Beneficiary Distribution Request - Capital Group

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RecordkeeperDirect?

Beneficiary Distribution Request

Beneficiary: Use this form to request a cash distribution, rollover or RMD from assets that were inherited from a RecordkeeperDirect

retirement plan participant. Discuss distribution options and restrictions with the employer sponsoring the plan. You may also want to consult

your tax advisor. If you have questions about this form, call us at (800) 421-4120.

Plan sponsor: Submit this form with or after the Beneficiary Transfer Authorization. You may want to review this form with your plan¡¯s TPA.

If there are multiple beneficiaries, each will need to complete and submit a separate Beneficiary Distribution Request.

1

Beneficiary information

Important: Distribution requests are subject to a 10-day hold after an address change unless your signature is guaranteed in Section 8.

If this form includes a signature guarantee, the original copy must be mailed.

Plan name

Plan ID number

Name of beneficiary

SSN/TIN (provide the last four digits)

? ? ? ? ?

Address of beneficiary

(

City

State

ZIP

)

Daytime phone

¡õ U.S. resident alien ¡õ Nonresident alien (Submit an IRS Form W-8BEN.)

Relationship to deceased participant:

¡õ Spousal beneficiary ¡õ Non-spousal beneficiary ¡õ Estate, charity or trust

Citizenship:

¡õ U.S. citizen

? ? ?¨C? ?¨C

Name of deceased participant

2

SSN of deceased participant (provide the last four digits)

Payment instructions for cash distribution or rollover

Capital Group will deduct a $25 processing fee for this distribution. Additional fees from the plan¡¯s third-party administrator may apply.

Refer to the Participant Fee Disclosure document or contact the employer sponsoring the plan for more information. Distribution amounts are taken

proportionately from all investment options in applicable contribution types.

Total cash distribution or rollover amount:

¡õ All

¡õ

OR

%

Notes regarding RMDs:

? If you (the beneficiary) or the deceased participant have not satisfied required minimum distribution requirements for the current year, an

RMD may need to be taken from this account. Contact your tax advisor and/or the employer sponsoring the plan for more information.

? RMDs are not eligible for rollover. In addition, RMDs cannot be converted to a Roth account.

? To request an RMD, complete Section 5. If requesting an RMD and a lump-sum distribution or rollover, the RMD will be deducted from

the total amount requested above.

Select A, B or C.

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A.

¡õ Single lump-sum cash distribution (Proceed to Section 3.)

Continued on next page

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Beneficiary Distribution Request

Name of beneficiary

2

Plan ID number

Payment instructions for cash distribution or rollover

(continued)

Notes regarding rollovers:

? Non-spousal beneficiaries are limited to moving funds to an inherited IRA.

? Roth assets can only be rolled over to another designated Roth account or to a Roth IRA.

? If pre-tax assets are rolled over to a Roth IRA, you may be taxed on the pre-tax portion. This type of rollover is also known as a Roth conversion.

B.

¡õ Direct rollover to an American Funds IRA

If rolling to a new American Funds account, attach an IRA application to this form. If rolling to an existing American Funds IRA, select

the receiving account type(s):

¡õ Traditional IRA

Existing account number:

¡õ Roth IRA

Existing account number:

Investment instructions (Select one.)

1.

¡õ Roll over to the same American Funds and percentages as currently invested.

OR

2.

Note: This option is NOT available if the account currently holds any non¨CAmerican Funds investments.

¡õ Roll over to the following funds. (If additional space is needed, attach a separate page.)

Fund name or number

Percentage

%

%

%

%

%

%

Total rollover

%

Notes: ? At the time of the rollover to an American Funds IRA, your retirement plan assets will automatically be converted to Class A

shares at Net Asset Value (NAV) (no sales charge).

? For a quick guide to fund names, numbers, minimums and share class restrictions, go to fundguide.

? If a fund is not selected and investment instructions were not previously provided for this rollover, the investment will be

placed in the money market fund.

? If you are rolling assets to multiple accounts, and wish to specify different investment instructions for each account,

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provide instructions on a separate page.

Continued on next page

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Beneficiary Distribution Request

Name of beneficiary

2

C.

Plan ID number

Payment instructions for cash distribution or rollover

(continued)

¡õ Direct rollover to a non¨CAmerican Funds IRA or retirement plan

Note: If you haven¡¯t already established the receiving account at the new provider, you¡¯ll need to do so before submitting this form.

If you are rolling assets to an employer-sponsored retirement plan, verify the plan will accept the rollover before submitting this form.

1. Receiving account(s)

Name of financial institution/payee

Account number/Plan ID

¡õ Traditional IRA

¡õ Roth IRA

¡õ Retirement plan

¡õ Inherited Traditional IRA

¡õ Inherited Roth IRA

Note: The rollover check(s) will be payable to the receiving financial institution and mailed to your address of record. Once you

receive the check, you¡¯ll need to forward it to the receiving financial institution.

