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2001 Spring Road, Suite 700
Oak Brook, IL 60523
877.682.4727 Telephone
630.368.5697 Fax
arp@mtrustcompany.com E-mail
www.mtrustcompany.com
Tracking Code:
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Need Assistance?
If you require assistance, please contact out Client Service Team during regular business hours, Monday - Friday from 8:00 a.m. - 4:30 p.m. CT and have you tracking code ready -
If your IRA was rolled over from a previous employer, please call 877.682.4727 or email arp@mtrustcompany.com

If you are contacting us about an INTRUST payout, please call 800.783.4022 or email INTRUSTpayout@mtrustcompany.com
Please resolve the following issues before proceeding
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Requirements

IRA Distribution Request
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Distribution Request Checklist
To request a distribution you will need:
Identifying information -Tax identification no. (e.g. social security number), date of birth, etc. Contact information - Legal residential address, e-mail address, phone no. Reason for distribution – e.g. normal, early, disability, or from an Inherited IRA
Additional items you may need during the distribution process: If requesting a rollover to your current employer's plan, please have the plan name, plan number, and check payable instructions If requesting a distribution to be directly deposited to your bank, please have your banking information available (e.g. bank name, address, routing number and your account number)
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Getting Started

IRA Distribution Request
Fields marked with * are required
IRA Distribution Request
Please fill in the information to complete this form, mandatory fields are marked with an asterisk *

First, we need to ask you a few questions to make sure that we can process your distribution online.

Online Eligibility

Are you seeking any of the following distribution types? *
Do you have non-cash assets that require liquidation for this distribution? *

Contact Details

IRA Distribution Request
Fields marked with * are required

Name

Date of Birth

Other Details

Contact Details

Address Details

IRA Distribution Request
Fields marked with * are required

Address Details

Address Limitations
P.O. Boxes are not acceptable as Residential addresses. Provide the address you use for tax filing.

If you provide a separate mailing address, the mailing address will be saved and stored for reference as your primary address of record. All future mail correspondence will be sent to this address including statements and tax reporting.

Note: FedEx cannot be sent to a P.O. Box address.

Residential Address

Verifying Address... Please wait.
Which Address? *

Mailing Address

Is your Mailing Address the same as your Residential Address? *
Verifying Address... Please wait.
Which Address? *

Identity Verification

IRA Distribution Request
Fields marked with * are required

Identity Verification

IMPORTANT USA PATRIOT ACT INFORMATION
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means to you:
You must provide us with your name, residential address, social security number, and date of birth, and other information that will allow us to identify you before you will be able to exercise control over your account. We may also ask for other identifying documents.

After you confirm your identity, the following data cannot be changed for this online form - name, address, social security/tax identification number and date of birth.
Do you confirm that the details you have entered are correct? *

VerifyResult

Address Confirmation

IRA Distribution Request
Fields marked with * are required

Address Confirmation

Which Address?
We compared the address you entered to a database of valid addresses and suggest changes.
Please review and select the most accurate.
Which address is most accurate? *

Verification Questions

IRA Distribution Request
Fields marked with * are required

Verification Questions

Additional verification is required.
To help verify your identity we’ve compiled a series of questions that only you should be able to answer. You will have 3 minutes to complete them.
User is currently completing their CIP questions
Please reload this page once the user has completed the CIP questions.

Personal Details

IRA Distribution Request
Fields marked with * are required

Meta-PersonalDetails

Age Calculation

We have calculated that you are at least 59½
We have calculated that you will be 59½ on
Did you know that if you wait until you turn 59½ to take a distribution you may avoid IRS penalties and fees associated with an early distribution?
Distributions processed on an IRA when the taxpayer has not reached age 59½ may be subject to additional IRS penalties and fees.
Do you agree with this calculation? *

Disability

Disability Exception to 10% Early Withdrawal Penalty
According to Internal Revenue Code section 72(m)(7), you are considered disabled if you cannot do any substantial gainful activity because your physical or mental condition can be expected to result in death or to be of long, continued, and indefinite duration.

In order for Millennium Trust Company to process a distribution with a disability exception to the early withdrawal penalty per the Internal Revenue Code, you will need to provide a copy of a physician's statement confirming your disability status.
Are you Disabled within meaning of the Internal Revenue Code section 72(m)(7)? *
Have you previously provided documentary evidence to Millennium of permanent disability? *

Citizenship

Which of the following best describes you? *

Account Details

IRA Distribution Request
Fields marked with * are required

Multiple Accounts

User needs to select an account.
Please reload this page once the user has selected an account.
Which Account?
Since you didn't provide us with a specific Account Number, we've searched our records for all relevant Accounts that belong to you.

Please review the following Accounts and select the Account to request a Distribution from.

