Voya Select Advantage IRA Application · Members of the Voya® family of companies Fax: 515-446-2148 Email: [email protected] Mail: PO Box 9271, Des Moines, IA 50306-9271

Voya Select Advantage IRA Application

A Mutual Fund Custodial Account

RETIREMENT | INVESTMENTS | INSUR ANCE

Only for use to add additional employees to an existing SIMPLE IRA or SEP IRA where the previous/current employee(s) have account numbers with an RXXXXXX-ZS format.

Order #154147 10/01/2020Page 1 of 8 - Incomplete without all pages.RETURN TO VOYA

1. Account owner informAtion

City State ZIP

City State ZIP

Mailing Address (If different than above.)

Street Address (PO boxes are not permitted.)

SSN/TIN Name

client Account number (Broker-dealer use only.)

Citizenship: (Select one.) c US Citizen c Resident Alien c Non-Resident Alien

If you are a Non-Resident Alien, please indicate your Country of Citizenship:

c Check the box if you are retired.Occupation Industry

Provide e-mail address (Please print.)

Do you want to enroll in electronic delivery of account documents? (Additional information is available in Section 9.) ..................................... c Yes c No

2. BeneficiArY informAtion Total percentage of primary beneficiary shares must equal 100%. Total percentage of contingent beneficiary shares must also equal 100%. If no percentages are listed, beneficiaries' shares will be distributed equally. If a trust is the beneficiary, please provide the entire trust name, trust date and TIN. Additional beneficiaries should be listed on a separate piece of paper that includes the owner’s signature and the date.

ApplicAtion for Voya select AdVAntAge irAA MutuAl fund custodiAl AccountVoya Institutional Trust Company, CustodianRecordkeeping provided by Voya Retirement Insurance and Annuity Company (the “Company”)Members of the Voya® family of companiesFax: 515-446-2148Email: [email protected]: PO Box 9271, Des Moines, IA 50306-9271 Customer Service: 699 Walnut Street STE. 1350 Des Moines, IA 50309-3942Website: venerableannuity.com Phone: 888-854-5950

Name Birth Date/Trust Date SSN/TIN %Beneficiary Type:

PrimaryAddress Phone Relationship to Owner


c Primary

c ContingentAddress Phone Relationship to Owner


c Primary

c ContingentAddress Phone Relationship to Owner

Birth Date c Male c FemaleHome Phone Mobile

Voya Institutional Trust Company (Windsor, CT) is custodian for IRA mutual fund custodial accounts distributed by Voya Financial Partners, LLC (member SIPC) or through other broker-dealers with which it has a wholesaling or selling agreement. Recordkeeping services provided by Voya Retirement Insurance and Annuity Company (Windsor, CT). Administrative services provided by Venerable Insurance and Annuity Company (Des Moines, IA).

Only for use to add additional employees to an existing SIMPLE IRA or SEP IRA where the previous/current employee(s) have account numbers with an RXXXXXX-ZS format.


I authorize automatic asset rebalancing of my account: c Quarterly c Semi-Annually c Annually

c option 1 – AutomAtic Asset reBAlAncing Indicate appropriate frequency below. Any subsequent fund transfer, add-on or partial withdrawal you direct, other than on a pro rata basis, will

terminate this program. If you have chosen to allocate 100% into one fund automatic asset rebalancing does not apply. This option may not be available within the first 35 calendar days of opening an account.

3. initiAl investment And plAn tYpe

IRA Conversion or Recharacterization Request (154174) is required if you intend on converting or recharacterizing your IRA at the time of application. Select the IRA Plan type you are converting from or recharacterizing from, then after your account is established, the conversion or recharacterization will be processed as indicated on the IRA Conversion or Recharacterization Request.

If you checked Transfer or Rollover and would like Voya to facilitate the movement of funds, submit Transfer or Rollover Request (154195) with this application.

type of irA Applied for: (Select onlY one) c SIMPLE IRA 408(p) c SEP IRA 408(k)

4. AdditionAl informAtion for simple irA or sep irA

City State ZIP

Mailing Address

Phone E-mail Address

note: for a simple irA, voya institutional trust company, custodian, is not a designated financial institution. Your employer’s simple plan must permit plan participants to designate the financial institution that will serve as the custodian.

