unemployment see IRS Publication 590-A, Contributions to Individual Retirement
compensation for 12 consecutive weeks (or would have been Arrangements (IRAs).
eligible to receive unemployment compensation but for self- If your payment includes employer stock that you do not
employed status). roll over
Will I owe state income taxes? If you do not do a rollover, you can apply a special rule to payments
This notice does not describe any State or local income tax rules of employer stock (or other employer securities) that are either
(including withholding rules). attributable to after-tax contributions or paid in a lump sum
after separation from service (or after age 59.5, disability, or the
participant’s death). Under the special rule, the net unrealized
Special rules and options
appreciation on the stock will not be taxed when distributed from the
If your payment includes after-tax contributions plan and will be taxed at capital gain rates when you sell the stock. Net
unrealized appreciation is generally the increase in the value of the
After-tax contributions included in a payment are not taxed. If a employer stock after it was acquired by the plan. If you do a rollover
payment is only part of your benefit, an allocable portion of your of a payment that includes employer stock (for example, by selling the
after-tax contributions is included in the payment, so you cannot stock and rolling over the proceeds within 60 days of the payment),
take a payment of only after-tax contributions. However, if you

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 page 36 of 44

the special rule relating to the distributed employer stock will not If you roll over your payment to a Roth IRA
apply to any subsequent payments from the IRA or employer plan.
If you roll over a payment from the plan to a Roth IRA, a special rule
Call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time) to applies under which the amount of the payment rolled over (reduced
find out the amount of any net unrealized appreciation. by any after-tax amounts) will be taxed. However, the 10% additional
If you have an outstanding loan that is being offset income tax on early distributions will not apply (unless you take the
amount rolled over out of the Roth IRA within 5 years, counting from
If you have an outstanding loan from the plan, your plan benefit may January 1 of the year of the rollover).
be offset by the amount of the loan, typically when your employment
ends. The loan offset amount is treated as a distribution to you at the If you roll over the payment to a Roth IRA, later payments from the
time of the offset. Generally, you may roll over all or any portion of Roth IRA that are qualified distributions will not be taxed (including
the offset amount. Any offset amount that is not rolled over will be earnings after the rollover). A qualified distribution from a Roth IRA
taxed (including the 10% additional income tax on early distributions, is a payment made after you are age 59.5 (or after your death or
unless an exception applies). You may roll over offset amounts to an disability, or as a qualified first-time homebuyer distribution of up to
IRA or an employer plan (if the terms of the employer plan permit the $10,000) and after you have had a Roth IRA for at least 5 years. In
plan to receive plan loan offset rollovers). applying this 5-year rule, you count from January 1 of the year for
which your first contribution was made to a Roth IRA. Payments from
How long you have to complete the rollover depends on what kind of the Roth IRA that are not qualified distributions will be taxed to the
plan loan offset you have. If you have a qualified plan loan offset, you extent of earnings after the rollover, including the 10% additional
will have until your tax return due date (including extensions) for the income tax on early distributions (unless an exception applies). You
tax year during which the offset occurs to complete your rollover. A do not have to take required minimum distributions from a Roth
qualified plan loan offset occurs when a plan loan in good standing IRA during your lifetime. For more information, see IRS Publication
is offset because your employer plan terminates, or because you 590-A, Contributions to Individual Retirement Arrangements (IRAs),
sever from employment. If your plan loan offset occurs for any other and IRS Publication 590-B, Distributions from Individual Retirement
reason, then you have 60 days from the date the offset occurs to Arrangements (IRAs).
complete your rollover.
