IRA Distribution Request for Withdrawal, Rollover or Return of

INVESTMENT AND INSURANCE PRODUCTS:

• NOT A DEPOSIT • NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY

• NO BANK GUARANTEE • MAY LOSE VALUE

J.P. Morgan Securities LLC

Member FINRA and SIPC

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

You can submit this form

and any attachments by:

Secure Message

For instructions on how to

submit this request by

secure message, visit

chase.com/brokerageforms.

Fax

(866) 786-4788

Mail

J.P. Morgan Securities LLC

Attn: Retirement - WM

Mail Code: IL1-0291

10 S. Dearborn St.

Chicago, IL 60603

If you have questions,

please send us a secure

message on chase.com.

Use this form to

• Authorize a one-time withdrawal from your J.P. Morgan Securities LLC (JPMS) Traditional/SEP or Roth

Individual Retirement Account (IRA) (including Beneficiary IRA).

• Authorize a one-time direct rollover from an IRA to an employer-sponsored plan.

• Authorize the return of an excess IRA contribution.

What you need to know

• Before submitting this form, please ensure that:

• There are sufficient funds in your account to cover the distribution amount and any fees. Your

request will not be processed if there are insufficient funds to cover it.

• Your legal address is on file because we will apply tax withholding requirements for the state of

residence listed in our records.

• Don't use this form to make a distribution to a Chase checking or savings account unless this request is

for a Return of Excess Contribution. A distribution to a Chase account (except for Return of Excess

Contribution) MUST be completed online on chase.com using the Pay & transfer tab.

• You can roll over only one IRA distribution to another IRA in any 12-month period, regardless of how

many IRAs you own or distributions you take (i.e., one 60-day IRA-to-IRA rollover in a 12-month

period). This restriction does not apply to other types of transactions. Refer to irs.gov/rollover

for more

information.

•

Use a different form to make a trustee-to-trustee transfer, do a conversion from a Traditional IRA to a

Roth IRA, roll over from a qualified retirement plan to an IRA, or do a recharacterization.

• This form must be notarized if you are submitting it by fax or mail. If you are submitting the form by

secure message, notarization is not required.

• You must provide your Social Security number and federal tax withholding election so we can process

your distribution. Forms without this information will not be processed.

• Refer to IRS Publications 590-B and 505 at irs.gov or consult your tax professional to learn more about

IRA distributions, federal income tax withholding, and estimated tax requirements and penalties.

• For best results, complete this form using Adobe Reader. You will need to print a copy for your

signature (and notarization, if necessary).

33103_CYI v7.4.1

Page 1 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Tell Us About Your IRA

Your Name

Your Social Security Number (IRS Form W-4R Line 1b)

Your Account Number

If you're not sure what

type of IRA you have, you

can review the name of the

account on your

investment statement.

Select your account type:

This is a Traditional or SEP IRA.

This is a Roth IRA.

Both your Social Security

Number and Account

Number are required.

Information regarding Roth IRA distributions

• Roth IRA contributions can be withdrawn at any time without federal income tax or penalty. After

age 59½, or under certain other circumstances, earnings that are withdrawn after 5 or more taxable

years may be exempt from federal income taxes and the 10% early withdrawal tax. Refer to IRS

Publication 590-B, instructions for Form 5329, and contact your tax professional with any questions

regarding whether this distribution may qualify for tax-free treatment or an exception.

• JPMS federal tax reporting treatment of Roth distributions — If:

• You are 59½ or older and the account has been funded at JPMS for 5 or more taxable years,

your distribution will be reported as a qualified distribution on IRS Form 1099-R.

• You are under 59½, your distribution will not be reported as a qualified distribution on IRS Form

1099-R.

• This account has been funded at JPMS for fewer than 5 taxable years, your distribution will not

be reported as a qualified distribution on IRS Form 1099-R.

• This account has been funded at JPMS for fewer than 5 taxable years but you held another Roth

IRA for 5 or more taxable years, or transferred this Roth account from another institution

resulting in 5 taxable years or more in total, your distribution will not be reported as a qualified

distribution on IRS Form 1099-R.

• Consult your tax professional to determine whether you have met the 5-year holding requirement or

if this distribution may qualify for tax-free treatment or an exception. Refer to IRS Publication 590-B

and instructions for Form 5329 for more information.

