Print Entire Kit
Print Forms Only
What’s inside:
• IRA Distribution
Form
• Bank Transfer
Service Form
IRA Distribution Kit
To authorize distributions from your Vanguard IRA®
If you meet the eligibility requirements, you can begin withdrawing funds
from your Vanguard IRA without incurring a premature distribution penalty.
Note: If taking required minimum distributions, use our Required Minimum
Distribution Service Form instead.
Eligibility
Normal distribution. You may begin making withdrawals at age 59½ even
if you continue working. Contributions and investment earnings are subject
to ordinary income tax in the year of the withdrawal.
Early (premature) distribution. If you’re under age 59½, your distributions
are subject to ordinary income tax and may also be subject to a 10% federal
penalty tax unless you meet an IRS exception. To claim an exception from the
premature distribution penalty, you must complete IRS Form 5329.
Rollover to an employer plan (for traditional IRAs only). Before using the
enclosed form, check with your employer to determine whether your plan has
its own requirements for accepting IRA assets.
Inherited traditional IRA distribution. If the original IRA owner has died and
you’re the beneficiary.
For details about your eligibility for IRA distributions, consult your tax advisor.
You may also refer to IRS Publications 571, 575, and 590, which are available
online at irs.gov.
Important information about charitable distributions
You’re eligible to transfer distributions from your IRA to an eligible charitable organization—without having to count the
distributions as taxable income—only if all of the following are true:
• You’re age 70½ or older.
• The distribution is from a traditional or Roth IRA. (The distribution cannot be made from a SEP-IRA or SIMPLE IRA
maintained under an employer plan and to which you contributed during the year of the distribution.)
• The distribution is for an amount that would otherwise be taxable (i.e., pre-tax contributions and earnings).
• The distribution is being made directly from your Vanguard account to the charity. (This includes checks payable to
the charity and sent to your address of record.)
• The charity is a qualified charity, as defined in section 170(b)(1)(A) of the Internal Revenue Code. Certain charities—
such as donor-advised funds, charitable remainder trusts, and private foundations—are excluded.
• The amount of your charitable distribution when added to the total amount of your charitable IRA rollover distributions made this calendar year, doesn’t exceed $100,000.
• Amounts withheld for taxes aren’t sent to the charity and wouldn’t qualify as a charitable distribution.
For more information about the rules of charitable distributions from an IRA, consult your tax adviser.
Special notes about determining
taxability of distributions
The information below and on the next page
pertains to the taxability of IRA withdrawals.
Roth IRA conversions
If you converted a traditional IRA to a Roth IRA, you
paid tax on those assets in the year you converted
them. Therefore, you won’t owe tax when you
withdraw them. But if you withdraw converted assets
less than five years after the conversion and you’re
under age 59½, you may owe a 10% federal penalty
tax on the withdrawal.*
Nondeductible IRA contributions
If you made nondeductible contributions to your
traditional IRA or rolled over after-tax money from
an employer’s retirement plan, part of your IRA
distributions will be exempt from additional federal
income tax. To calculate the taxable portion of your
distribution, complete IRS Form 8606 (available online
at irs.gov or by phone at 800-TAX-FORM). See
Section VII of The Vanguard Traditional IRA, SEP-IRA,
and Roth IRA Disclosure Statement for an example of
this calculation.
If you’re withdrawing assets from a Roth IRA, use
IRS Form 8606 to calculate the taxable amount of any
earnings you’ve withdrawn.
Inherited IRAs (traditional and Roth)
• You may have to take minimum distributions.
When you inherit an IRA, the IRS generally
requires you to take your first annual distribution
by December 31 of the year after the year in
which the IRA’s original owner died. You may have
additional options if you inherited the IRA from
your spouse.
• Some traditional IRA withdrawals may be
tax-free. If an inherited traditional IRA includes
nondeductible contributions or after-tax money
rolled over from an employer’s retirement plan,
part of your withdrawals may be tax-exempt. To
determine the taxable amount of your withdrawals,
refer to the original owner’s IRS Form 8606 or
Form 8606 worksheets, or consult a tax advisor.
• Some Roth IRA withdrawals may be taxable.