If you do a rollover to a designated Roth account in the Plan
If you were born on or before January 1, 1936
You cannot roll over a distribution to a designated Roth account in
If you were born on or before January 1, 1936 and receive a lump sum another employer’s plan. However, you can roll the distribution over
distribution that you do not roll over, special rules for calculating into a designated Roth account in the distributing plan. If you roll over
the amount of the tax on the payment might apply to you. For more a payment from the plan to a designated Roth account in the plan, the
information, see IRS Publication 575, Pension and Annuity Income. amount of the payment rolled over (reduced by any after-tax amounts
If your payment is from a governmental section 457(b) plan directly rolled over) will be taxed. However, the 10% additional tax on
early distributions will not apply (unless you take the amount rolled
If the plan is a governmental section 457(b) plan, the same rules
over out of the designated Roth account within the 5-year period that
described elsewhere in this notice generally apply, allowing you to
begins on January 1 of the year of the rollover).
roll over the payment to an IRA or an employer plan that accepts
rollovers. One difference is that, if you do not do a rollover, you will If you roll over the payment to a designated Roth account in the plan,
not have to pay the 10% additional income tax on early distributions later payments from the designated Roth account that are qualified
from the plan even if you are under age 59.5 (unless the payment distributions will not be taxed (including earnings after the rollover).
is from a separate account holding rollover contributions that were A qualified distribution from a designated Roth account is a payment
made to the plan from a tax-qualified plan, a section 403(b) plan, or made both after you are age 59.5 (or after your death or disability)
an IRA). However, if you do a rollover to an IRA or to an employer plan and after you have had a designated Roth account in the plan for at
that is not a governmental section 457(b) plan, a later distribution least 5 years. In applying this 5-year rule, you count from January 1
made before age 59.5 will be subject to the 10% additional income tax of the year your first contribution was made to the designated Roth
on early distributions (unless an exception applies). Other differences account. However, if you made a direct rollover to a designated Roth
include that you cannot do a rollover if the payment is due to an account in the plan from a designated Roth account in a plan of
“unforeseeable emergency” and the special rules under “If your another employer, the 5-year period begins on January 1 of the year
payment includes employer stock that you do not roll over” and “If you made the first contribution to the designated Roth account in
you were born on or before January 1, 1936” do not apply. the distributing plan or, if earlier, to the designated Roth account in
the plan of the other employer. Payments from the designated Roth
If you are an eligible retired public safety officer and your
account that are not qualified distributions will be taxed to the extent
payment is used to pay for health coverage or qualified
of earnings after the rollover, including the 10% additional income tax
long-term care insurance
on early distributions (unless an exception applies).
If the plan is a governmental plan, you retired as a public safety
If you are not a plan participant
officer, and your retirement was by reason of disability, or was after
normal retirement age, you can exclude from your taxable income Payments after death of the participant. If you receive a distribution
plan payments paid directly as premiums to an accident or health plan after the participant’s death that you do not roll over, the distribution
(or a qualified long-term care insurance contract) that your employer will generally be taxed in the same manner described elsewhere in this
maintains for you, your spouse, or your dependents, up to a maximum notice. However, the 10% additional income tax on early distributions
of $3,000 annually. For this purpose, a public safety officer is a law and the special rules for public safety officers do not apply, and the
enforcement officer, firefighter, chaplain, or member of a rescue special rule described under the section “If you were born on or before
squad or ambulance crew. January 1, 1936” applies only if the participant was born on or before
January 1, 1936.

