Qualified Retirement Plan Transfer/rollover Form
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Qualified Retirement Plan Transfer/Rollover Form
Use this form to transfer or rollover eligible retirement assets to a non-Invesco sponsored qualified
retirement plan.
• Do not use this form to transfer or rollover assets to an Invesco Trust Company (ITC) custodial
retirement plan or Invesco Solo 401(k) Plan.
• For more information, please see the Additional Information section on page 3 of this form.
PLEASE USE BLUE OR BLACK INK
PLEASE PRINT CLEARLY IN BLOCK CAPITAL LETTERS
1 | Participant Information
Full Name
Start
here >.
Use
"Tab"
Social Security Number (Required)
Date of Birth (Required) (mm/dd/yyyy)
key to
move to
next
field.
Mailing Address
City
State
ZIP
Primary Phone Number
Alternate Phone Number
2 | Assets Are Moving from This Account (Required)
Name of Current Trustee/Custodian/Employer
Account Number at Current Trustee/Custodian/Employer
Mailing Address of Current Trustee/Custodian/Employer
City
State
ZIP
Attention
Trustee/Custodian/Employer Phone Number
Note: Some trustees/custodians/employers may require pre-liquidation of assets, payment of fees, and/or completion of their
own forms before transferring assets to Invesco Investment Services, Inc. (IIS). To expedite your request, please contact your
current trustees/custodians/employers to verify their requirements.
Yes, I have contacted the current trustee/custodian/employer. I have filed the necessary paperwork and have met their
requirements for transferring or rolling over assets.
No, I have not.
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QRP-FRM-1-E 06/15
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