Employer Name Tax Identification #

Employer Contact Name Group Billing # (If known)

5. AutomAtic Asset reBAlAncing / dollAr cost AverAging / dividend And cApitAl gAin distriButions

(Select one option only.)

c option 2 – dollAr cost AverAging (dcA) Should you elect this option, you must allocate a percentage of the initial investment amount to one of the Source Funds in section 6 of this application.

You will also need to submit the Dollar Cost Averaging Allocation Request (178168). This option is not available within the first 30 days of opening an account. Your DCA program will begin on the calendar day your account was established.

If your account was established on or after the 29th of the month, then DCA will occur on the 1st of each month. Multiple DCA programs are not permitted.

Available source funds:

(620) Voya Government Liquid Assets (363) Voya GNMA Income Fund (8479) Voya Intermediate Bond (1532) PIMCO Total Return Fund

c option 3 – dividend And cApitAl gAin distriButions By selecting this option, you are electing to have all dividend and capital gain distributions from the funds in which you are invested allocated to the (620)

Voya Government Liquid Assets Portfolio. By default, dividend and capital gain distributions are reinvested in additional shares of the designated fund(s).

initial investment Amount: $ ($5,000 minimum required. Make all checks payable to Voya Institutional Trust Company.)

c Check here, and complete the following, if a portion or all of the account investment is from a transfer or rollover for which we will not be provided with Voya transfer paperwork prior to receiving money from the other company.

Company

Account Number Amount

Company

Account Number Amount

source of initial investment Amount: c Transfer c Rollover (See Disclosure Statement for requirements.)

c New contribution for tax year (Traditional IRA and Roth IRA only.)

c SEP IRA / SIMPLE IRA Contribution


6. initiAl investment AllocAtion

Based on your risk tolerance, your initial investment will be allocated as you have indicated below. Allocations must be in whole percentages and must total 100%. if no mutual fund allocation is selected, or if the allocation exceeds 100%, your initial investment will be deposited into the (620) government liquid Assets portfolio. if your allocation is below 100% or if there are closed funds, the remaining percentage will be allocated into the (620) government liquid Assets portfolio in order to reach 100%.

percentage fund # fund name (class) ticker symbol percentage fund # fund name (class) ticker symbol

Asset Allocation fund-of-funds % 6775 Calvert Growth Allocation (A) CAAAX % 5172 Calvert Conservative Allocation (A) CCLAX % 5199 Calvert Moderate Allocation (A) CMAAX % 6857 Lord Abbett Multi-Asset Income Fund (R3) LIXRX % 1729 Voya Retirement Conservative (Adviser) IRCAX % 1730 Voya Retirement Moderate (Adviser) IRMPX % 1731 Voya Retirement Moderate Growth (Adviser) IRMGX % 1732 Voya Retirement Growth (Adviser) IRGPX

% 1917 Voya Solution Moderately Aggressive (Adviser) IAGAX

Balanced/Asset Allocation

% 2402 Franklin Income Fund (R) FISRX % 2425 Janus Henderson Balanced Fund (R) JDBRX % 8069 PIMCO All Asset Fund (R) PATRX % 1742 Voya Balanced Income (Adviser) IIFAX % 269 VY Invesco Equity and Income (Adviser) IUAAX

% 320 VY T. Rowe Price Capital Appreciation (Adviser) ITRAX

Bond

% 1598 American Funds The Bond Fund of AmericaSM (F-1) BFAFX

% 7282 BlackRock High Yield Bond (R) BHYRX % 2458 BlackRock Inflation Protected Bond (A) BPRAX % 7529 Calvert Bond (A) CSIBX % 3190 Eaton Vance Government Opportunities Fund (R) ERGOX % 7561 Fidelity® Advisor Strategic Income Fund (M) FSIAX

% 1938 Loomis Sayles Strategic Income Fund (Admin) NEZAX

% 1568 Lord Abbett Bond Debenture Fund (R3) LBNRX

% 6823 Lord Abbett Short Duration Income Fund (R3) LDLRX

% 6917 PGIM High Yield Fund (R) JDYRX

% 3454 PGIM Short-Term Corporate Bond Fund, Inc. (R) JDTRX

% 6916 PIMCO Income Fund (R) PONRX % 1532 PIMCO Total Return (R) PTRRX % 2242 Voya Floating Rate Fund (R) IFRRX % 363 Voya GNMA Income Fund (A) LEXNX % 8479 Voya Intermediate Bond (Adviser) IIBPX % 1020 Voya High Yield (Adviser) IPYAX