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 page 37 of 44

 If you are a surviving spouse. If you receive a payment from the See Form W-8BEN for claiming that you are entitled to a reduced rate
plan as the surviving spouse of a deceased participant, you have of withholding under an income tax treaty. For more information see
the same rollover options that the participant would have had, also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication
as described elsewhere in this notice. In addition, if you choose to 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.
do a rollover to an IRA, you may treat the IRA as your own or as an
Other special rules
inherited IRA.
If a payment is one in a series of payments for less than 10 years,
An IRA you treat as your own is treated like any other IRA of yours,
your choice whether to make a direct rollover will apply to all later
so that payments made to you before you are age 59.5 will be
payments in the series (unless you make a different choice for later
subject to the 10% additional income tax on early distributions
payments).
(unless an exception applies) and required minimum distributions
from your IRA do not have to start until after you are age 70.5. If your payments for the year are less than $200 (not including
payments from a designated Roth account in the plan), the plan is
If you treat the IRA as an inherited IRA, payments from the IRA will
not required to allow you to do a direct rollover and is not required
not be subject to the 10% additional income tax on early
to withhold federal income taxes. However, you may do a 60-day
distributions. However, if the participant had started taking required
rollover.
minimum distributions, you will have to receive required minimum
distributions from the inherited IRA. If the participant had not Unless you elect otherwise, mandatory cash out of more than $1,000
started taking required minimum distributions from the plan, you (not including payments from a designated Roth account in the plan)
will not have to start receiving required minimum distributions from will be directly rolled over to an IRA chosen by the plan administrator.
the inherited IRA until the year the participant would have been age A mandatory cash out is a payment from the plan to a participant
70.5. made before age 62 (or normal retirement age, if later) and without
If you are a surviving beneficiary other than a spouse. If you consent, where the participant’s benefit does not exceed $5,000 (or
receive a payment from the plan because of the participant’s death such lower amount stated in the plan) not including any amounts held
and you are a designated beneficiary other than a surviving spouse, under the plan as a result of a prior rollover made to the plan.
the only rollover option you have is to do a direct rollover to an You may have special rollover rights if you recently served in the U.S.
inherited IRA. Payments from the inherited IRA will not be subject Armed Forces. For more information, see IRS Publication 3, Armed
to the 10% additional income tax on early distributions. You will Forces’ Tax Guide. You also may have special rollover rights if you
have to receive required minimum distributions from the inherited were affected by a federally declared disaster (or similar event),
IRA. or if you received a distribution on account of a disaster. For more
Payments under a qualified domestic relations order. If you are the information on special rollover rights related to disaster relief, see
spouse or former spouse of the participant who receives a payment the IRS website at [Link].
from the plan under a qualified domestic relations order (QDRO),
you generally have the same options and the same tax treatment the For more information
participant would have (for example, you may roll over the payment
to your own IRA or an eligible employer plan that will accept it). You may wish to consult with the plan administrator or a professional
Payments under the QDRO will not be subject to the 10% additional tax advisor, before taking a payment from the plan. Also, you can
income tax on early distributions. find more detailed information on the federal tax treatment of
payments from employer plans in: IRS Publication 575, Pension
If you are a nonresident alien and Annuity Income; IRS Publication 590-A, Contributions to
If you are a nonresident alien and you do not do a direct rollover to a Individual Retirement Arrangements (IRAs); IRS Publication 590-B,
U.S. IRA or U.S. employer plan, instead of withholding 20%, the plan is Distributions from Individual Retirement Arrangements (IRAs); and
generally required to withhold 30% of the payment for federal income IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans).
taxes. If the amount withheld exceeds the amount of tax you owe (as These publications are available from a local IRS office, or on the web
may happen if you do a 60-day rollover) you may request an income at [Link], or by calling [Link].
tax refund by filing Form 1040NR and attaching your Form 1042-S.

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 page 38 of 44

Your rollover options

You are receiving this notice because all or a portion of a payment you accept the rollover. The rules of the Roth IRA or employer plan that
are receiving from the plan may be eligible to be rolled over to a Roth holds the rollover will determine your investment options, fees, and
IRA or designated Roth account in an employer plan. This notice is rights to payment from the Roth IRA or employer plan (for example,
intended to help you decide whether to do a rollover. no spousal consent rules apply to Roth IRAs and Roth IRAs may not
provide loans). Further, the amount rolled over will become subject to
This notice describes the rollover rules that apply to any payments
the tax rules that apply to the Roth IRA or the designated Roth account
from the plan that are from a designated Roth account, if such
in the employer plan. In general, these tax rules are similar to those
account is available in your employer’s plan. If you also receive a
described elsewhere in this notice, but differences include:
payment from the plan that is not from a designated Roth account,
refer to the earlier “Your Rollover Options” section. • If you do a rollover to a Roth IRA, all of your Roth IRAs will be
considered for purposes of determining whether you have satisfied
Rules that apply to most payments from a designated Roth account are
the 5-year rule (counting from January 1 of the year for which your
described in the “General Information About Rollovers” section. Special
first contribution was made to any of your Roth IRAs).
rules that only apply in certain circumstances are described in the
“Special Rules and Options” section. • If you do a rollover to a Roth IRA, you will not be required to take a
distribution from the Roth IRA during your lifetime and you must
General information about rollovers keep track of the aggregate amount of the after-tax contributions
in all of your Roth IRAs (in order to determine your taxable income
How can a rollover affect my taxes? for later Roth IRA payments that are not qualified distributions).

After-tax contributions included in a payment from a designated Roth • Eligible rollover distributions from a Roth IRA can only be rolled over
account are not taxed, but earnings might be taxed. The tax treatment to another Roth IRA.
of earnings included in the payment depends on whether the payment How do I do a rollover?
is a qualified distribution. If a payment is only part of your designated
Roth account, the payment will include an allocable portion of the There are two ways to do a rollover. You can either do a direct rollover
earnings in your designated Roth account. or a 60-day rollover.