If you inherited a Roth IRA from someone who
established a Roth IRA less than five years ago,
you may owe tax on part of your withdrawals. For
details, see The Vanguard Traditional IRA, SEP-IRA,
and Roth IRA Disclosure Statement.
• There’s no penalty for early withdrawal. You can
withdraw money at any age from your inherited
IRA—either traditional or Roth—without incurring a
federal penalty tax.
Before completing the enclosed form for
an inherited IRA, call us for instructions at
800-662-2739.
*The 10% penalty doesn’t apply to rollovers from one IRA to another within a 60-day period or to distributions taken because of your death
or disability. Also exempt from the penalty are withdrawals taken to pay for a first home ($10,000 lifetime maximum), to cover medical
expenses in excess of 7.5% of adjusted gross income, to pay health insurance premiums if you received unemployment compensation
for at least 12 consecutive weeks, to pay qualified postsecondary education costs, or for substantially equal periodic payments. For more
details, read Section VII of The Vanguard Traditional IRA, SEP-IRA, and Roth IRA Disclosure Statement, or consult a professional tax or
financial advisor. See IRS Form 5329 for instructions on tax filing for any penalty tax on withdrawals.
1 of 2
How IRA distributions are taxed
If you’re under age 59½
If you’re age 59½ or older
Traditional IRA
Your distributions are generally
subject to ordinary income tax
and may also be subject to a 10%
federal penalty tax.*
Your distributions are generally
subject to ordinary income tax,
but are penalty-free.
Roth IRA
• Distributions of contributed
assets are tax-free and
penalty-free.
• Distributions of contributed
and converted assets are taxfree and penalty-free.
• Distributions of converted
assets are subject to a 10%
federal penalty tax unless an
exception applies.*
• Distributions of earnings are
subject to ordinary income
tax, but not the 10% federal
penalty tax.
• Distributions of earnings are
subject to ordinary income tax.
Earnings are also subject to a
10% federal penalty tax unless
an exception applies.*
These rules also apply if you’re
disabled or purchasing a first
home.
• Distributions of contributed
and converted assets are
tax-free.
All distributions are tax-free and
penalty-free.
accounts held less
than five years**
Roth IRA
accounts held five
years or more**
• Distributions of earnings are
subject to ordinary income
tax unless the distribution is
taken because of your death
or disability, or a first-time
home purchase. Earnings
may also be subject to a 10%
federal penalty tax unless an
exception applies.*
**The 10% penalty doesn’t apply to rollovers from one IRA to another within a 60-day period or to distributions taken because
of your death or disability. Also exempt from the penalty are withdrawals taken to pay for a first home ($10,000 lifetime
maximum), to cover medical expenses in excess of 7.5% of adjusted gross income, to pay health insurance premiums if you
received unemployment compensation for at least 12 consecutive weeks, to pay qualified postsecondary education costs, or
for substantially equal periodic payments. For more details, read Section VII of The Vanguard Traditional IRA, SEP-IRA, and
Roth IRA Disclosure Statement, or consult a professional tax or financial advisor. See IRS Form 5329 for instructions on tax
filing for any penalty tax on withdrawals.
**The five-year holding period begins on January 1 of the first year for which you made a Roth contribution or January 1 of the
first year in which you converted assets—whichever comes first. For conversions, the five-year holding period begins on
January 1 of the year in which the conversion was made and is determined separately for each conversion.
NRSB 022013
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Form RRDFT
Clear All
Vanguard Brokerage Account
IRA Distribution Form
Effective July 2014
Use this form if you hold your Vanguard mutual funds in your Vanguard
Brokerage Account traditional IRA, SEP-IRA, Roth IRA, or inherited IRA
and want to request a one-time distribution from the account. We’ll
liquidate the Vanguard fund shares you indicate and distribute the
proceeds as cash.* Use a separate form for each IRA.
Questions?
Call 800-662-2739.
If you need other forms or want to
complete this form online, go to
vanguard.com/serviceforms.
Don’t use this form to convert a traditional or SEP-IRA to a Roth IRA, to
remove an excess IRA contribution, or to distribute assets in-kind. Contact
us for instructions.
Print in capital letters and use black ink.