% 6813 Voya Strategic Income Opportunities Fund (R) ISIRX

international % 3632 Aberdeen Emerging Markets Fund (R) GEMRX % 2035 American Funds EuroPacific Growth Fund® (F-1) AEGFX % 3048 Calvert International Opportunities (A) CIOAX

% 9209 Invesco Developing Markets Fund (R) ODVNX

% 8269 Invesco International Equity Fund (R) QIVNX

% 7989 Invesco Oppenheimer International Growth Fund (R) OIGNX

% 1587 Voya International High Dividend Low Volatility (Adviser) IFTAX

% 8800 Janus Henderson Global Equity Income (S) HFQSX % 1550 Voya International Index (Adviser) IIIAX

% 366 Voya Multi-Manager International SmallCap Fund (A) NTKLX

% 1048 VY JP Morgan Emerging Markets Equity (Adviser) IJEAX

% 1047 VY T.Rowe Price International Stock (Adviser) IMIOX

large-cap Blend % 7109 American Funds Fundamental InvestorsSM (F-1) AFIFX % 351 Invesco Main Street Fund (R) OMGNX % 3437 Voya Corporate Leaders 100 Fund (R) VYCFX

% 1556 Voya Russell™ Large Cap Index Portfolio (Adviser) IRLIX

% 1357 Voya U.S. Stock Index Portfolio (S2) ISIPX % 272 VY Columbia Contrarian Core (Adviser) ISBAX

large-cap growth

% 2033 American Funds The Growth Fund of America® (F-1) GFAFX

% 7305 Calvert Equity (A) CSIEX % 2170 Fidelity® Advisor New Insights Fund (M) FNITX % 5005 Franklin DynaTech Fund (A) FKDNX % 1775 Voya Large Cap Growth (Adviser) IEOPX

% 2714 Voya Russell™ Large Cap Growth Index (Service) IRLSX

% 256 VY T. Rowe Price Growth Equity (Adviser) IGEAXlarge-cap value

% 2037 American Funds Washington Mutual Investors FundSM (F-1) WSHFX

% 7272 BlackRock Equity Dividend Fund (R) MRDVX % 8250 Columbia Dividend Income Fund (R) CDIRX % 5326 Invesco Diversified Dividend Fund (A) LCEAX % 2711 Voya Russell™ Large Cap Value Index (Service) IRVSX % 316 VY T. Rowe Price Equity Income (Adviser) ITEAX

mid-cap Blend % 3542 Principal MidCap Fund (R1) PMSBX

% 1559 Voya RussellTM Mid Cap Index (Adviser) IRMAX


6. initiAl investment AllocAtion (continued)

percentage fund # fund name (class) ticker symbol percentage fund # fund name (class) ticker symbol

mid-cap growth

% 2385 Eaton Vance Atlanta Capital SMID-Cap Fund (R) ERSMX

% 7478 Federated Hermes Kaufmann Fund (R) KAUFX % 8474 Voya MidCap Opportunities (Adviser) IAMOX % 442 VY Baron Growth (Adviser) IBSAX

% 266 VY T. Rowe Price Diversified Mid Cap Growth Portfolio (Adviser) IAXAX

mid-cap value

% 447 VY American Century Small-Mid Cap Value (Adviser) IASAX

% 441 VY JPMorgan Mid Cap Value (Adviser) IJMAX

money market % 620 Voya Government Liquid Assets (Service 2) ITLXX

other % 1848 Federated Hermes Prudent Bear Fund (A) BEARX

sector % 6217 BlackRock Health Sciences Opportunities (R) BHSRX

% 6946 Columbia Seligman Global Technology Fund (R) SGTRX

% 7409 Fidelity® Advisor Financial Services Fund (M) FAFSX % 2393 Fidelity® Advisor Materials Fund (M) FMFTX

