IRA Change Information Form For Existing Citibank IRA Customers

What you need to Know

This form may be used for Citibank Traditional IRAs, Roth IRAs or SEP-IRAs.

Change in circumstance requests do require updated tax form validations,

and the submission of applicable forms as outlined below

Please review the information below before you complete this form.

THIS FORM CAN BE USED TO:

Change in Circumstance:

Change the name on your account

• A copy of a Court Order, Marriage Certificate,

Divorce Decree or Separation Agreement

• A completed applicable IRS Form W-9 (if you are a U.S.

Person) or W-8BEN (if you are a Non-U.S. Person)

Change or update your Social Security Number

• A photocopy of your new Social Security Card

• A completed applicable IRS Form W-9 (if you are a U.S.

Person) or W-8BEN (if you are a Non-U.S. Person)

Change your birth date

• legal proof of the correct birthdate

• A completed applicable IRS Form W-9 (if you are a U.S.

Person) or W-8BEN (if you are a Non-U.S. Person)

Report a Change in Circumstance

• A completed IRA Change Information Form

• A completed applicable IRS Form W-9 (if you are a U.S.

Person) or W-8BEN (if you are a Non-U.S. Person)

Servicing:

Start or stop automatic monthly IRA deposits from your

Citibank N.A. consumer checking account to an IRA Insured

Money Market Account or a Roth IRA Insured Money

Market Account

• A completed IRA Change Information Form

Please note the following:

– Automatic deposits cannot be debited from a CitiBusiness

acco

unt and all automatic deposits are considered Current

Year contributions for the year in which they are received

– All fields must be completed: Deduct $ (dollar amount),

ay of the month to deduct the funds, the month in

which deductions are to begin, the Citibank N.A.

consumer checking account to be deducted and the

Citibank Retirement Account to receive the Current Year

contribution

Designate or change the beneficiary or beneficiaries

• A completed IRA Change Information Form

Please note the following:

– If you are changing your beneficiary, the information

ou provide on this form will take the place of any other

prior beneficiary designation. Be sure to read the Guide

for Naming a Beneficiary for Citibank Retirement Plans

included with this form before making changes to your

beneficiary

Please return the completed form to a Citibank branch or

mail the form to:

Regular Mail

Retirement Plan Services

P.O. Box 769001

San Antonio, TX 78245-9951

Overnight Delivery:

Retirement Plan Services

100 Citibank Drive

San Antonio, TX 78245

If you have any questions

Call Retirement Plan Services at 1-800-695-5911. For TTY: we

accept 711 or other Relay Service. Representatives are available

to assist you Monday through Friday 8:00 a.m. – 10:00 p.m.

Eastern Time, and Saturday 9:00 a.m. – 5:30 p.m. Eastern Time.

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IRA Change Information Form

For Existing Citibank IRA Customers

Please complete this section

Designate type of retirement plan(s) you wish to update:  Traditional IRA  Roth IRA  SEP-IRA

Branch Number:

_____________________________________

Owner’s Information

Social Security Number:

_____________________________

 Mr.  Mrs.  Ms.

First Name:

_________________________________ Middle: _________________________________ Last Name: ____________________________________

Address: ______________________________________________________________________________________________________________________________

City: _______________________________________State: _______________________________________ Zip: ________________________________________

Daytime Phone Number:____________________________________________________

By providing a phone number, you agree that we or our service providers can contact you at that number by text message, artificial

voice, pre-recorded or autodialed calls. Your phone plan charges may apply.

PLEASE COMPLETE ONLY THOSE SECTIONS APPROPRIATE TO THE CHANGES YOU WISH TO MAKE

A. Please change my name, address, social security number, telephone number or birthdate to:

Reminder: Any Change in Circumstance requires an updated tax form.

Plan Owner’s Prior Name:

_____________________________________________________________________________________________________________

Plan Owner’s Updated Name:_________________________________________________________________________________________________________

Updated Address:

____________________________________________________________________________________________________________________

City: _______________________________________State: _______________________________________ Zip: ________________________________________

Updated Daytime Phone Number: __________________________________________

By providing a phone number, you agree that we or our service providers can contact you at that number by text message, artificial

voice, pre-recorded or autodialed calls. Your phone plan charges may apply.

Updated Social Security Number:

________________________________Updated Date of Birth: _____________________________________________

Previous Signature: ______________________________________________Updated Signature: ________________________________________________

B. Automatic IRA Deposit (Check one)

 Please deduct $ ______________ (maximum monthly contributions are based on current IRS regulations, please contact a tax advisor

with any questions regarding your specific situation) on the

________ day of each month, beginning the month of ___________________

from my Citibank N.A. consumer checking account number: ____________________________________________

and deposit to my Citibank  Traditional IRA  Roth IRA  SEP-IRA

 Check here if this is a change from your existing automatic IRA deposits

 I would lik

e to stop automatic  Traditional IRA  Roth IRA  SEP-IRA

deposits from my Citibank N.A. consumer checking account number: ___________________________________

 If your Citibank N.A. consumer checking account number has changed, please indicate the new number below

My new account number is: __________________________________________________________

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C. Beneficiary Designation

To Name a Beneficiary

If you designate more than one primary beneficiary, the proceeds will be distributed equally among the survivors unless you indicate

the share percentage for each. Any secondary beneficiary or beneficiaries you name will only receive your Citibank retirement plan

balance if there are no surviving primary beneficiaries. If you designate more than one secondary beneficiary, the proceeds will be

shared equally among the survivors unless you indicate the share percentage for each.

By naming a beneficiary on this form, you cancel any earlier designation you may have made with respect to the assets in that

retirement plan.

• If you do not name your spouse as beneficiary, there may be tax implications for your estate or beneficiary.

• If you do not name a beneficiary, the beneficiary will automatically be your estate.

• You cannot name a beneficiary for a particular Citibank retirement plan investment account.

• The person(s) named here will be the beneficiary(ies) of your entire Citibank retirement plan.

• The name of the person will govern, not the relationship.

Naming a Trust as a Beneficiary

You must provide a Tax ID Number for the trust and a copy of the trust instrument to Retirement Plan Services in order for funds to be

disbursed from the plan.

Other Important Points to Remember

• You may designate any number of beneficiaries for the plan(s) you select. If you designate more than three beneficiaries, please

attach a separate sheet that includes the beneficiary information (plan type(s), name, address, relationship, social security number

and date of birth), your signature and signed date.

• Your beneficiary can elect the method of receiving distributions from your Citibank IRA.

• If no beneficiary survives you, or if no beneficiary designation is in effect at your death, or if your beneficiary is your estate, we will

pay the balance of that retirement plan to your estate.

• You may cancel or change a beneficiary designation at any time by using a Citibank Change Information Form.

06/23 RPS509 Page 3 of 4

The beneficiary information you provide here will take the place of all previous Citibank IRA beneficiary designations.

All fields are required.

Primary Beneficiary(ies)

Name

_______________________________________________________________________________________________________________________________