1. Account owner information
Vanguard Brokerage Account number Enter all eight digits.
Provide your name
as it appears on
your account.
>
Name first, middle initial, last
Last four digits of Social Security number
2. Reason for distribution
Zip code
For details about your eligibility for IRA distributions, consult your tax advisor.
Check only one option under Traditional or SEP-IRA or Roth IRA, depending on which type of IRA
you own. This information enables us to properly code your IRS Form 1099-R. If you don’t check a
box, your distributions won’t be processed.
Traditional or SEP-IRA
■ Normal distribution (IRS distribution code 07). I’m age 59½ or older.
• Normal distributions are subject to ordinary income tax.
• You’re eligible to begin taking distributions at age 59½ even if you continue working.
• If you’re over age 70½ and making a charitable distribution, select Option C in
Section 4. A Medallion signature guarantee is required for this request.
■ Early (premature) distribution (IRS distribution code 01). I’m under age 59½.
If distributing from
a traditional or
SEP-IRA, choose
the reason that best
applies to you.
>
• Distributions before age 59½ may be subject to ordinary income tax and may also be
subject to a 10% federal penalty tax unless you meet an IRS exception.
• To claim an exception from the penalty tax, you must complete IRS Form 5329.
■ Traditional rollover to an employer plan (IRS distribution code G). I want to roll over
my IRA directly to an employer plan (a 401(k), for example).
• You can’t roll over after-tax amounts from your IRA. Vanguard can’t certify to your
employer whether your IRA contributions were pre-tax or after-tax.
• When completing Section 4, you must select Option D.
■ Inherited traditional IRA distribution (IRS distribution code 04). The original IRA owner
has died and I’m the beneficiary.
**We can’t accept requests by mail to sell individual stocks, bonds, certificates of deposit, exchange-traded funds (ETFs), or non-Vanguard
mutual funds. To process these requests, please log on to your account at vanguard.com or call us.
1 of 6
Form RRDFT
Roth IRA
■ Normal distribution (IRS distribution code T). I’m age 59½ or older.
You’re eligible to begin taking distributions at age 59½ even if you continue working.*
If distributing from
a Roth IRA, choose
the reason that best
applies to you.
■ Early (premature) distribution (IRS distribution code J). I’m under age 59½.
>
• Nonqualified distributions of earnings before age 59½ may be subject to ordinary
income tax and a 10% federal penalty tax unless you meet an IRS exception.
• To claim an exception from the penalty tax, you must complete IRS Form 5329.
■ Inherited Roth IRA distribution (IRS distribution code T). The original IRA owner has
died and I’m the beneficiary.*
3. Amount you want to distribute
• If you indicate a dollar amount for a fund and market fluctuations have caused the value of that
fund to decrease below your requested amount, we won’t process the distribution.
• We can’t accept requests by mail to sell individual stocks, bonds, certificates of deposit, ETFs,
or non-Vanguard mutual funds. To process these requests, please log on to your account at
vanguard.com or call us.
• Money recently added to your account by check or electronic bank transfer may not be
immediately available to distribute from your account.
• If there’s a debit balance in the account, we may not be able to process the distribution.
• Open orders in your account may affect the amount(s) available for distribution.
Check one.
If you check this box,
skip to Section 4.
> ■ Total amount. Sell all shares of my Vanguard mutual funds in the Vanguard Brokerage
Account listed in Section 1, including my money market settlement fund, and distribute
the proceeds.
■ Partial amount. Sell only the fund shares indicated below and distribute the proceeds.
If you wish to redeem the entire amount of a fund, indicate 100% or check “All” next to
the fund.
■ My money market settlement fund
If you need more
space to list
additional funds,
either photocopy
this section or attach
additional sheets as
necessary. Each sheet
must be signed and
dated and include the
account number.