% 8002 Invesco Gold & Special Minerals Fund (R) OGMNX

% 8379 Invesco SteelPath MLP Income Fund (A) MLPDX

% 8386 Invesco SteelPath MLP Select 40 Fund (A) MLPFX

% 7220 Invesco Real Estate Fund (R) IARRX

% 6218 Ivy Energy Fund (R IYEFX

% 8667 Janus Henderson Global Real Estate JERSX

% 5997 Mainstay CBRE Global Infrastructure Fund (A) VCRAX

% 6540 PGIM Jennison Utility Fund (R) JDURX

% 2268 PIMCO Commodity Real Return Strategy Fund (R) PCSRX

small-cap Blend % 3787 Ivy Small Cap Core Fund (R) IYSMX % 1562 Voya RussellTM Small Cap Index (Adviser) IRSIX % 9240 Voya Small Company (Adviser) IASCX % 315 VY JPMorgan Small Cap Core Equity (Adviser) IJSAX

small-cap growth

% 7477 Federated Hermes Kaufmann Small Cap Fund (R) FKKSX

% 3633 Ivy Small Cap Growth Fund (R) WSGRX % 9241 Voya SmallCap Opportunities (Adviser) ISOPX

small-cap value % 1216 VY Columbia Small Cap Value II (Adviser) ICSAX

target date fund-of-funds % 2640 Voya Index Solutions 2025 (Service 2) IXXVX % 6767 Voya Index Solutions 2030 (Service 2) IDXIX % 2641 Voya Index Solutions 2035 (Service 2) IXISX % 2642 Voya Index Solutions 2045 (Service 2) ISVLX % 1163 Voya Index Solutions 2055 (Service 2) IISTX % 2643 Voya Index Solutions Income (Service 2) IIIPX % 749 Voya Solution 2025 (Adviser) ISZAX % 760 Voya Solution 2035 (Adviser) ISQAX % 763 Voya Solution 2045 (Adviser) ISRAX % 1169 Voya Solution 2055 (Adviser) IASPX % 766 Voya Solution Income (Adviser) ISWAX

world Allocation % 1572 American Funds Capital Income Builder® (F-1) CIBFX % 1620 BlackRock Global Allocation Fund, Inc. (R) MRLOX % 3199 Invesco Balanced Risk Allocation Fund (A) ABRZX % 2442 Loomis Sayles Global Allocation (A) LGMAX % 1922 Voya Global Diversified Payment Fund (A) VYGQX % 8273 Voya Global Perspectives Fund (A) IAPVX

world Bond

% 5355 Fidelity® Advisor New Markets Income Fund (M) FGWMX

% 1437 Invesco International Bond Fund (R) OIBNX

% 178 Templeton Global Bond Fund (A) TPINX % 1746 Voya Global Bond Fund (A) INGBX

world stock

% 1752 VY Morgan Stanley Global Franchise (Adviser) IGFAX

% 445 VY enheimer Global (Adviser) IGMAX


7. preAutHoriZed pAYment plAn AutHoriZAtion** (Bank account verification required.)

c Monthly c Quarterly c AnnuallyFrequency:

Start Date (mm/dd/yyyy) Amount ($50 minimum) $

If funds are being deducted from a savings account, you must submit a letter from the bank (on bank letterhead) that includes verification of the bank routing/ABA number, bank account number, and bank account owner’s name. If your start date is on or after the 29th of the month, withdrawals will automatically occur on the 28th of each month. Your contribution will apply to the tax year in which it was received. Your request must be received no later than 10 days before the next scheduled additional payment. If you would like to discontinue or change this authorization, please contact Customer Service at the phone number or the address on page 1 of this application.

I hereby authorize the Company to initiate a debit entry(ies) to the account indicated and in the amount and frequency listed below. This authorization shall remain in force until I give the Company written notice of termination of this authorization. I understand and agree that I will indemnify the Company for any costs it incurs should there be insufficient funds in the below listed account. If insufficient funds, the additional payment will not be applied. The additional payment will be applied pro-rata across current fund allocations.

**If you have provided authorization for a Preauthorized Payment Plan, please request a copy of this application from your Registered Representative for your records.