If the payment from the plan is not a qualified distribution and you If you do a direct rollover, the plan will make the payment directly
do not do a rollover to a Roth IRA or a designated Roth account in an to your Roth IRA or designated Roth account in an employer plan.
employer plan, you will be taxed on the earnings in the payment. If you You should contact the Roth IRA sponsor or the administrator of the
are under age 59.5, a 10% additional income tax on early distributions employer plan for information on how to do a direct rollover.
(generally distributions made before age 59.5) will also apply to the If you do not do a direct rollover, you may still do a rollover by making
earnings (unless an exception applies). However, if you do a rollover, a deposit (generally within 60 days) into a Roth IRA, whether the
you will not have to pay taxes currently on the earnings and you will payment is a qualified or nonqualified distribution. In addition, you
not have to pay taxes later on payments that are qualified distributions. can do a rollover by making a deposit within 60 days into a designated
If the payment from the plan is a qualified distribution, you will not be Roth account in an employer plan if the payment is a nonqualified
taxed on any part of the payment even if you do not do a rollover. If you distribution and the rollover does not exceed the amount of earnings
do a rollover, you will not be taxed on the amount you roll over and any in the payment. You cannot do a 60-day rollover to an employer plan of
earnings on the amount you roll over will not be taxed if paid later in a any part of a qualified distribution. If you receive a distribution that is
qualified distribution. a nonqualified distribution and you do not roll over an amount at least
equal to the earnings allocable to the distribution, you will be taxed
A qualified distribution from a designated Roth account in the plan is a
on the amount of those earnings not rolled over, including the 10%
payment made after you are age 59.5 (or after your death or disability)
additional income tax on early distributions if you are under age 59.5
and after you have had a designated Roth account in the plan for
(unless an exception applies).
at least 5 years. In applying the 5-year rule, you count from January
1 of the year your first contribution was made to the designated If you do a direct rollover of only a portion of the amount paid from the
Roth account. However, if you did a direct rollover to a designated plan and a portion is paid to you at the same time, the portion directly
Roth account in the plan from a designated Roth account in another rolled over consists first of earnings.
employer plan, your participation will count from January 1 of the year If you do not do a direct rollover and the payment is not a qualified
your first contribution was made to the designated Roth account in the distribution, the plan is required to withhold 20% of the earnings for
plan, or, if earlier, to the designated Roth account in the other employer federal income taxes (up to the amount of cash and property received
plan. other than employer stock). This means that, in order to roll over the
What types of retirement accounts and plans may accept entire payment in a 60-day rollover to a Roth IRA, you must use other
my rollover? funds to make up for the 20% withheld.

You may roll over the payment to either a Roth IRA (a Roth individual How much may I roll over?
retirement account or Roth individual retirement annuity) or a If you wish to do a rollover, you may roll over all or part of the amount
designated Roth account in an employer plan (a tax-qualified plan, a eligible for rollover. Any payment from the plan is eligible for rollover,
section 403(b) plan, or a governmental section 457(b) plan) that will except:

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 | Qualified Defined Contribution plans (Benefit Event Process without Life Annuities) page 39 of 44
• Certain payments spread over a period of at least 10 years or over September 11, 2001 for more than 179 days;
your life or life expectancy (or the lives or joint life expectancy of
• Payments of certain automatic enrollment contributions requested
you and your beneficiary);
to be withdrawn within 90 days of the first contribution; and
• Required minimum distributions after age 70.5 (or after death);
• Payments for certain distributions relating to certain federally
• Hardship distributions; declared disasters.
• ESOP dividends; If I do a rollover to a Roth IRA, will the 10% additional
• Corrective distributions of contributions that exceed tax law
income tax apply to early distributions from the IRA?
limitations; If you receive a payment from a Roth IRA when you are under age
59.5, you will have to pay the 10% additional income tax on early
• Loans treated as deemed distributions (for example, loans in default
distributions on the earnings paid from the Roth IRA, unless an
due to missed payments before your employment ends);
exception applies or the payment is a qualified distribution. In general,
• Cost of life insurance paid by the plan; the exceptions to the 10% additional income tax for early distributions
• Payments of certain automatic enrollment contributions requested from a Roth IRA listed above are the same as the exceptions for early
to be withdrawn within 90 days of the first contribution; and distributions from a plan, However, there are a few differences for
payments from a Roth IRA including:
• Amounts treated as distributed because of a prohibited allocation
of S corporation stock under an ESOP (also, there will generally • The exception for payments after you separate from service if you
be adverse tax consequences if you roll over a distribution of will be at least age 55 in the year of the separation (or age 50 for
S corporation stock to an IRA). qualified public safety employees) does not apply.