Dollar amount
or
Percentage
or
Percentage
or
Percentage
or
Percentage
or
Percentage
$
Vanguard fund name
Fund symbol Dollar amount
Vanguard fund name
Fund symbol Dollar amount
Vanguard fund name
Fund symbol Dollar amount
Vanguard fund name
Fund symbol Dollar amount
All
or
All
or
All
or
All
or
All
■
.0%
$
>
or
■
.0%
$
■
.0%
$
■
.0%
$
.0%
■
*If our records indicate that five or more full tax years have passed since your first contribution or conversion to your Roth IRA at Vanguard
(including contributions made by April 15 for the prior year), we’ll automatically use IRS distribution code Q—not T—when submitting your
IRS Form 1099-R for the distribution.
Return ALL pages of this form, even if some sections are left blank.
2 of 6
Form RRDFT
4. How you want to distribute the proceeds
Check and complete A, B, C, D, or E.
■ Option A. Send the proceeds directly to my bank account.
Electronic bank transfers can take two to three business days to arrive at your bank once
Vanguard processes your request. Check one.
■ I want to use the bank information I already have on file with Vanguard to
process this distribution request. In most cases, you can process this type of
distribution online at vanguard.com or by phone without having to submit this form.
If you check this box
and don’t enclose our
Bank Transfer Service
Form, we won’t be
able to process your
distribution until
we obtain the bank
information.
Bank name
Account type
■ Savings
>
■ Checking
Last four digits of bank account
number
■ I want to add new bank information. I’ve also enclosed the Bank Transfer Service
Form, which contains the bank information to be used for this distribution.
■ Option B. Make a check payable to me and send it to the mailing address you have
on file for me.
If you check this box,
a Medallion signature
guarantee is required
in Section 6.
>
■ Option C. Make a check payable to someone else and mail it to the following
address. Select this option for charitable distributions, which must be made payable to a
qualified charitable organization in order to be qualified by the IRS.* If you’d like the check
sent to the mailing address we have on file for you, leave the address fields blank.
Name of payee not to exceed 30 characters
Street or P.O. box
City, state, zip
■ Option D. Make a check payable to the employer plan/institution listed below. The
check will be made payable to [Name of employer plan/institution FBO] [Name of the
Vanguard Brokerage Account owner] and sent to the plan/institution address you indicate
below. (FBO means “for benefit of.”) If you’d like the check mailed to the address we
have on file for you, leave the address fields blank.
Name of plan/institution not to exceed 30 characters Account number
Street or P.O. box
City, state, zip
If the registrations
on your IRA and the
receiving account don’t
match, a Medallion
signature guarantee is
required in Section 6.
>
■ Option E. Send the proceeds to my existing nonretirement Vanguard
Brokerage Account.
Account number
*Charitable distributions can’t be made from a SEP-IRA maintained under an employer plan and to which you contributed during the year
of the distribution.
Return ALL pages of this form, even if some sections are left blank.
3 of 6
Form RRDFT
5. Income tax withholding elections
• Regardless of your withholding election, you’re responsible for paying any tax due on the taxable
portion of your distribution(s). If your account has no taxable earnings, Vanguard won’t withhold
federal or state income tax from your distribution(s).
• If taxes are withheld on the distribution, the amount you requested in Section 3 will decrease by
the amount withheld.
• You may be subject to penalty taxes if federal and state taxes are due and either your estimated tax
payments or the amount of tax you have withheld is insufficient under IRS rules or your state’s rules.
• Your withholding for federal and state taxes, when combined, can’t exceed 99% of your distribution.
Federal income tax withholding
• Distributions from a Roth IRA aren’t subject to withholding, but you may request withholding if
you wish.
• Distributions from traditional, rollover, and SEP-IRAs are subject to federal tax withholding at a rate
of 10% unless you check the Don’t withhold box or specify a higher amount below.
Special rules for addresses outside the U.S.
If your account is registered to an address outside the U.S. or your payment is being directed
outside the U.S., we’re required to presume your tax status to be foreign and withhold 30%
federal income tax from your distribution unless one of the following applies:
• You’re a U.S. person (including a resident alien) and we have a valid IRS Form W-9 on
file. We’re required to withhold 10% federal income tax from your distribution. You can’t
elect out of federal income tax withholding for distributions delivered outside the U.S.