Name SSN/TIN

Name SSN/TIN

By checking the box below and signing this form, you authorize the Company to act upon fund transfer and distribution instructions, whether oral, written, online, or otherwise from the registered representative(s) named in Section 10. In addition, you authorize the Company to act upon fund transfer instructions, whether oral, written, online, or otherwise from the individual(s) named below not registered with the Financial Industry Regulatory Authority (FINRA), by furnishing their Social Security number or alternative identification number. For distributions, the company will only permit cash from the account to be sent by check to the address of record, a transfer to a bank account pre-authorized by the account owner(s) or to an account at a third party financial institution for the benefit of the account owner(s). A voided check must be on file in order to have your distribution deposited directly into your personal bank account.

I agree that neither the Company nor or any of the Company’s affiliates will be held responsible for my decisions or for the investment recommendations or decisions of my agent(s), and is under no duty whatsoever to question any instructions received from the agent(s) or the suitability of any transactions requested by him/her/them. I understand that the Company reserves the right to reject, at any time, instructions that the Company believes to be suspicious, fraudulent or otherwise unauthorized, or illegal.

I understand that certain transactions may result in tax liability for me and that I am solely responsible for obtaining tax advice regarding any transactions undertaken on my behalf by my agent(s). I authorize the Company to accept federal and state withholding elections provided, on my behalf, by the registered representative(s) named in Section 10.

I agree to indemnify and hold the Company and its affiliates and subsidiaries, and their respective officers, employees, and agents harmless from acting on instructions, whether oral, written, online, or otherwise, reasonably believed by the Company to have originated from my agent(s), and from all acts of my agent(s) involving the Select Advantage account(s) covered by this authorization. In the event of my disability or incapacity, this authorization will remain in full force and effect. This authorization will terminate only when one of the following occurs:

• The Company receives notice of my revocation. I understand that I have the right to revoke this authorization at any time and, if I have named multiple agents, I understand that I must specifically identify the agent(s) whose authority I am revoking. I further understand that each authorization covering the same account(s) submitted to the Company will revoke any prior authorization only to the extent indicated in such subsequent authorization. Any revocation will not affect any liability resulting from transactions initiated before the Company has had a reasonable amount of time to act upon such notice.

• The Company receives notice of my death. I understand that the authority granted under this authorization terminates at my death. My death will not affect any liability resulting from transactions initiated before the Company has had a reasonable amount of time to act upon such notice.

• The Company receives notice that the registered representative(s) named in Section 10 are no longer affiliated with the broker-dealer under which they are currently registered.

c I authorize the Company to act upon fund transfer and distribution instructions given by my registered representative(s).

To provide a nonregistered individual with fund transfer authorization, please complete the following. If the individual’s Social Security number is not provided, the individual will not be authorized.

8. fund trAnsfer And distriBution AutHoriZAtion

note: the bank account from which the funds will be drawn must belong to and be in the name of the owner of this select Advantage account.

Bank Account Owner Name

Bank Account Number Bank Routing # (9 digits)

Sample Checkx Financial InstitutionMEMO Not Negotiable

987654321 1234567890123 5678

Routing Number (9 digits)Account Number


8. fund trAnsfer And distriBution AutHoriZAtion (continued)

regardless of whether or not federal or state income tax is withheld, you are liable for taxes on the taxable portion of the payment. if you do not have a sufficient amount withheld, you may be subject to tax penalties under the estimated tax payment rules. An election made for a single non-recurring distribution applies only to the payment for which it is being made. for recurring payments, your withholding election will remain in effect until it is changed or revoked. You may change or revoke your election at any time prior to a payment being made by submitting irs form W-4p. u.s. persons having their payment delivered outside the u.s. or its possessions may not make an election of no withholding. in this case, if you choose no withholding, the default rate will be applied. non-resident aliens are subject to a mandatory 30% withholding rate unless they are eligible for a reduced rate or exemption under a tax treaty and the required documentation is submitted.

Non-periodic payments – 10% withholding: Withdrawals from irA’s that are payable on demand are considered “non-periodic payments” and are subject to a flat 10% federal withholding rate unless you choose not to have federal income tax withheld. You can choose not to have withholding applied to your irA withdrawal by checking the applicable box below. You may also elect withholding in excess of the flat 10% rate.

FEDERAL WITHHOLDING INSTRUCTIONS:c DO NOT withhold any federal income tax unless mandated by law. c DO withhold federal taxesADDITIONAL AMOUNT you want withheld from your payment(s) $ or %. (Note: This amount is in addition to the standard federal withholding rate applicable to your distribution.)