33103_CYI v7.4.1

Page 2 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

What Type of Distribution Are You Taking?

Normal Distribution — I'm age 59½ or older.

Early Distribution — I'm under age 59½; an IRS early distribution penalty may apply.

Distribution to Beneficiary, Executor, Trustee or Representative from this Beneficiary IRA.

Direct Rollover from this Traditional IRA (including SEP IRA) to an Employer-Sponsored Plan. Submit

a signed letter of acceptance from the receiving employer-sponsored plan administrator with this form.

Direct rollovers will be made payable to the receiving employer-sponsored plan.

Return of Excess Contribution from this Traditional or Roth IRA (cash distribution only). Select this

option to remove an invalid, ineligible or over contribution. Note: If this is selected, you will not be able

to make additional contributions for this tax year into any of your IRAs at JPMS. You must provide the

following information:

Consult your tax

professional regarding the

tax treatment and use of a

returned excess

contribution.

For what tax year did you make the excess contribution?

(year)

How much was the original excess contribution?

(dollar amount)

Are you requesting the return of this excess contribution after your tax filing deadline, including

the available 6-month IRS extension, for the tax year you entered in question 1? (If you select

'Yes,' you can withdraw the excess contribution without taking into account any gains or losses. If

you select 'No,' the amount returned will include any net income (gain or loss) attributable to the

excess contribution.)

Yes (go to question 5)

How much was the net income (gain or loss) attributable

to the excess contribution? (This may be a negative

number. You do not need to calculate this amount if you

answered 'Yes' to question 3.)

(dollar amount)

Amount that we will return to you:

(dollar amount)

Treasury regulations

require a specific

calculation be used to

determine whether there is

a gain or loss on your

excess contribution when

removing it on or before

your tax filing deadline. If

there is a loss, the amount

will be deducted from the

excess contribution

amount to be withdrawn.

Use IRS Publication 590-A

worksheets (or contact

your tax professional)

when calculating your gain

or loss amount.

Information regarding IRA distributions

• If you are under age 59½, you may be subject to an additional 10% early withdrawal tax unless you

meet one of the IRS exceptions.

• There may be an IRS limit on the distributable amount eligible for an exception.

• It is your responsibility to understand the parameters of your distribution request before submitting this

IRA Distribution Request for Withdrawal, Rollover or Return of Excess Contribution form.

• Refer to Section 72(t)(2) of the Internal Revenue Code, IRS Publication 590-B and consult your tax

professional for further guidance.

Select your distribution type:

33103_CYI v7.4.1

Page 3 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

What Assets Would You Like to Distribute?

Important information about your distribution

• For cash distributions, ensure there is enough cash in your account to cover the amount of the

distribution before submitting this request. The request will not be processed if there are insufficient

funds to cover the request.

• If you are closing this account, any residual credits will be paid out according to your instructions on

this form.

• For securities distributions, make sure you have enough cash to cover any federal and state tax

withholding amounts or the request cannot be processed. The value of your securities may vary due to

market fluctuations and will be determined at the close of business on the transaction date. As a result,

specific dollar withholding amounts may be a lower or higher percentage of the distribution than

expected.

• Custodial fees and termination fees may be charged if your distribution depletes your account. Be sure

there is enough cash available to cover these fees after the distribution. Fees can be found at

chase.com/online-investing-fees.

If you need more room,

attach an additional sheet

to this form that includes

your name, account

number and security

descriptions. Sign and date

the additional sheet.

Distribute all of my assets and close my account. If you would like an all-cash distribution, ensure that

all assets have been liquidated. (Please proceed to Section 4 — do not complete the table below.)

Distribute only the cash and/or securities listed below. For securities, only whole shares may be

distributed unless you note that you want "All" shares distributed, which would include fractional

shares.

Select only one.

Only complete the cash

and securities table if you

select the second option.

If you select the first option,

proceed to Section 4.

CASHSECURITIES

Enter Dollar Amount or "All" (Gross)

Security Description Symbol/CUSIP

Enter Number of

Shares or "All"

33103_CYI v7.4.1

Page 4 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

How Would You Like to Receive the Distribution?

Fill out only one section

(A, B, C or D).