• You’re not a U.S. person and we have on file a valid IRS Form W-8 on which you’ve
claimed tax treaty benefits. If you’re eligible for a reduced withholding rate based on a
tax treaty your country has with the U.S., you may claim the reduced rate by completing
Form W-8, including the section titled “Claim of Tax Treaty Benefits,” and providing either
your U.S. taxpayer identification number (TIN) or your foreign TIN. If your claim is valid, the
reduced rate will be applied.
If you have an address outside the U.S. and aren’t sure whether we have a Form W-9 or W-8
on file for your account, please call us. We’ll provide you with further instructions for completing
either a paper Form W-9 or an electronic Form W-8.
Check one.
If you don’t check a
box, Vanguard will
withhold 10% of the
distribution(s).
■ Don’t withhold federal income tax from my distribution(s).
>
■ Withhold at a rate of
% from my distribution(s).
The rate must be at least 10%.
Return ALL pages of this form, even if some sections are left blank.
4 of 6
Form RRDFT
State income tax withholding
Vanguard will apply withholding for your state as you instruct below. If you have questions regarding
state withholding, contact your tax advisor or your state’s taxing authority. If you aren’t a resident
of one of the following states, skip to Section 6.
Residents of Iowa, Kansas,
Maine, Massachusetts, Nebraska,
and Oklahoma
If federal tax is withheld, state tax withholding is mandatory.
Vanguard will automatically withhold the minimum required by
your state unless you specify a higher amount below.
Residents of Arkansas,
California, Delaware, Michigan,
North Carolina, Oregon,
and Vermont
If federal tax is withheld, state tax withholding is mandatory
unless you specifically elect not to have state tax withheld. Vanguard
will automatically withhold the minimum required by your state
unless you either check the Don’t withhold box or specify a higher
amount below.
Residents of Mississippi
If federal tax is withheld, state tax withholding is mandatory if
your distribution is subject to the federal early withdrawal penalty.
Vanguard will automatically withhold the minimum required by
your state unless you specify a higher amount below.
Residents of Indiana, Louisiana,
Maryland, Missouri, Montana,
New Jersey, New Mexico, New
York, Utah, and Wisconsin
State tax may be withheld regardless of your federal withholding
election. Vanguard will withhold as you indicate below. If no box is
checked, we won’t withhold.
Check one.
■ Don’t withhold state income tax from my distribution(s).
■ Withhold my state’s minimum requirement.
■ Withhold this amount:
We’ll withhold at least your state’s minimum requirement.
%
or
$
Return ALL pages of this form, even if some sections are left blank.
5 of 6
Form RRDFT
6. Authorization of account owner
Read carefully before signing.
Important:
• If you selected Option A in Section 4 and want to send this distribution to a bank that isn’t
already on file with Vanguard, you must complete our Bank Transfer Service Form and mail it
with this form. If you don’t include this form, there will be a delay in processing your request.
• You must obtain a Medallion signature guarantee when signing if you either selected Option C
in Section 4 or selected Option E and the registrations on your IRA and the receiving account
don’t match.
By signing below, You acknowledge that You have read and understand these distribution
instructions and further acknowledge that these instructions are binding. If You are distributing
the assets listed in Section 3 to a third party, You hereby irrevocably relinquish all rights, title,
and interest to those assets.
If a Medallion
signature guarantee is
required, DO NOT sign
this form until you’re
in the presence of an
authorized officer.
Signature of account owner
> X
Print name
Medallion signature guarantee
You can get a
Medallion signature
guarantee from an
authorized officer of
a bank, broker, and
many other financial
institutions.
Date mm/dd/yyyy
if required
Authorized officer’s title
>
Signed guarantee stamp must be original and
state “Signature guaranteed”
Name of institution
A notary public
CANNOT provide a
signature guarantee.
Date mm/dd/yyyy
Mailing information
Make a copy of your completed form for your records.
Mail your completed form and any other required information in the enclosed postage-paid envelope.
If you don’t have
a postage-paid
envelope, mail to:
>
Vanguard
P.O. Box 2600
Valley Forge, PA 19482-2600
For overnight
delivery, mail to:
>
Vanguard
455 Devon Park Drive
Wayne, PA 19087-1815
Return ALL pages of this form, even if some sections are left blank.
Vanguard Brokerage Services is a division of Vanguard Marketing Corporation, member FINRA and SIPC.