Please choose carefully as there is no way to change your selection other than starting this application again.
Account Number
Account Type
Account Title

Account Details

Account Type

What type of account would you like to take a distribution from? *

Inherited Account

A retirement account that is left to a beneficiary after the owner's death.
Did you inherit this account as a beneficiary of the account owner? *
Did you inherit this account from a spouse? *
Has a death certificate and/or other documentation to your inheritance been previously provided to Millennium? *

AccountLookupResult

Distribution Type

IRA Distribution Request
Fields marked with * are required

Distribution from a Traditional IRA

What type of distribution do you want to take?
1.Paid to directly to me: If you want to withdraw funds from your IRA, payable directly to you, please click the "Withdraw my funds from my IRA and pay directly to me" button below. Once your request is processed, your funds will be paid directly to you. Be sure you understand whether any taxes or penalties may apply - read the information in the box below about Early (Premature) Distribution.
2.Direct rollover to my new employer's retirement plan: If you want to directly roll over your IRA balance to your new employer's retirement plan, click the "Directly roll over to my new employer's retirement plan" button below. You will be directed to the section of this form where you will need to provide information about your employer. Once your request is processed, a check will be issued, payable to your employer's retirement plan, and mailed to you. You will need to send the check to your employer's retirement plan in order to complete the rollover.
Choose your distribution type: *
Early (Premature) Distribution
This distribution type would apply to a tax payer that has not reached age 59 ½.

Distributions before age 59 ½ may be subject to ordinary income tax and may also be subject to a 10% federal penalty tax unless you meet an IRS exception.
A distribution from a SIMPLE IRA taken within two years of the date the first contribution was made may be subject to a 25% penalty tax unless you meet an IRS exception.
Note: If you believe an exception may apply to the early withdrawal penalty, you should consult your tax advisor to determine if you need to submit IRS Form 5329 to the IRS.

Distribution from a Roth IRA

Is the 5 year holding period on your Roth IRA complete? *

Confirmation

Based on the information you have provided your distribution will be processed as .
Do you confirm this selection? *

Direct Rollover

IRA Distribution Request
Fields marked with * are required

Direct Rollover

Rollover to an Employer Sponsored Qualified Plan
Please review your Employer’s Qualified Plan Rollover documentation for the Check Payable instructions. If you are unsure or do not have such documentation, please contact your plan administrator.

Direct Rollover checks cannot be made payable directly to you. Do not add “FBO your name” to the check payable area as Millennium will automatically include that on your check.

Note: It is your responsibility to ensure that the Qualified Plan named below will accept the rollover of your benefit payment. Payment by check through this portal can only be sent to your mailing address and not mailed directly to your plan. If your rollover funds are returned to Millennium for any reason, a return check fee may apply.
Is your employer U.S. Based? *

Distribution Amount

IRA Distribution Request
Fields marked with * are required

Distribution Amount

INVESTING OPTIONS FOR YOUR IRA
Are you looking to diversify your retirement holdings?

Your IRA can hold a wide range of investment types such as mutual funds, ETFs, stocks, bonds, and CDs.

For details, contact us at 877-682-4727.
Early Distribution - Exception applies (Periodic payments)
Note: You are responsible for notifying Millennium Trust of the exact amount of each payment to meet the IRS requirements. Consult your tax advisor for assistance. Please indicate the amount of the payment to be distributed.
Description
Shares
Market Value
Total
Would you like to take a one-time distribution or systematic payments? *
Would you like to take a Total or Partial Distribution? *
Actual distribution amount may vary based on changes in the valuation of the account assets and applicable fees.

Confirmation

Do you confirm that the distribution amount is correct? *

Account Fees

Systematic Payments

IRA Distribution Request
Fields marked with * are required

Systematic Payments

Systematic Payments
Systematic Payments are issued on the 15th of each month.

The request must be received by the 1st of the month in which you wish to have the payments begin.

Systematic payments, including your tax withholding election, will continue until Millennium receives written direction to cancel.

Note: Systematic payments with a set dollar amount will be discontinued if there are three consecutive failed attempts due to insufficient cash.
How often would you like distributions to occur? *
In which month would you like to begin distributions? *

Taxation Withholding

IRA Distribution Request
Fields marked with * are required

Federal Tax Withholding Election

How much Federal Tax would you like withheld? *

Federal Tax Withholding Election

Federal Tax Withholding Election for Non-U.S. Persons
Our records show that there is a treaty on file between the US and .

The minimum Federal Income Tax Withholdings under this treaty is %.

You may elect to withhold more income tax, but cannot elect less than %.

Federal Tax Withholding Election for Non-U.S. Persons
Our records show that there is no treaty between the US and , therefore your minimum Federal Income Tax Withholding will be 30%.

