Fund to use in calculating the gain or loss associated with this repurchase offer. If the owner(s) does not provide this information, the Fund will use its chosen default method, First-In, First-Out (FIFO). Note that the Fund’s default method may not be the most tax advantageous method. The owner(s) may want to consult their financial advisor or tax professional before completing this section.
Select one option then complete the additional information requested, if applicable:
☐ First-In, First-Out (FIFO)
First-In, First-Out uses the first lots purchased into the account to determine the cost basis of the Shares and to calculate the gain or loss.
☐ Specific Share Identification
Specific Share Identification allows the owner(s) to select the Shares from any purchase or reinvested lot that has not previously been sold. Indicate in the table below the number and class of Shares and date of purchase for each lot to be repurchased in this transaction. To the extent all Shares tendered are not accepted by the Fund, the Fund will use the Shares listed in the first row of the table and proceed to the next row(s) as necessary until all Shares accepted by the Fund are accounted.
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NUMBER OF SHARES | | CLASS OF SHARES | | DATE OF PURCHASE |
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Note that Shares tendered within 12 months of the original issue date of such Shares will be subject to a fee of 2.00% of the net asset value of the Shares repurchased by the Fund (“Early Withdrawal Fee”). The Early Withdrawal Fee will be made by reducing the repurchase proceeds.
In addition, if no withholding election is indicated below, IRS regulations require that 10% Federal income tax withholding be taken from your IRA distributions. We encourage you to consult your accountant or tax advisor regarding your IRA distributions. Even if you elect not to have Federal income tax withheld, you are liable for payment of Federal income tax on the taxable portion of your distribution. You may be subject to tax penalties under the estimated tax payment rules if your payments of estimated tax and withholdings are not adequate.
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| | Federal Income Tax Withholding is to be withheld at % (If a percentage is not specified, 10% will automatically be withheld). |
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| | I elect NOT to have Federal Income Tax withheld. |
E. SIGNATURE (all registered holders must sign)
Signatures on this Repurchase Request Form must be affixed with a medallion guarantee unless
| (iii) | the Repurchase Request Form is signed by the registered holder of the Shares tendered or |
| (iv) | such Shares are tendered for the account of an Eligible Institution (as defined in the Offer to Purchase). In all other cases, all signatures on the Repurchase Request Form must be guaranteed by an Eligible Institution. |
The signatory (“Signatory”) authorizes and instructs the Fund to make a cash payment (payable by check or wire transfer) for Shares accepted for purchase by the Fund, without interest thereon and less any applicable withholding taxes, to which the Signatory is entitled in accordance with the instructions in Section C “Remittance Information” above. By executing this Repurchase Request Form, the Signatory hereby delivers to the Fund in connection with the repurchase offer the number of Shares indicated in Section B “Number of Shares Being Tendered” above.