Financial Distribution Directions

FINANCIAL DISTRIBUTION DIRECTIONS

Client Name:    Account/Reference No.:

Plan / Agreement Reference:    Paying Agent/Administrator:

Effective Date of Directions:

Distribution Instructions

These Financial Distribution Directions (the Directions) instruct the Paying Agent to distribute funds from the account referenced above to the payees listed below in accordance with the amounts, priorities and methods specified. The Client represents and warrants that the Client has full authority to direct distributions from the referenced account and that these Directions do not conflict with any court order, lien, or other third‑party claim.

Payee Schedule

Enter each payee and the corresponding distribution instruction. Amounts may be fixed dollar amounts or percentages; if percentages are used, indicate with a % symbol in the amount field.

Method of Distribution

Select the primary method(s) for disbursement. If multiple methods are selected, fund allocation follows the priority order set forth in the Payee Schedule above.

Wire Transfer     ACH / Direct Deposit     Physical Check     Internal Ledger Transfer

Withholding, Tax Reporting and Certifications

The Client acknowledges that the Paying Agent may be required to withhold taxes or report distributions to tax authorities. The Client certifies that the tax identification information provided for each payee is true and correct to the best of the Client's knowledge and that the Client will provide any required documentation to permit accurate tax reporting. The Client further authorizes the Paying Agent to withhold amounts as required by law and to apply such withheld amounts against the distribution obligations.

Client certifies that Taxpayer Identification Numbers for listed payees are on file with or have been provided to the Paying Agent.

Representations, Authorization and Indemnity

By signing these Directions, the Client represents and warrants that: (a) the Client is authorized to direct distributions from the referenced account; (b) these Directions do not conflict with any applicable statute, agreement, court order, security interest, or levy; and (c) all payee information and amounts are complete and accurate. The Client authorizes the Paying Agent to act on these Directions and agrees to indemnify and hold harmless the Paying Agent, its officers, directors, employees and agents from and against any losses, claims, damages or liabilities arising from reliance on these Directions, except to the extent caused by the Paying Agent's gross negligence or willful misconduct.

The Paying Agent may rely upon facsimile, electronic or scanned copies of executed Directions and is not required to investigate the authenticity of any signature, instruction, or supporting documentation provided in connection with these Directions.

Fees, Charges and Handling

The Client agrees to pay any applicable processing fees, wire fees, postage, taxes and other charges associated with executing these Directions. The Paying Agent may deduct such fees from the distribution amounts or from the account from which distributions are made. Any returned items, failed transfers, or corrections required due to incorrect payee or bank information shall be charged to the Client.

Amendment and Revocation

These Directions may be amended or revoked only by a written notice executed by the Client and acknowledged in writing by the Paying Agent. The Paying Agent is entitled to rely on these Directions until it has received and had a reasonable opportunity to act on a valid and acknowledged amendment or revocation.

Delivery and Contact Information

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