2. Expedite delivery ¡ª optional:

¡õ Check this box to expedite delivery. (A $25 delivery fee will be deducted.)

Estimated delivery time is two business days from the date the request is processed. Physical address is required ¡ª no P.O. boxes.

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? Proceed to Section 5.

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Beneficiary Distribution Request

Name of beneficiary

3

A.

Plan ID number

Delivery instructions for cash distribution

Select one of the three options below. If no selection is made, a distribution check will be sent via regular mail.

¡õ Send the distribution electronically (via ACH) to the bank account in Section 4. Once processed, the distribution will be delivered to

your bank within three business days following the transaction. (This option is not available for nonresident alien distributions.)

Note: To receive your distribution without delay, either you must provide a signature guarantee, or your bank registration must be

validated electronically (by Capital Group upon receipt of this form). If neither of these conditions are met, the distribution is

subject to a 10-day hold and/or may be sent out via check. We reserve the right to reject ACH requests. For more information,

refer to the Bank Verification Terms & Conditions.

¡õ Send a check to the address of record via regular mail. Proceed to Section 5.

C. ¡õ Send a check to the address of record and expedite delivery. Estimated delivery time is two business days from the date the request

B.

is processed. Proceed to Section 5. (A $25 delivery fee will be deducted. Physical address is required ¡ª no P.O. boxes.)

4

Bank information ¡ª Complete only if requesting electronic deposit

The receiving bank account must be a U.S. checking or savings account. Your bank information will be retained. We will use a third-party service to

validate your bank information. Refer to the Bank Verification Terms & Conditions.

Attach an unsigned, voided check below. Please do not staple.

The check must be preprinted with the bank name and registration, routing number and account number. Your name (the beneficiary identified

in Section 1) MUST be included in the bank registration. If these requirements are not met, an electronic deposit cannot be made, and a

physical check will be mailed to you instead.

Tape your check here.

John Doe

DATE

D

I

VO

Bank account registration

PAY TO THE

ORDER OF

Anytown Bank

|:999999999|:

Bank routing number

$

DOLLARS

Bank name

0000000000||:

Bank account number

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Note: In lieu of a voided check, you may submit a letter from your bank providing the registration, routing number, account number and

account type (checking or savings). The letter must be on the bank¡¯s letterhead.

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Beneficiary Distribution Request

Name of beneficiary

5

Plan ID number

Required minimum distribution (RMD) ¡ª if applicable

If you (the beneficiary) or the deceased participant have not satisfied required minimum distribution requirements for the current year, an RMD may

need to be taken from this account. Contact your tax advisor and/or the employer sponsoring the plan for more information. Distribution amounts are

taken proportionately from all investment options in applicable contribution types.

A. RMD amount

$

Note: We cannot accept RMD calculation requests.

B. Roth payment instructions

If the account does not contain Roth assets, proceed to C. If applicable, indicate how you wish to have the RMD amount taken from

the Roth account. If a box is not checked and the account holds Roth funds, the RMD will be processed proportionately from Roth and

non-Roth funds.

There are funds in a Roth money source and I wish to deplete:

¡õ Roth funds first ¡õ Non-Roth funds first

C. Delivery instructions

¡õ Send the distribution electronically (via ACH) to the bank account in Section 4. Once processed, the distribution will be delivered

to your bank within three business days following the transaction. (This option is not available for nonresident alien distributions.)

Note: To receive your distribution without delay, either you must provide a signature guarantee, or your bank registration must be

validated electronically (by Capital Group upon receipt of this form). If neither of these conditions are met, the distribution is

subject to a 10-day hold and/or may be sent out via check. We reserve the right to reject ACH requests. For more information,

refer to the Bank Verification Terms & Conditions.

¡õ Mail a check directly to me at the address of record.

D. Federal income tax withholding

The taxable amount of the RMD, including earnings applicable to after-tax contributions, will be subject to 10% withholding unless otherwise

indicated below.

Refer to IRS Form W-4R for additional information. Insufficient withholding or underpayment of estimated taxes may result in IRS penalties.

If you are a nonresident alien (NRA), 30% NRA withholding may apply to the distribution.

¡õ DO NOT withhold federal taxes. Your U.S. residence address is required to honor this request (no P.O. boxes).

Residence address (physical address required ¡ª no P.O. boxes)

¡õ Withhold federal income tax at the rate of

City

State

ZIP

% (Whole % only)*

*Rates that include decimals will be rounded to the nearest whole number.

E. State income tax withholding

If your state requires withholding or if the amount you enter below is less than the minimum for your state, Capital Bank and Trust

Company (CB&T) will withhold at least the minimum state tax. CB&T does not withhold taxes for all states.

¡õ DO NOT withhold ¡õ Withhold $

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Note: To review the impacts of withholding for your state of residence, visit statetax or speak with your

tax advisor. If a state form W-4P is required, the form must be completed and provided to the employer sponsoring the plan.

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