ACH DEPOSIT INTO MY BANK/FINANCIAL INSTITUTION ACCOUNT

Important information about distribution via direct deposit

This must be a non-Chase

bank/financial institution

account, UNLESS you

selected 'Return of Excess

Contribution' in Section 2.

A 'Return of Excess

Contribution' distribution

may be deposited into a

Chase or non-Chase

account.

Deposit directly into my bank/financial institution account using the instructions below.

Bank/Financial Institution Name

Checking

Savings

Account Type (select one)

Bank/Financial Institution Account Number

Routing Number

• Don't use this form to make a distribution to a Chase checking or savings account unless this

request is for a Return of Excess Contribution. A distribution to a Chase account (except for Return

of Excess Contribution) MUST be completed online on chase.com using the Pay & transfer tab.

• If you are requesting a distribution to a non-Chase bank/financial institution account, you must first

verify that your non-Chase account is linked to your JPMS IRA. If the non-Chase account is not

linked, we will be unable to process your distribution request. To view or edit your linked non-Chase

accounts, go to chase.com → Pay & transfer → Transfer money → External accounts.

• When you link your JPMS IRA to a non-Chase bank/financial institution account, you will notice a $1

charge and a $1 credit to your bank/financial institution account. We do this to validate the account

before linking it to your JPMS IRA.

SEND A CHECK

Optional overnight delivery: Send this check overnight using the delivery instructions below.

Overnight delivery requests will expedite a check's receipt, but only after the transaction itself is

processed. Note that overnight delivery to a PO Box is unavailable.

Send a check, made payable to me, to my address of record.

Send a check, made payable to me, to the alternative address below.

Send a check, made payable to a third party, to the address below.

City State ZIP Code

Mailing Address

Payee Name

Mailing Address

City State ZIP Code

There may be additional

fees associated with

overnight delivery.

Overnight delivery fees can

be found at

chase.com/

online-investing-fees.

33103_CYI v7.4.1

Page 5 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

DISTRIBUTE MY ASSETS TO A JPMS NON-RETIREMENT BROKERAGE ACCOUNT

Distribute the assets I listed in Section 3 to my existing JPMS non-retirement brokerage account.

Distribute the assets I listed in Section 3 to an existing JPMS non-retirement brokerage account of a

third party.

Account Number

Third Party Name

DISTRIBUTE AS A WIRE TRANSFER

Send a wire to me or a third party using the wire instructions below.

Receiving Account Information

Bank/Financial Institution Name

Wire Routing Number Bank/Financial Institution Account Number

Bank/Financial Institution Account Holder Name

Please confirm the Wire Routing Number with your bank/financial institution. A financial

institution's wire and checking/savings routing numbers are not always the same.

Intermediary Bank/Financial Institution Details and Special Instructions (complete if applicable)

Not all banks and financial institutions can receive wires directly through the Fed Funds wire

system. In these situations, wires are normally routed through an intermediary bank or financial

institution that then credits an account established for the receiving bank or financial institution. If

this applies, complete Section I below. In some cases, the receiving bank or financial institution may

need additional information in order to credit those funds to the right party. Typical examples

include situations where the account number belongs to another financial firm or pension plan. If

this applies, complete Section II below.

Intermediary Bank/Financial Institution Details

Intermediary Bank/Financial Institution Name

Intermediary Bank/Financial Institution Account Number

II.

Special Instructions

Account Number

Final Recipient Name

Reference Details (optional) Instruction Description

We may call you at the

number on file for your

account to confirm the

wire before it is processed.

Please ensure you have

enough cash available in

your account to cover the

wire fee. Please refer to

the Fee Schedule at

chase.com/online-

investing-fees for Wire

Transfer fees.

Fed Wire

33103_CYI v7.4.1

Page 6 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Tax Withholding Elections

• U.S. Person (U.S. Citizen or Resident Alien) or Beneficiary that is a U.S. Estate, Trust or Charity

• Distributions from an IRA are subject to federal and, in some cases, state income tax withholding.

• If applicable, state income tax must be withheld according to the requirements for your state of residence.

• Several states require withholding from your distribution if you are subject to federal income tax withholding and may

require that their specific state withholding form be completed.

• Consult your tax professional for additional information regarding state income tax withholding.

