FORM: IRA Required Minimum Distribution (RMD)

Method 1: Submit Electronically

Fill out the form on the lower half of this page – Click here


Method 2: Print and Mail

Click here to download a PDF of the IRA Required Minimum Distribution (RMD) form.

Screen Shot 2015-05-19 at 11.24.28 AMSend completed form to:

Polish Roman Catholic Union of America
Attn: Annuity Department
984 N. Milwaukee Ave.
Chicago, IL 60642-4101

If you have any questions please contact us online or call 1-800-772-8632


The required minimum distribution (RMD) must be calculated separately for each IRA you maintain based on your single or joint life expectancy, as elected, and determined by the appropriate IRS annuity tables. The RMD is normally required to be taken by December 31 of each year. However, the initial RMD can be delayed until April 1 following the year you reached 701⁄2 (required beginning date). If the choice is made to delay the first RMD, rather than taking it by December 31 of the year in which you reached 701⁄2, then you are required to take two distributions in the following year- one by April 1 and the other one by December 31. Minimum distributions must then be made by December 31 of each subsequent year. You will have to pay the IRS a 50% penalty tax if you fail to take the RMD on time.

Generally, you are required to receive a RMD from each IRA you have. However, the IRS permits such amounts to be totaled, and the total RMD may be taken from any one or more of your IRAs.
  1. To waive taking your RMD or to revoke a prior RMD waiver election, please complete sections 1, 2, 3, 8 and 9.
  2. To take your RMD, please complete sections 1, 2, 4, 5, 6, 7 and 8.
1. Account Information

Certificate (Policy)/ Account Number

2. Annuitant Information




Home Phone Number*:
() - x

Work Phone Number:
() - x

E-Mail Address*:

Social Security Number/TIN*:

Date of Birth*:
/ /

3. RMD Waiver Election - Choose only one

Current Year: My RMD for will be satisfied by a distribution from another IRA.

Standing Election: Beginning with , and until further notice, my RMD will be distributed from another IRA. Until I revoke this election, do no pay my scheduled distributions from this IRA.

Revoke Prior Election: Beginning with , I revoke my previous election to have my RMD satisfied by a distributed from another IRA.

4. RMD Calculation - Choose only one

Based on Uniform Life Expectant Table
Annuity Owner's date of birth: / /

Based on Joint Life and Last Survivor Expectancy Table
Annuity Owner date of birth: / /
Is the sole primary beneficiary of your spouse? yesno
Spouse's date of birth (if sole primary beneficiary): / /

I request a specific amount for my RMD: $ , .

If you have more than one PRCUA IRA, or if you have another IRA with a different financial institution, then the life expectancy calculation for the above-referenced account may not satisfy the total IRS minimum distribution requirements for annuitants over 70 1/2. Please consult your tax advisor for assistance.

5. Frequency of Distribution


Beginning month and year for the RMD distribution(s): / /

Process all subsequent years RMD based on the same time period and frequency of this RMD.

6. Tax Withholding Election - Choose only one

The distributions you take from your IRA are subject to federal income tax withholding unless you elect not to have withholding apply. If you do not select a box below, you are deemed to elect 20% tax withholding.

I elect NOT to have federal income tax withholding. I understand that I am still liable for payment for federal income tax on the distribution received. I also understand that I may be subject to federal income tax penalties under the estimated tax payment rules if my payments of the estimated tax and withholding are insufficient.

Withhold federal income tax rate of % from distributions.

Withhold federal income tax amount of $ , , .

7. Payment Information - Choose only one

By check to the mailing address currently on file for this account. By ACH/EFT (Complete Form ACH1)

By check to a third party address (Payable to the owner(s) or FBO the owner(s)):


(please include a completed Annuity Application which is available for download here).


This form must be signed by the IRA Annuitant (or Beneficiary or Executor for Death Benefits only).

By checking this box, you hereby affirm that the information you have provided is true and correct and that you are aware of all the consequences affecting the distribution requested by this form. This authority is to remain in full force and effect until PRCUA has received written notification from me (or either of us) of its termination in such time and manner as to afford PRCUA a reasonable opportunity to act on it.

Today's Date*:
/ /


This form requires a witness ONLY if your distribution is to be sent to a third party or to an address different from what we currently have on file for your annuity. Please note that for those types of distributions, the form will not be processed unless a witness signs and dates in the appropriate areas below.

By checking this box, you hereby affirm that you are the witness mentioned above.

Please ensure that all the above fields have been filled out correctly

* Please verify you are a human:


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