You may elect to increase the withholding, but you cannot waive or reduce this amount.

How much Federal Tax would you like withheld? *

State Tax Withholding Election

State Tax Withholding
By choosing a total distribution, we are required to withhold state taxes for from your distribution.
State income tax will be withheld ONLY if you instruct us to withhold it, whether or not you elect to have federal income tax withheld.
State income tax will be withheld ONLY if you instruct us to withhold it, whether or not you elect to have federal income tax withheld. However, state income tax withholding is required if a total distribution is elected or taken by default.
State income tax withholding is required when federal withholding is elected or taken by default.
State income tax withholding is required. However, if you believe you will not have a balance due on your state income tax return, you may elect not to have state income tax withheld by submitting your state's W-4P form.
How much State Tax would you like withheld? *
Form W-4P Required
Your state's Form W-4P is required if you elect to waive your state withholding.

Total Tax Withholding Election

Payment Method

IRA Distribution Request
Fields marked with * are required

Payment Method

Available Payment Methods
Millennium is now offering a Prepaid Debit Card as a distribution payment option.
This card provides multiple alternatives to access your money:
Use the card for purchases everywhere debit cards are accepted Obtain cash from ATM’s
Information on accessing these options will be mailed to you along with the prepaid card.

Systematic Payments
Please note if cash funds are not available at the time of distribution, your check or ACH will not be issued as scheduled.
Which Payment Method would you like? *
Please note that by selecting payment by wire, a $ bank wire fee will be deducted from your account and your distribution will not be processed until we receive the original distribution request form with the proper Signature Guarantee affixed. A Signature Guarantee may be obtained from an authorized officer at a brokerage firm, bank or other financial institution. Certification by a notary public is not a substitute for a Signature Guarantee. Also funds can only be wired to a US Bank.
Please note that by selecting payment by wire, a $ bank wire fee will be deducted from your account and your distribution will not be processed until we receive the original distribution request form with the proper Signature Guarantee affixed. A Signature Guarantee may be obtained from an authorized officer at a brokerage firm, bank or other financial institution. Certification by a notary public is not a substitute for a Signature Guarantee. Also funds can only be wired to a US Bank.

As a result distributions processed from the original documents, will take longer to review and process. If you want faster processing, please select the Prepaid Debit Card which can be submitted on line and your distribution will be mailed within 5-7 business days.

Banking Information

Bank Details
After entering the ABA routing number, we will lookup the Bank Name associated with that number. If the Bank Name that populates is different than your Bank Name, please go back and re-enter the correct ABA number.



Bank Details
After entering the ABA routing number, we will lookup the Bank Name associated with that number.
If the Bank Name that populates is different than your Bank Name, please go back and re-enter the correct ABA number.

Please ensure the accuracy of your financial institution’s ACH instructions. If ACH is returned due to the incorrect ACH instructions, an additional $30.00 will be charged.

Bank Account Type *

Verification Questions

IRA Distribution Request
Fields marked with * are required

Verification Questions

Additional verification is required.
To help verify your identity we’ve compiled a series of questions that only you should be able to answer. You will have 3 minutes to complete them.
User is currently completing their CIP questions
Please reload this page once the user has completed the CIP questions.

Payment Delivery

IRA Distribution Request
Fields marked with * are required

ACH Delivery

ACH Delivery
PLEASE NOTE: You have chosen the payment method of ACH to receive your distribution from your IRA account. An ACH can take up to 3 business days to post to your bank account after it has been processed pending fund availability.

Expedited Processing

Expedited Processing
Please note that expedited processing requests will be processed within 3 to 5 business days upon receipt of the documentation unless corrections or address changes are required.
Would you like Expedited Processing on your application? *

Delivery Method

Which Delivery Method would you like? *
Delivery Summary
Your will be sent to via .

Fee Schedule

IRA Distribution Request
Fields marked with * are required

Fees

Account Fee Schedule
Administration and Custody Account Fees
Please refer to the fee schedule you received in your welcome kit.
Fee charges associated with this distribution
Total Fees
Agreement to Fee Schedule and Disclosures
Please click on the link below to download a copy of the fee schedule including the account fees and fee disclosures associated with your account. You are required to download and review the entire fee schedule before you will be allowed to check the box and proceed with you IRA Form.

Summary & Preview

IRA Distribution Request
Fields marked with * are required
Please review the details of your distribution request before continuing. Changes can be made by clicking the back button to the section that needs to be edited. Any errors in the Contact Details section will require you to close your internet browser and restart a new distribution request.