• U.S. Person residing abroad

• If you are a U.S. person residing abroad, you are not permitted to opt out of federal income tax withholding. We will withhold

10% unless a greater amount is elected.

• Consult your tax professional for additional information regarding state income tax withholding.

• Withholding for Nonresident Alien or a Beneficiary that is a Foreign Estate, Trust or Charity

• If you are a nonresident alien, this form must be accompanied by a properly completed IRS Form W-8BEN.

• We will generally withhold tax at a rate of 30%.

• If you are a foreign simple or grantor trust, you must provide Form W-8IMY along with any necessary supporting

documentation required by the Form W-8IMY instructions.

The following General Instructions, Marginal Rate Tables and Specific Instructions are mandated and provided by the IRS. They

may help you select the appropriate withholding rate for this distribution. You must complete the federal and state income tax

election sections that follow these instructions. Contact your tax professional for any questions. Note: References to specific

pages and line numbers align to the IRS Form W-4R that can be found at irs.gov/FormW4R

General Instructions

Section references are to the Internal Revenue Code.

Future developments. For the latest information about any future

developments related to Form W-4R, such as legislation enacted

after it was published, go to

www.irs.gov/FormW4R.

Purpose of form. Complete Form W-4R to have payers withhold the

correct amount of federal income tax from your nonperiodic

payment or eligible rollover distribution from an employer

retirement plan, annuity (including a commercial annuity), or

individual retirement arrangement (IRA). See page 2 for the rules

and options that are available for each type of payment. Don’t use

Form W-4R for periodic payments (payments made in installments at

regular

intervals over a period of more than 1 year) from these plans or

arrangements. Instead, use Form W-4P, Withholding Certificate for

Periodic Pension or Annuity Payments. For more information on

withholding, see Pub. 505, Tax Withholding and Estimated Tax.

Caution: If you have too little tax withheld, you will generally owe tax

when you file your tax return and may owe a penalty unless you

make timely payments of estimated tax. If too much tax is withheld,

you will generally be due a refund when you file your tax return. Your

withholding choice (or an election not to have withholding on a

nonperiodic payment) will generally apply to any future payment

from the same plan or IRA. Submit a new Form W-4R if you want to

change your election.

2024 Marginal Rate Tables

You may use these tables to help you select the appropriate withholding rate for this payment or distribution. Add your income from all

sources and use the column that matches your filing status to find the corresponding rate of withholding. See page 2 for more information

on how to use this table.

Single

Married filing separately

Total income

over—

Tax rate for every

dollar more

$0 0%

14,600 10%

26,200 12%

61,750 22%

115,125 24%

206,550 32%

258,325 35%

623,950* 37%

If married filing separately, use $380,200 instead for this 37% rate.

Married filing jointly

Qualifying surviving spouse

Total income

over—

Tax rate for every

dollar more

$0 0%

29,200 10%

52,400 12%

123,500 22%

230,250 24%

413,100 32%

516,650 35%

760,400 37%

Head of household

Total income

over—

Tax rate for every

dollar more

$0 0%

21,900 10%

38,450 12%

85,000 22%

122,400 24%

213,850 32%

265,600 35%

631,250 37%

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 75085T

Form W-4R (2024)

33103_CYI v7.4.1

Page 7 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Form W-4R (2024)

Page 2

General Instructions (continued)

Nonperiodic payments—10% withholding. Your payer must

withhold at a default 10% rate from the taxable amount of

nonperiodic payments unless you enter a different rate on line 2.

Distributions from an IRA that are payable on demand are treated as

nonperiodic payments. Note that the default rate of withholding may

not be appropriate for your tax situation. You may choose to have no

federal income tax withheld by entering “-0-” on line 2. See the

specific instructions below for more information. Generally, you are

not permitted to elect to have federal income tax withheld at a rate

of less than 10% (including “-0-”) on any payments to be delivered

outside the United States and its territories.

Note: If you don’t give Form W-4R to your payer, you don’t provide

an SSN, or the IRS notifies the payer that you gave an incorrect SSN,

then the payer must withhold 10% of the payment for federal

income tax and can’t honor requests to have a lower (or no) amount

withheld. Generally, for payments that began before 2024, your

current withholding election (or your default rate) remains in effect

unless you submit a Form W-4R.