© 2014
The Vanguard Group, Inc.
All rights reserved.
RRDFT 072014
6 of 6
Bank Transfer Service Form
For adding bank information so that you can make electronic or wire transfers between a U.S. bank account
and your Vanguard account
How to get started
Mail the form to:
You may be able to add a bank (or savings and loan
or credit union) online without having to use a form.
Log on to your account at vanguard.com. From the
menu, choose My Accounts and select Account
maintenance. Then select Bank information to add
a new bank.
Vanguard
P.O. Box 1110
Valley Forge, PA 19482-1110
If you choose to submit this form to add a bank,
you’ll need to provide the following documentation:
• A voided check, preprinted deposit slip,
statement, or letter from the bank (see Section 2).
The bank must be a member of the ACH network.
If you plan to send wires, the bank must also be
a member of the Federal Reserve System. If the
bank requires “for further credit to” information,
attach instructions.
• Signatures of all Vanguard account owners
(or their full agents) and bank account owners
(see Section 3). Check with the bank if you
have questions about who must sign to provide
authorization for this service. If the appropriate
signatures aren’t provided, the bank account may
not be linked to your Vanguard account.
Important: If the name(s) on the Vanguard
account and the bank account(s) aren’t the
same, all owners must have their signatures
individually notarized.
For overnight delivery:
Vanguard
455 Devon Park Drive
Wayne, PA 19087-1815
Allow approximately one week after we receive this
form in good order for the bank account information
to be added to your Vanguard account.
Set up automatic transfers
Once you’ve received confirmation that the bank
account has been linked to your Vanguard account,
you can set up automatic transfers between
the accounts. Simply log on to your account at
vanguard.com. From the menu, choose My
Accounts and select Account maintenance,
then either Automatic investment or Automatic
withdrawal. If you need assistance, call us.
This page is intentionally left blank
Form BTSF
Clear All
Bank Transfer Service Form
Effective August 2015
Questions?
Call 800-662-2739.
Use this form to add a U.S. bank account to your Vanguard
account so that you can easily move money between the bank account
and your Vanguard account by electronic bank transfer or wire.
If you need other forms, go to
vanguard.com/serviceforms.
Print in capital letters and use black ink.
1. Vanguard account you’re adding bank account information to
List only one Vanguard account and provide the requested information for each owner or authorized
signer. If any authorized signer is acting as an agent for the account, check the Agent box to the
right of the name. Only full agents can add bank information; limited agents aren’t permitted.
Note: Vanguard may add the bank information to other accounts that list you as an owner, including
any future accounts you open.
Vanguard account
number
List only one
Vanguard account
and provide all
requested
information.
Taxpayer ID
number (last
four digits)
Zip code
Name of account owner or
authorized signer
Check, if
applicable.
Agent
>
Agent
If you need more space to list additional owners, provide an additional copy of this page.
2. Bank account information
You must provide
this information.
>
Bank routing number Enter all nine digits.
Account type
Checking
Savings
You must also provide at least one of the following:
• A voided check or preprinted deposit slip. Starter checks aren’t acceptable.
• A bank account statement that contains the account number and the registration of the bank
account (all other information can be crossed out).
• A letter from the bank on bank letterhead, signed by a bank officer, that contains the routing
number, account number, account registration, and authorized signers. Important: We must
receive this letter if the bank account is owned by and registered in the name of an organization
or trust, and the names of the individuals whose signatures are required for withdrawals from
the organization’s or trust’s bank account don’t appear on the voided check, preprinted deposit
slip, or statement.
Tape your check or
deposit slip here.
Don’t staple or
alter in any way
other than voiding.
>
John A. Sample
123 Street
Anywhere, USA 12345
PAY TO THE
ORDER OF
MEMO
:000123456:
Bank routing number
87654
BANK NAME
CITY USA
VOID
12345678987654321:
Account number
$
DOLLARS
VOID AFTER 60 DAYS
87654
Check number
1 of 3
Form BTSF
3. Signatures
All Vanguard and bank account owners/authorized signers must sign below. If the Vanguard
account owners/authorized signers aren’t the same as the bank account owners/authorized
signers, everyone’s signature must be notarized.