Call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time) to • The exception for qualified domestic relations orders (QDROs)
find out what portion of a payment is eligible for rollover. does not apply (although a special rule applies under which, as part
of a divorce or separation agreement, a tax-free transfer may be
If I don’t do a rollover, will I have to pay the 10% additional made directly to a Roth IRA of a spouse or former spouse).
income tax on early distributions?
• The exception for payments made at least annually in equal or close
If a payment is not a qualified distribution and you are under age to equal amounts over a specified period applies without regard to
59.5, you will have to pay the 10% additional income tax on early whether you have had a separation from service
distributions with respect to the earnings allocated to the payment
that you do not roll over (including amounts withheld for income tax), • There are additional exceptions for (1) payments for qualified higher
unless one of the exceptions listed below applies. This tax is in addition education expenses, (2) payments up to $10,000 used in a qualified
to the regular income tax on the earnings not rolled over. first-time home purchase, (3) payments after you have received
unemployment compensation for 12 consecutive weeks (or would
The 10% additional income tax does not apply to the following have been eligible to receive unemployment compensation but for
payments from the plan: self-employed status).
• Payments made after you separate from service if you will be at least
Will I owe state income taxes?
age 55 in the year of the separation;
This notice does not describe any State or local income tax rules
• Payments that start after you separate from service if paid at
(including withholding rules).
least annually in equal or close to equal amounts over your life or
life expectancy (or the lives or joint life expectancy of you and your
beneficiary);
Special rules and options
• Payments from a governmental plan made after you separate from If you miss the 60-day rollover deadline
service if you are a qualified public safety employee and you are at
Generally, the 60-day rollover deadline cannot be extended. However,
least age 50 in the year of the separation;
the IRS has the limited authority to waive the deadline under certain
• Payments made due to disability; extraordinary circumstances, such as when external events prevented
you from completing the rollover by the 60-day rollover deadline.
• Payments after your death;
Under certain circumstances, you may claim eligibility for a waiver
• Payments of ESOP dividends; of the 60-day rollover deadline by making a written self-certification.
• Corrective distributions of contributions that exceed tax law Otherwise, to apply for a waiver from the IRS, you must file a private
limitations; letter ruling request with the IRS. Private letter ruling requests require
the payment of a nonrefundable user fee. For more information,
• Cost of life insurance paid by the plan;
see IRS Publication 590-A, Contributions to Individual Retirement
• Payments made directly to the government to satisfy a federal tax Arrangements (IRAs).
levy;
If your payment includes employer stock that you do not
• Payments made under a qualified domestic relations order (QDRO); roll over
• Payments up to the amount of your deductible medical expenses If you receive a payment that is not a qualified distribution and you
(without regard to whether you itemize deductions for the taxable do not roll it over, you can apply a special rule to payments of employer
year); stock (or other employer securities) that are paid in a lump sum after
separation from service (or after age 59.5, disability or the participant’s
• Certain payments made while you are on active duty if you were a
death). Under the special rule, the net unrealized appreciation on the
member of a reserve component called to active duty after
stock included in the earnings in the payment will not be taxed when