Eligible rollover distributions—20% withholding. Distributions you

receive from qualified retirement plans (for example, 401(k) plans

and section 457(b) plans maintained by a governmental employer)

or tax-sheltered annuities that are eligible to be rolled over to an IRA

or qualified plan are subject to a 20% default rate of withholding on

the taxable amount of the distribution. You can’t choose withholding

at a rate of less than 20% (including “-0-”). Note that the default

rate of withholding may be too low for your tax situation. You may

choose to enter a rate higher than 20% on line 2. Don’t give Form

W-4R to your payer unless you want more than 20% withheld.

Note that the following payments are not eligible rollover

distributions for purposes of these withholding rules:

• Qualifying “hardship” distributions;

• Distributions required by federal law, such as required minimum

distributions;

• Generally, distributions from a pension-linked emergency savings

account;

• Eligible distributions to a domestic abuse victim;

• Qualified disaster recovery distributions;

• Qualified birth or adoption distributions; and

• Emergency personal expense distributions.

See Pub. 505 for details. See also Nonperiodic payments—10%

withholding above.

Payments to nonresident aliens and foreign estates. Do not use

Form W-4R. See Pub. 515, Withholding of Tax on Nonresident Aliens

and Foreign Entities, and Pub. 519, U.S. Tax Guide for Aliens, for

more information.

Tax relief for victims of terrorist attacks. If your disability payments

for injuries incurred as a direct result of a terrorist attack are not

taxable, enter “-0-” on line 2. See Pub. 3920, Tax Relief for Victims

of Terrorist Attacks, for more details.

Specific Instructions

Line 1b

For an estate, enter the estate’s employer identification number

(EIN) in the area reserved for “Social security number.”

Line 2

More withholding. If you want more than the default rate withheld

from your payment, you may enter a higher rate on line 2.

Less withholding (nonperiodic payments only). If permitted, you

may enter a lower rate on line 2 (including “-0-”) if you want less

than the 10% default rate withheld from your payment. If you have

already paid, or plan to pay, your tax on this payment through other

withholding or estimated tax payments, you may want to enter “-0-”.

Suggestion for determining withholding. Consider using the

Marginal Rate Tables on page 1 to help you select the appropriate

withholding rate for this payment or distribution. The tables are most

accurate if the appropriate amount of tax on all other sources of

income, deductions, and credits has been paid through other

withholding or estimated tax payments. If the appropriate amount of

tax on those sources of income has not been paid through other

withholding or estimated tax payments, you can pay that tax through

withholding on this payment by entering a rate that is greater than

the rate in the Marginal Rate Tables.

The marginal tax rate is the rate of tax on each additional dollar of

income you receive above a particular amount of income. You can

use the table for your filing status as a guide to find a rate of

withholding for amounts above the total income level in the table.

To determine the appropriate rate of withholding from the table,

do the following. Step 1: Find the rate that corresponds with your

total income not including the payment. Step 2: Add your total

income and the taxable amount of the payment and find the

corresponding rate.

If these two rates are the same, enter that rate on line 2. (See

Example 1 below.)

If the two rates differ, multiply (a) the amount in the lower rate

bracket by the rate for that bracket, and (b) the amount in the higher

rate bracket by the rate for that bracket. Add these two numbers;

this is the expected tax for this payment. To get the rate to have

withheld, divide this amount by the taxable amount of the payment.

Round up to the next whole number and enter that rate on line 2.

(See Example 2 below.)

If you prefer a simpler approach (but one that may lead to

overwithholding), find the rate that corresponds to your total income

including the payment and enter that rate on line 2.

Examples. Assume the following facts for Examples 1 and 2. Your

filing status is single. You expect the taxable amount of your

payment to be $20,000. Appropriate amounts have been withheld

for all other sources of income and any deductions or credits.

Example 1. You expect your total income to be $62,000 without

the payment. Step 1: Because your total income without the

payment, $62,000, is greater than $61,750 but less than $115,125,

the corresponding rate is 22%. Step 2: Because your total income

with the payment, $82,000, is greater than $61,750 but less than

$115,125, the corresponding rate is 22%. Because these two rates

are the same, enter “22” on line 2.