STATE WITHHOLDING INSTRUCTIONS:My residence state for tax purposes is (If your current physical and/or mailing address is outside of your state of legal residence for tax purposes, please enter your tax state here. If no U.S. state or territory is on record and one is not specified, we will presume this income is not reportable to any U.S. state or territory.)

c DO NOT withhold any state income tax unless mandated by law.c DO withhold state taxes in the amount of $ or %. (If you make this election, a dollar amount or percentage must be specified and cannot be less than any required withholding.)

if you do not make an election or if your state requires a greater amount of withholding, we will withhold at the rate specified by your state of residence for the type of payment you are receiving. in some cases, your state specific withholding election form is required to opt out of withholding or to choose a rate other than the state’s default rate. refer to the attached state income tax Withholding notification and/or your state department of taxation for details.


Date Owner Signature

9. Acknowledgement And signAture (Please read carefully and sign below.)

By signing this application (a) the Account Owner named above (i) appoints Voya Institutional Trust Company, or its successors, as Custodian of the Account established under the Voya Select Advantage Traditional, Roth or SIMPLE Individual Retirement Account Agreement(s) (Agreement), as applicable, included with the application materials, (ii) state that you have received, read, and accept the terms of the Agreement and the Voya Select Advantage Traditional, Roth or SIMPLE Individual Retirement Account Disclosure Statement, as applicable, (iii) acknowledge receipt of the current prospectus(es) of the investment company or companies in which the assets of the Account may be invested, (iv) consent to the Recordkeeping Fee(s) and the Maintenance Fee (if applicable) as specified in the Agreement (and as may be changed from time to time), (v) agree to promptly give instructions to the Custodian necessary to enable the Custodian to carry out its duties under the Agreement and (vi) represent that whenever information as to any taxable year is required to be filed with the Internal Revenue Service, you will file such information with the Internal Revenue Service unless filed by the Custodian (vii) represents that any rollover contributions are eligible for rollover pursuant to the terms of the Internal Revenue Code, including but not limited to the requirement to reinvest such amounts within 60 days of the date of receipt of the distribution and (b) the Custodian hereby agrees to accept this Agreement. The Account Owner and the Custodian agree to be bound by all of the provisions of the Agreement incorporated herein by reference.

You further understand that you must carefully review each account confirmation statement or other documentation of transaction that you receive to ensure that your instructions have been properly acted upon. If any discrepancies are noted, you agree to notify Voya Institutional Trust Company in a timely manner, but in no event more than 30 days from receipt of such confirmation statement or documentation of transaction. Failure to notify one of the above entities on a timely basis will relieve such entities of any liability with respect to the transaction and any discrepancy.

Electronic DeliveryBy checking “Yes” to electronic delivery of your account documents and providing your e-mail address, you elect to enroll in electronic delivery of your account documents. When your account is opened, you will receive an e-mail with a link to finalize your enrollment in electronic delivery, including the Terms and Conditions of electronic delivery.

Please add [email protected] to your trusted e-mail addresses to ensure that electronically delivered documents are received.

Until your enrollment in electronic delivery has been finalized, you will receive all correspondence via U.S. Mail. While electronic delivery may significantly reduce the amount of mail sent to you, certain documents and service-related correspondence will continue to be sent via U.S. Mail.

U.S. TAXPAYER CERTIFICATIONSUnder penalties of perjury, I certify that: 1. The Taxpayer Identification Number that appears on this form is correct. 2. I am not subject to back-up withholding due to failure to report interest and dividend income; c If I am subject to backup withholding, I have checked here. 3. I am a U.S. person. if you are a non-resident Alien, please check the box below.c under penalties of perjury, i certify that i am a non-resident Alien.the amount paid to you will be subject to 30% tax withholding unless you submit an irs form W-8 and are entitled to claim a reduced rate of withholding under the applicable u.s. tax treaty.The Internal Revenue Service does not require your consent to any provision of this document other than the certifications (in bold above) required to avoid back-up withholding.


I hereby acknowledge that I have provided to the account owner a paper copy of the Voya Select Advantage Traditional, Roth or SIMPLE Individual Retirement Account Disclosure Statement and Custodial Account Agreement. I also acknowledge that I have provided a copy of the application to the account owner if they elected to start a Preauthorized Payment Plan or if the account owner has requested a copy of the application.

