- 2 -
|
Form 5305-RB (Rev. 4-2017) Page 2
Article VIII
This endorsement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other
published guidance. Other amendments may be made with the consent of the persons whose signatures appear on the contract.
Article IX
Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If
provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply
that they have been reviewed or pre-approved by the IRS.
General Instructions not includible in gross income. For more Article V. This article describes how
information on Roth IRAs, including the distributions will be made from the Roth
Section references are to the Internal required disclosures the issuer must give IRA after the annuitant’s death. Elections
Revenue Code unless otherwise noted. the annuitant, see Pub. 590-A, made pursuant to this article should be
Contributions to Individual Retirement reviewed periodically to ensure they
Purpose of Form Arrangements (IRAs), and Pub. 590-B, correspond to the annuitant’s intent.
Form 5305-RB is a model annuity Distributions from Individual Retirement Under paragraph 2 of Article V, the
endorsement that meets the Arrangements (IRAs). annuitant’s spouse is treated as the
requirements of section 408A. However, owner of the Roth IRA upon the death of
only Articles I through VIII have been Definitions the annuitant, rather than as the
reviewed by the IRS. A Roth individual Issuer. The issuer is the insurance beneficiary. If the spouse is to be treated
retirement annuity (Roth IRA) is company providing the annuity contract. as the beneficiary, and not the owner, an
established after the contract, which The insurance company may use other overriding provision should be added to
includes this endorsement, is fully terms besides “issuer” to refer to itself, Article IX.
executed by both the individual such as, “company,” “insurer,” or “us.” Article IX. Article IX and any that follow
(annuitant) and the issuer. To make a Annuitant. The annuitant is the person it may incorporate additional provisions
regular contribution to a Roth IRA for a who establishes the annuity contract. that are agreed to by the annuitant and
year, the IRA must be established no The insurance company may use other issuer to complete the contract. They
later than the due date (excluding terms besides “annuitant” to refer to the may include, for example, definitions,
extensions) of the individual’s income tax person who establishes the annuity investment powers, voting rights,
return for the year. The contract must be contract, such as, “owner,” “applicant,” exculpatory provisions, amendment and
for the exclusive benefit of the annuitant “insured,” or “you.” termination, removal of the issuer,
and his or her beneficiaries. issuer’s fees, state law requirements,
beginning date of distributions,
Do not file Form 5305-RB with the Specific Instructions accepting only cash, treatment of
IRS. Instead, keep it with your records. excess contributions, prohibited
Article I. The annuitant may be subject
Unlike contributions to traditional to a 6% tax on excess contributions if transactions with the annuitant, etc.
individual retirement arrangements, (1) contributions to other individual Attach additional pages if necessary.
contributions to a Roth IRA are not retirement arrangements of the annuitant
deductible from the annuitant’s gross have been made for the same tax year,
income; and distributions after 5 years (2) the annuitant’s adjusted gross
that are made when the annuitant is income exceeds the applicable limits in
591/2 years of age or older or on Article II for the tax year, or (3) the
account of death, disability, or the annuitant’s and spouse’s compensation
purchase of a home by a first-time is less than the amount contributed by
homebuyer (limited to $10,000), are or on behalf of them for the tax year.
Form 5305-RB (Rev. 4-2017)
|