Example 2. You expect your total income to be $43,700 without

the payment. Step 1: Because your total income without the

payment, $43,700, is greater than $26,200 but less than $61,750,

the corresponding rate is 12%. Step 2: Because your total income

with the payment, $63,700, is

33103_CYI v7.4.1

Page 8 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Form W-4R (2024)

Page 3

greater than $61,750 but less than $115,125, the corresponding

rate is 22%. The two rates differ. $18,050 of the $20,000 payment

is in the lower bracket ($61,750 less your total income of $43,700

without the payment), and $1,950 is in the higher bracket ($20,000

less the $18,050 that is in the lower bracket). Multiply $18,050 by

12% to get $2,166. Multiply $1,950 by 22% to get $429. The sum

of these two amounts is $2,595. This is the estimated tax on your

payment. This amount corresponds to 13% of the $20,000 payment

($2,595 divided by $20,000). Enter “13” on line 2.

Privacy Act and Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal Revenue laws of

the United States. You are required to provide this information only if

you want to (a) request additional federal income tax withholding

from your nonperiodic payment(s) or eligible rollover distribution(s);

(b) choose not to have federal income tax withheld from your

nonperiodic payment(s), when permitted; or (c) change a previous

Form W-4R (or a previous Form W-4P that you completed with

respect to your nonperiodic payments or eligible rollover

distributions). To do any of the aforementioned, you are required by

sections 3405(e) and 6109 and their regulations to provide the

information requested on this form. Failure to provide this

information may result in inaccurate withholding on your

payment(s).

Failure to provide a properly completed form will result in your

payment(s) being subject to the default rate; providing fraudulent

information may subject you to penalties.

Routine uses of this information include giving it to the

Department of Justice for civil and criminal litigation, and to cities,

states, the District of Columbia, and U.S. commonwealths and

territories for use in administering their tax laws. We may also

disclose this information to other countries under a tax treaty, to

federal and state agencies to enforce federal nontax criminal laws, or

to federal law enforcement and intelligence agencies to combat

terrorism.

You are not required to provide the information requested on a

form that is subject to the Paperwork Reduction Act unless the form

displays a valid OMB control number. Books or records relating to a

form or its instructions must be retained as long as their contents

may become material in the administration of any Internal Revenue

law. Generally, tax returns and return information are confidential,

as required by section 6103.

The average time and expenses required to complete and file this

form will vary depending on individual circumstances. For estimated

averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be

happy to hear from you. See the instructions for your income tax

return.

33103_CYI v7.4.1

Page 9 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

You must make an

election for both federal

and state tax withholding.

5A. FEDERAL WITHHOLDING ELECTION (DO NOT LEAVE BLANK)

You may elect not to have federal income tax withholding apply to your distribution. Your election will

remain in effect until you revoke it in writing, which can be done at any time. There are penalties for not

paying enough federal income taxes during the year, either through withholding on distributions or by

making estimated tax payments.

You must elect to have either:

No federal income tax withheld from your distribution by entering "0" in the election box, OR•

• Federal income tax withheld by entering a whole percent from 1 to 100 in the election box.

The following section is mandated and provided by the IRS. (

Reference to page 2 and Marginal Rate

Tables align to the IRS Form W-4R that can be found at

irs.gov/FormW4R

I elect to have no state income tax withheld from my distribution, or I certify that I am not subject to

state tax withholding.

I elect to have the following percentage withheld from my distribution.

I elect to have the following dollar amount withheld from my distribution.

(percentage)

(in whole dollars)

Certain states require withholding of a specific minimum percentage of your distribution or federal tax

withholding amount or an amount in whole dollars. By signing this form, you authorize JPMS to adjust the

withholding amount or percent requested to meet those requirements.

5B. STATE WITHHOLDING ELECTION

Important: DO NOT

LEAVE BLANK.

Enter 0 to waive federal

tax or a whole percent

from 1% to 100% as your

federal withholding

election. If you would like

the default withholding

rate, enter either 10% or

20%, as applicable.

If your requested gross

distribution amount is not

a whole number, the

application of your chosen

tax withholding rate may

result in a fractional penny,

which will be rounded up to

the nearest whole penny.

This may result in a higher

effective tax withholding

rate (%).

Your withholding rate is determined by the type of payment you will receive.

