Administrative Forms

Change of name, Address or Beneficiary to a Roth IRA Account Form # 36R Revised 9/99

Change of Name, Address or Beneficiary to a Roth IRA Account

Purpose of Form: To change name, address and other pertinent data for the IRA accountholder and for changing beneficiaries and/or beneficiary data.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Change of name, Address or Beneficiary to a Roth IRA Account Form # 36RA Revised 9/99

Roth IRA Contribution Form & In-house Transfer Form # 54-RB Revised 7/07

Roth IRA Contribution Form

Purpose of Form: To document Roth IRA contributions.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Contribution Form # 54-R Revised 01/07

Roth IRA Contribution Form

Purpose of Form: Recommended form to document Roth IRA contributions.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Trust or Self-Directed Contribution Form # 54-RSD Revised 01/07

Roth IRA Trust or Self-Directed Contribution Form

Purpose of Form: Recommended contribution form for contributions to a Trust or Self-Directed Roth IRA.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Internal Recharacterization of IRA Contribution Form # 54-TR1 Revised 04/06

Internal Recharacterization of IRA Contributions

Purpose of Form: Used when an accountholder wants to recharacterize a contribution that was made to one type of IRA plan to that of another type of IRA plan.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

External Recharacterization of IRA Contribution Form # 54-TR2 Revised 04/06

External Recharacterization of IRA Contributions

Purpose of Form: Used when an accountholder wants to recharacterize a contribution that was made to one type of IRA plan to that of another type of IRA plan.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Instruction & Authorization to Transfer Roth IRA Funds Form # 56-R Revised 12/01

Instruction & Authorization to Transfer Roth IRA Funds

Purpose of Form: Requests a transfer of Roth IRA funds from the current custodian/trustee to your financial institution. It is designed to be completed at the financial institution that will be receiving the IRA funds.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Instruction & Authorization to Transfer Roth IRA Funds Form # 56-RI Revised 12/01

Instruction & Authorization to Transfer Roth IRA Funds Inherited

Purpose of Form: Requests a transfer of Roth IRA funds from the current custodian/trustee to your financial institution. It is designed to be completed at the financial institution that will be receiving the IRA funds.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Distribution Form # 57-R Revised 03/08

Roth IRA Distribution Form

Purpose of Form: Documents all Roth IRA distributions. It is also the Substitute W-4P for the accountholder's federal withholding election.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Self-Directed or Trust Distribution Form # 57-RSD Revised 04/07

Roth IRA Self-Directed or Trust Distribution Form

Purpose of Form: Documents all Roth IRA Self-Directed or Trust distributions. It is also the Substitute W-4P for the accountholder's federal withholding election.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Beneficiary Designation and Revocation Form # 61-RA Revised 09/07

Roth IRA Beneficiary Designation and Revocation

Purpose of Form: Used to make Roth IRA Beneficiary designations.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Beneficiary Designation Form # 61-RB Revised 09/07

Roth IRA Beneficiary Designation

Purpose of Form: Used to make Roth IRA Beneficiary designations.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Beneficiary Designation Form # 61-R Revised 09/07

Roth IRA Beneficiary Designation

Purpose of Form: Make Roth IRA Beneficiary designations.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Rollover Certification and Conversion Certification Form # 65-RI Revised 11/06

Rollover Certification

Purpose of Form: Have the accountholder irrevocable certify the rollover, as required by the IRS, and to fully document the rollover procedure.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Certifications for Rollovers to a Roth IRA Form # 65-R2 Revised 5/08

Certifications for Rollovers to a Roth IRA

Purpose of Form: Have the accountholder irrevocable certify the rollover, as required by the IRS, and to fully document the rollover procedure.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA - Certification for Conversion to a Roth IRA Form # 65-R3 Revised 11/06

Roth IRA - Certification for Conversion to a Roth IRA

Purpose of Form: Have the accountholder irrevocable certify the rollover, as required by the IRS, and to fully document the rollover procedure.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Direct Rollover Request Form for a Designated Roth Account Form # 66-R Revised 11/06

Direct Rollover Request Form for a Designated Roth Account

Purpose of Form: Have the accountholder irrevocable certify the rollover, as required by the IRS, and to fully document the rollover procedure.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Withdrawal of 2008 Excess Contribution from a Roth IRA Form # 67-R Revised 09/07

Withdrawal of 2008 Excess Contribution From a Roth IRA

Purpose of Form: Explains the rules and documents the accountholder's request for withdrawal of a 1998 excess contribution.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Roth IRA Beneficiary Distribution Election & Certification Form & Payment Instruction Form # 204-R Revised 11/06

Roth IRA Beneficiary Distribution Election & Certification Form & Payment Instruction

Purpose of Form: Used by a Roth IRA Beneficiary to elect the payout schedule and method of distributions.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Inherited Roth IRA Instructions/Certification RMD Rules Form # 205-R Revised 11/06

Inherited Roth IRA Instructions/Certification RMD Rules

Purpose of Form: Used by a Roth IRA Beneficiary to elect the payout schedule and method of distributions.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Certification for Rollovers & Direct Rollovers to a Roth IRA Form # 65-R2 Revised 11/06

Certification for Rollovers & Direct Rollovers to a Roth IRA

Purpose of Form: Have the accountholder irrevocable certify the rollover, as required by the IRS, and to fully document the rollover procedure.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.