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 | Qualified Defined Contribution plans (Benefit Event Process without Life Annuities) page 40 of 44
distributed to you from the plan and will be taxed at capital gain income tax on earnings allocated to the payment (unless an exception
rates when you sell the stock. If you do a rollover to a Roth IRA of a applies). Other differences include that you cannot do a rollover if the
nonqualified distribution that includes employer stock (for example payment is due to an “unforeseeable emergency” and the special rules
by selling the stock and rolling over the proceeds within 60 days of under “If your payment includes employer stock that you do not roll
the distribution), you will not have any taxable income and the special over” and “If you were born on or before January 1, 1936” do not apply.
rule relating to the distributed employer stock will not apply to any
If you receive a nonqualified distribution, are an eligible
subsequent payments from the Roth IRA or employer plan. Net
retired public safety officer, and your payment is used to pay
unrealized appreciation is generally the increase in the value of the
for health coverage or qualified long-term care insurance
employer stock after it was acquired by the plan.
If the plan is a governmental plan, you retired as a public safety officer,
Call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time) to
and your retirement was by reason of disability or was after normal
find out the amount of any net unrealized appreciation.
retirement age, you can exclude from your taxable income nonqualified
If you receive a payment that is a qualified distribution that includes distributions paid directly as premiums to an accident or health plan
employer stock and you do not roll it over, your basis in the stock (used (or a qualified long-term care insurance contract) that your employer
to determine gain or loss when you later sell the stock) will equal the maintains for you, your spouse, or your dependents, up to a maximum
fair market value of the stock at the time of the payment from the plan. of $3,000 annually. For this purpose, a public safety officer is a law
enforcement officer, firefighter, chaplain, or member of a rescue squad
If you have an outstanding loan that is being offset
or ambulance crew.
If you have an outstanding loan from the plan, your plan benefits may
If you are not a plan participant
be offset by the amount of the loan, typically when your employment
ends. The loan offset amount is treated as a distribution to you at the Payments after death of participant. If you receive a distribution
time of the offset. Generally, you may roll over all or any portion of after the participant’s death that you do not roll over, the distribution
the offset amount. If the distribution attributable to the offset is not a will generally be taxed in the same manner described elsewhere in
qualified distribution and you do not roll over the offset amount, you this notice. However, whether the payment is a qualified distribution
will be taxed on earnings included in the distribution (including the generally depends on when the participant first made a contribution
10% additional income tax on early distributions, unless an exception to the designated Roth account in the plan. Also, the 10% additional
applies). You may roll over the earnings included in the loan offset income tax on early distributions and the special rules for public safety
to a Roth IRA or designated Roth Account in an employer plan (if the officers do not apply, and the special rule described under the section
terms of the employer plan permit the plan to receive plan loan offset “If you receive a nonqualified distribution and you were born on or
rollovers). You may also roll over the full amount of the offset to a Roth before January 1, 1936” applies only if the participant was born on or
IRA. before January 1, 1936.
How long you have to complete the rollover depends on what kind of If you are a surviving spouse. If you receive a payment from the
plan loan offset you have. If you have a qualified plan loan offset, you plan as the surviving spouse of a deceased participant, you have
will have until your tax return due date (including extensions) for the the same rollover options that the participant would have had, as
tax year during which the offset occurs to complete your rollover. A described elsewhere in this notice. In addition, if you choose to do a
qualified plan loan offset occurs when a plan loan in good standing is rollover to a Roth IRA, you may treat the Roth IRA as your own or as
offset because your employer plan terminates, or because you sever an inherited Roth IRA.
from employment. If your plan loan offset occurs for any other reason,
A Roth IRA you treat as your own is treated like any other Roth IRA
then you have 60 days from the date the offset occurs to complete
of yours, so that you will not have to receive any required minimum
your rollover.
distributions during your lifetime and earnings paid to you in a
If you receive a nonqualified distribution and you were born nonqualified distribution before you are age 59.5 will be subject
on or before January 1, 1936 to the 10% additional income tax on early distributions (unless an
exception applies).
If you were born on or before January 1, 1936, and receive a lump sum
distribution that is not a qualified distribution and that you do not roll If you treat the Roth IRA as an inherited Roth IRA, payments from
over, special rules for calculating the amount of the tax on the earnings the Roth IRA will not be subject to the 10% additional income tax
in the payment might apply to you. For more information, see IRS on early distributions. An inherited Roth IRA is subject to required
Publication 575, Pension and Annuity Income. minimum distributions. If the participant had started taking required
minimum distributions from the plan, you will have to receive
If your payment is from a governmental section 457(b) plan
required minimum distributions from the inherited Roth IRA. If the
If the plan is a governmental section 457(b) plan, the same rules participant had not started taking required minimum distributions,
described elsewhere in this notice generally apply, allowing you to roll you will not have to start receiving required minimum distributions
over the payment to an IRA or an employer plan that accepts rollovers. from the inherited Roth IRA until the year the participant would
One difference is that, if you receive a payment that is not a qualified have been age 70.5.
distribution and you do not roll it over, you will not have to pay the 10%
If you are a surviving beneficiary other than a spouse. If you receive
additional income tax on early distributions from the plan even if you
a payment from the plan because of the participant’s death and you
are under age 59.5 (unless the payment is from a separate account
are a designated beneficiary other than the surviving spouse, the
holding rollover contributions that were made to the plan from a tax-
only rollover option you have is to do a direct rollover to an inherited
qualified plan, a section 403(b) plan, or an IRA). However, if you do a
Roth IRA. Payments from the inherited Roth IRA, even if made in a
rollover to an IRA or to an employer plan that is not a governmental
nonqualified distribution, will not be subject to the 10% additional
section 457(b) plan, a later distribution that is not a qualified
income tax on early distributions. You will have to receive required
distribution made before age 59.5 will be subject to the 10% additional
minimum distributions from the inherited Roth IRA.