• For nonperiodic payments, the default withholding rate is 10%. You can choose to have a different rate by entering a

rate between 0% and 100% on line 2. Generally, you can’t choose less than 10% for payments to be delivered

outside the United States and its territories.

• For an eligible rollover distribution, the default withholding rate is 20%. You can choose a rate greater than 20% by

entering the rate on line 2. You may not choose a rate less than 20%.

See page 2 for more information.

Complete this line if you would like a rate of withholding that is different from the

default withholding rate. See the instructions on page 2 and the Marginal Rate Tables

below for additional information. Enter the rate as a whole number (no decimals). . . .

33103_CYI v7.4.1

Page 10 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Authorization

By signing below, I authorize JPMS to make this one-time distribution from my JPMS IRA as indicated on this form.

I acknowledge and understand:

• There may be fees associated with the liquidation of certain investments and/or the distribution.

• I am responsible for ensuring that there are sufficient funds available in my JPMS IRA for this distribution.

• This distribution may have important tax consequences. This distribution and any tax withholding, if applicable, will be reported to

the IRS on Form 1099-R or Form 1042-S.

• I should consult a legal, accounting or tax professional with any questions.

• I assume full responsibility for the tax consequences of this election and the resulting distribution.

• If indicated on this form, and subject to the terms of the Brokerage Account Agreement governing my JPMS IRA, I authorize JPMS

to direct the distribution of money electronically according to the instructions outlined on this form between the JPMS IRA and the

bank/financial institution account designated on this form, and authorize that bank/financial institution to credit and/or debit the

same to the bank/financial institution account. JPMS will undertake to make transfers as directed, but is not responsible for

damages of any nature resulting from delays, failures, omissions or errors relating to such transfers. I understand that, in rare

instances, erroneous credits or debits may be made to the bank/financial institution account. If such is the case, I authorize JPMS

to reverse such errors by debiting or crediting the bank/financial institution account and crediting or debiting the JPMS IRA as is

appropriate.

• The origination of Automated Clearing House (ACH) transactions to or from my account(s) must comply with the provisions of U.S.

law.

• This authorization is to remain in effect until JPMS receives written notification from me (provided to J.P. Morgan Securities LLC,

Mail Code: IL1-0291, 10 S. Dearborn St., Chicago, IL 60603) of its termination in such time and manner as to afford JPMS and the

bank/financial institution a reasonable opportunity on which to act.

• I agree to indemnify and hold JPMS and its successors, affiliates, assigns, officers, directors, agents and employees (the

Indemnified Parties) harmless from, and to pay the Indemnified Parties promptly on demand, any and all losses, liabilities,

damages, claims, costs or expenses (including attorney fees and expenses) incurred by the Indemnified Parties in connection with

their reliance on this distribution request and authorization(s), including in the event that I fail to meet applicable requirements

regarding the requested distribution from my IRA. These indemnification provisions are in addition to (and in no way limit or

restrict) any rights that any of the Indemnified Parties may have under any other agreement(s) between myself and any of the

Indemnified Parties or under any federal or state statutes, laws, rules or regulations. This indemnity shall survive termination of

any authorization with respect to transactions entered into during the term of the authorization.

I certify that:

• No tax or legal advice has been given to me by JPMS and all decisions regarding this election are my own.

• Under penalties of perjury, I am a U.S. person (including a U.S. resident alien).

• For a rollover to an employer-sponsored plan, these funds are eligible for rollover to the plan as I have met or will meet all

applicable requirements, including that I have retained any Required Minimum Distribution (RMD) and I am not rolling over any

funds I am required to withdraw.

Your Signature Date (month/day/year)

33103_CYI v7.4.1

Page 11 of 12

Your Account NumberYour Name

IRA Distribution Request for Withdrawal, Rollover or

Return of Excess Contribution (Self-Directed Investing)

Identity Verification

If you are submitting this form by secure message, notarization is not required.

If you are submitting this form by fax or mail, it must be notarized. Please have a notary public complete the box below.

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate

is attached, and not the truthfulness, accuracy or validity of that document.

STATE OF

COUNTY OF

Subscribed, sworn to and acknowledged before me by

Name of Document Signer (above)

this

Day

day of

Month

Year

Signature of Notary Public

)

) SS:

)

Place Stamp Here

My commission expires

33103_CYI v7.4.1

Page 12 of 12