Summary & Preview

Authorization & Certification

IRA Distribution Request
Fields marked with * are required

Authorization & Certification

Electronic Services Agreement
The distribution request may be conducted electronically by checking the box below and agreeing to the Consent to Conduct Transactions Electronically and to Receive Electronic Disclosures and Notices agreement ("Electronic Services Agreement"). 

To review the Electronic Services Agreement, click here.
Authorization & Certification
I authorize and direct you to make the distribution requested herein and certify that all of the information provided on this form is correct.



I understand that I am responsible for all taxes and penalties that may result from this distribution, if any. I certify that Millennium Trust and its affiliates, including InspiraFS, Inc., have not provided me with any tax, investment or legal advice, and I have consulted a tax professional to the extent I have deemed necessary concerning the taxable effect of this distribution.
U.S. Citizens or Other U.S. Persons (including U.S. Resident Aliens)
Under penalties of perjury, I certify that:
(1)The number shown on this form is my correct tax identification number; and
(2) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding, or if so notified, such notice is no longer in effect; and
(3) I am a U.S. citizen or other U.S. person (including a U.S. resident alien).

The IRS does not require that I consent to any provisions of this document other than this certification to avoid backup withholding.
Prudential Guaranteed Fund ("PGF") Disclosure Notice
Prudential Guaranteed Fund ("PGF") Custodial Agreement and Disclosure Statement
Prudential Guaranteed Fund ("PGF") Custodial Agreement and Disclosure Statement
Standard IRA Stable Asset Fund("SSAF") Custodial Agreement and Disclosure Statement
Standard IRA Stable Asset Fund("SSAF") Custodial Agreement and Disclosure Statement

Required Documents

IRA Distribution Request
Fields marked with * are required
In order to complete your distribution request, you are required to send the following items to Millennium Trust.

Attachment Logic

Required Documents

Identity Documents
Please submit a valid form of Identification. These include:

Passport State Issued ID Valid (non-expired) government issued IDs
PLEASE NOTE: The form of ID you use should clearly display your name, date of birth, address and signature.
Identity Verification
Please provide one of the following to verify your identity: Valid (unexpired) Government Issued ID State Issued ID Valid (unexpired) Passport
Note: The form of identification that you submit should clearly display your current name, date of birth and signature.
Name Documents
We require documentation to support your identity and any changes to the name we have on our records. Below is a list of documentation that Millennium will accept.

Name changes due to marriage or divorce – Please provide a copy of your marriage certificate or divorce decree. If there have been multiple name changes for this reason, please provide all documentation that shows the trail from the name on file to your current last name.Name changes due to Naturalization – Please provide a copy of the Naturalization certificate and/or court documentation to verify your current name.Name changes processed through the court – Please provide the Certified court document showing the approved name change.For differences in name such as an additional last name or use of a middle name – Please provide a copy of your birth certificate.
Address Verification
Please submit a copy of your valid form of identification to verify your current residential address and mailing address (if one was provided). These include:

State Issued ID Valid (non-expired) government issued IDs Valid (non-expired) Passport
If your current address is not on your ID, please provide a copy of one of the following:

Utility Bill (electric, gas or water) dated within the past 90 days Paystub dated within the past 60 days Tax Bill Sent to the Home Address and dated within the past 90 days
PLEASE NOTE: The form of ID you use should clearly display your name, date of birth, address and signature.
Social Security / Tax ID
We require a copy of your Social Security Card or Individual Taxpayer Identification Card/Certification letter.
Physicians Statement
Physicians Statement is Required for Record of Permanent Disability.
Certified Death Certificate of Previous Owner
Certified Death Certificate of Previous Account Owner is required for inherited accounts.
Voided Check for ACH
You are required to provide a copy of a voided check for ACH requests.

Note: For Accounts without checks, submit a preprinted deposit slip or a letter from the other financial institution, on letterhead and signed by an officer. This documentation must include the account title, account number, ABA routing number and account type.
IRS Form W-8BEN
The IRS Form W-8BEN is required to be submitted for tax withholding on Non-U.S. Persons.
Signature Guarantee
A Signature Guarantee is required for this request. Please print a copy of the completed form provided to you after your submission and obtain a Signature Guarantee. Then send the entire original signed document to Millennium via mail.
Form W-4P
The Form W-4P is required if you elect to waive your state withholding.

TM Attachments

Attachment Name
Attachment Description
Optional/Required

Signature Guarantee

IRA Distribution Request
Fields marked with * are required
You will need to print this document. All requests requiring a Signature Guarantee or certified legal documentation must be received by mail. A Signature Guarantee may be obtained from an authorized officer at a brokerage firm, bank or other financial institution. Certification by a Notary public is Not a substitute for a Signature Guarantee. More detail can be found here: http://www.sec.gov/answers/sigguar.htm
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