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 | Qualified Defined Contribution plans (Benefit Event Process without Life Annuities) page 41 of 44
Payments under a qualified domestic relations order. If you are the cashout is a payment from the plan to a participant made before age
spouse or a former spouse of the participant who receives a payment 62 (or normal retirement age, if later) and without consent, where the
from the plan under a qualified domestic relations order (QDRO), participant’s benefit does not exceed $5,000 (or such lower amount
you generally have the same options the participant would have (for stated in the plan) not including any amounts held under the plan as a
example, you may roll over the payment as described in this notice). result of a prior rollover made to the plan.
If you are a nonresident alien You may have special rollover rights if you recently served in the U.S.
Armed Forces. For more information on special rollover rights related
If you are a nonresident alien and you do not do a direct rollover to a
to the U.S. Armed Forces, see IRS Publication 3, Armed Forces’ Tax
U.S. IRA or U.S. employer plan, instead of withholding 20%, the plan
Guide. You also may have special rollover rights if you were affected
is generally required to withhold 30% of the payment for federal
by a federally declared disaster (or similar event), or if you received a
income taxes. If the amount withheld exceeds the amount of the tax
distribution on account of a disaster. For more information on special
you owe (as may happen if you do a 60-day rollover), you may request
rollover rights related to disaster relief, see the IRS website at
an income tax refund by filing Form 1040NR and attaching your
[Link].
Form 1042-S. See Form W-8BEN for claiming that you are entitled to
a reduced rate of withholding under an income tax treaty. For more
information, see also IRS Publication 519, U.S. Tax Guide for Aliens, For more information
and IRS Publication 515, Withholding of Tax on Nonresident Aliens
You may wish to consult with the plan administrator or a professional
and Foreign Entities.
tax advisor before taking a payment from the plan. Also, you can
Other special rules find more detailed information on the federal tax treatment of
If a payment is one in a series of payments for less than 10 years, your payments from employer plans in: IRS Publication 575, Pension and
choice whether to make a direct rollover will apply to all later payments Annuity Income; IRS Publication 590-A, Contributions to Individual
in the series (unless you make a different choice for later payments). Retirement Arrangements (IRAs); IRS Publication 590-B, Distributions
from Individual Retirement Arrangements (IRAs); and IRS Publication
If your payments for the year (only including payments from the
571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications
designated Roth account in the plan) are less than $200, the plan is
are available from a local IRS office, on the web at [Link], or by
not required to allow you to do a direct rollover and is not required to
calling [Link].
withhold federal income taxes. However, you may do a 60-day rollover.
Unless you elect otherwise, a mandatory cashout from the designated
Roth account in the plan of more than $1,000 will be directly rolled
over to a Roth IRA chosen by the plan administrator. A mandatory

If you have additional questions after reading this notice, call 1.800.547.7754, 7 a.m. - 9 p.m. Monday - Friday (Central Time).

RBC12-12 | 03/2019 | Qualified Defined Contribution plans (Benefit Event Process without Life Annuities) page 42 of 44
 Questions?
 We’re here to help. Call 1.800.547.7754, Monday through Friday, 7 a.m. - 7 p.m. (Central Time).

RBC12-12 | 03/2019 page 43 of 44

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RBC12-12 | © 2019 Principal Financial Services, Inc. | 03/2019 | t16090901ja