Compensation will be split equally if no percentage is indicated. Partial percentages will be rounded up. Percentages must total 100%. The primary registered representative will be given the highest percentage in the case of unequal percentages.

primary registered representative: split ________ %

registered representative #2: split ________ %

Print Name Signature

Print Name Signature

Phone Broker Code

Phone Broker Code

10. registered representAtive informAtion And Acknowledgement

SSN CRD #

SSN CRD #

Broker-Dealer Broker-Dealer Branch #


registered representative #3: split ________ %

Print Name Signature Phone Broker Code

SSN CRD #


Page 1 of 1 Order #206792 12/10/2018

Keep With CUStOMeR

State Income tax WIthholdIng notIfIcatIon

NotificatioNIf you are a resident of arkansas, california, connecticut, Delaware, District of columbia, Georgia1, iowa, Kansas, Maine, Maryland1, Massachusetts, Michigan, Nebraska2, North carolina3, oklahoma, oregon, Vermont, or Virginia1, your state requires state income tax withholding on the taxable portion of your distribution from your 401, 403(b), 408 (IRA), Governmental 457 Plan or Non-Qualified annuity. This state income tax withholding is in addition to the mandatory 20% (or, in some cases, 10%) federal income tax withholding. Please note, when a state cost basis differs from federal, the federal cost basis will be used in determining taxability for state income tax withholding purposes.

• If youarea residentofcalifornia or oregon state income tax withholding will be calculated unless you complete the state withholding section of your Withdrawal Request indicating your election “out” of state income tax withholding.

• Ifyouarearesidentofarkansas, North carolina3 or Vermont, state withholding will be automatically calculated when federal income tax withholding applies. If you do not elect “out” of 10% federal income tax withholding, you can still choose to elect out of state withholding. Requesting North Carolina withholding over mandatory amounts requires their Form NC-4P, Withholding Certificate for Pension or Annuity Payments.

• Ifyouarearesidentofiowa, Maine, Massachusetts, Nebraska2, or oklahoma, state income tax withholding will be automatically calculated as these states do not allow an election “out” of state income tax withholding when federal income tax withholding applies.

• If youarea residentofDelaware, Kansas or Maryland1 and are subject to mandatory 20% federal income tax withholding, state income tax withholding will be automatically calculated. State withholding is not required when 10% federal income tax withholding applies.

• Ifyouarea residentofVirginia1 or Michigan, state income tax withholding will be calculated automatically unless you meet certain criteria and claim an exemption from withholding. To claim an exemption or to request withholding over mandatory amounts, complete Form VA-4P for Virginia or Form MI-4P for Michigan, and return the appropriate form to us with, and to the same designated location as, your Withdrawal Request.

• IfyouarearesidentoftheDistrict of columbia4 and are receiving a total distribution of your account balance, state income tax withholding will be automatically calculated. State withholding is not required for partial distributions.

• IfyouarearesidentofGeorgia1 and are receiving periodic payments, state income tax withholding will be automatically calculated unless you elect out.

• Ifyouarearesidentofconnecticut and are receiving partial non-periodic payments, state income tax withholding will be taken at the highest marginal rate unless you claim exemption from withholding or request additional withholding by completing Form CT-W4P. If you are receiving a total payment of your account balance, state income tax withholding will be taken at the highest marginal rate unless you request additional withholding by completing Form CT-W4P. You cannot claim exemption from withholding for a total payment. If you are receiving a periodic payment, state income tax withholding will be taken at the highest marginal rate unless you complete Form CT-W4P. Form CT-W4P must be returned to us with, and to the same designated location as, your Withdrawal Request.

1Maryland, Virginia and Georgia state income tax withholding is not required for distributions from 408 Plans.2Nebraska state income tax withholding is not required for premature distributions from 408 Plans.3North Carolina does not apply to distributions from NC state and local government or federal retirement systems for those vested as of 8/12/89.

important: State tax withholding rules can change, and the rules cited above may not reflect current state legislative requirements. Please consult with a tax or investment advisor to obtain the most up-to-date information.

Documents

Voya Select Advantage IRA Application · Members of the Voya® family of companies Fax: 515-446-2148 Email: [email protected] Mail: PO Box 9271, Des Moines, IA 50306-9271