If I am/we are the owner(s)/authorized signer(s) of the Vanguard account, I/we:
• Authorize The Vanguard Group, Inc., and/or Vanguard Marketing Corporation, and any affiliates of
either (individually or collectively, “Vanguard”), to add the bank account information provided in this
form to my/our Vanguard account(s).
• Authorize Vanguard to send redemption proceeds to the bank account identified in this form as
I/we, or someone I/we have authorized, direct, or to secure payment by electronic bank transfer
of amounts invested by me/us or someone I/we have authorized.
• Agree that Vanguard will not incur any loss, liability, cost, or expense for adding bank account
information to my/our Vanguard account(s). or for sending money to, or taking money from, that
bank account if directed to do so by me, us, or someone we have authorized.
• Understand that this authorization may be terminated by me/us at any time by written notification
to Vanguard. The termination request will be effective as soon as Vanguard has had a reasonable
amount of time to act upon it.
If I am/we are the owner(s) and/or authorized signer(s) of the bank account, I/we:
• Authorize The Vanguard Group, Inc., and/or Vanguard Marketing Corporation, and any affiliates of
either (individually or collectively, “Vanguard”) to make credit or debit entries (“ACH transactions”)
to my/our bank account at the direction of a Vanguard account owner or other authorized person.
• Authorize the bank to accept any such ACH transactions without responsibility for their
correctness.
• Acknowledge that the origination of ACH transactions to my/our bank account must comply with
U.S. law.
• Understand that I/we may terminate this authorization at any time by written notification to the
bank and to Vanguard. The termination will be effective as to Vanguard as soon as Vanguard has
had a reasonable amount of time to act on it.
• Represent and warrant that I am/we are the owner(s) or authorized signer(s) of the bank account
identified in this form, and that no other owner or authorized signer of the bank account is required
to sign to authorize the initiation of ACH transactions to the bank account.
If you’re required to
have your signature
notarized, do NOT
sign until you’re in
the presence of a
notary public.
Signature
Date mm/dd/yyyy
> X
Print name
Acknowledgment of signature
Date mm/dd/yyyy
The notarization must
be dated within
30 days of receipt
of this document
by Vanguard.
>
Name of person signing
County or state
On
of
has appeared before me, has proven to be the person whose name is signed above, and has
acknowledged that this authorization is his/her wish.
Signature of notary public
Notary seal if state requires a seal
Commission expiration date mm/dd/yyyy
(continued on the next page)
All owners of the Vanguard account and the bank account must sign in this section.
2 of 3
Form BTSF
(continued from the previous page)
If you’re required to
have your signature
notarized, do NOT
sign until you’re in
the presence of a
notary public.
Signature
Date mm/dd/yyyy
> X
Print name
Acknowledgment of signature
Name of person signing
Date mm/dd/yyyy
The notarization must
be dated within
30 days of receipt
of this document
by Vanguard.
>
County or state
On
of
has appeared before me, has proven to be the person whose name is signed above, and has
acknowledged that this authorization is his/her wish.
Signature of notary public
Notary seal if state requires a seal
Commission expiration date mm/dd/yyyy
If you’re required to
have your signature
notarized, do NOT
sign until you’re in
the presence of a
notary public.
Signature
Date mm/dd/yyyy
> X
Print name
Acknowledgment of signature
Date mm/dd/yyyy
The notarization must
be dated within
30 days of receipt
of this document
by Vanguard.
>
Name of person signing
County or state
On
of
has appeared before me, has proven to be the person whose name is signed above, and has
acknowledged that this authorization is his/her wish.
Signature of notary public
Notary seal if state requires a seal
Commission expiration date mm/dd/yyyy
If you need more space for additional signatures and notarizations, provide an additional
copy of this page.
Return ALL pages of this form, even if some sections are left blank.
Print Entire Kit
Print Forms Only
© 2015
The Vanguard Group, Inc.
All rights reserved.
BTSF 072015
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P.O. Box 1110
Valley Forge, PA 19482-1110
Connect with Vanguard ® > vanguard.com > 800-662-2739
© 2013 The Vanguard Group, Inc.
All rights reserved.
NRSBCV 022013