|
Converge Retirement Plan
Defined Contribution Rollover Request
(For Distributions From Another Retirement Plan or Vehicle)
Date:___________________
To:
Current Custodian:___________________________________________________________
Address:___________________________________________________________________
City: _____________________________ State: _______ Zipcode:_____________________
TSA account number/s: __________________ ______________ ___________________
__________________ ______________ ___________________
Amount to be rolled over to the Converge Retirement Plan:_____________________________
(If entire amount, write 100%)
I would like the amount designated above to be transferred to my Converge Retirement Plan
account. I understand that the Converge Retirement Plan is qualified to accept this rollover and
will place these funds into my Defined Contribution ('Supplemental') account.
The rollover check should made out to Converge Retirement Plan, TTEF, FBO (participant name)
and sent to:
Converge Retirement Plan
2002 S. Arlington Heights Road
Arlington Heights, IL 60005
====================================================================
From:
Participant's Name:_____________________________________________________________
Address:_____________________________________________________________________
City: _____________________________________ State: ______ Zipcode:________________
Social Security Number:__________/_______/___________ BGC Account #: _______________
Participant's Signature:______________________________ Date: ______________________
Please return this form to the Converge Retirement Plan and we will forward it to your financial institution with a letter verifying that we will accept Rollovers from a qualified retirement plan or vehicle.
Click here to download the above file.
|
