Qualified Retirement Plan Transfer/rollover Form Page 2
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4PLEASE USE BLUE OR BLACK INK
PLEASE PRINT CLEARLY IN BLOCK CAPITAL LETTERS
3 | Instructions to Delivering Trustee/Custodian (Complete options A, B if applicable, and C.)
A. Transfer/Rollover assets from my: (Select one.)
Traditional IRA
SARSEP IRA
403(b)
401(k)
Rollover IRA
SIMPLE IRA
403(b) Roth Deferral Contribution
401(k) Roth Deferral Contribution
SEP IRA
Profit Sharing Plan
Money Purchase Pension Plan
Other Employer Retirement Plan
In accordance with my custodial agreement or plan document, I hereby authorize my current trustee/custodian/employer to
deduct from my account at the time of transfer any outstanding fees due.
B. Distribution reason for rollover from qualified plan: (Select one.)
Termination of employment
Death
Disability
Attainment of retirement age (typically 59½)
Plan termination
C. Distribution Instructions: (Select one.)
OPTION 1: Transfer “in kind” — A transfer “in kind” is the movement of currently owned Invesco funds from one custodian
to IIS without liquidating. If you do not currently own Invesco funds, this option is not available to you.
Please transfer “in kind” existing Invesco funds held in the account(s) listed in section 2.
Transfer “in kind” ALL.
Transfer “in kind” partial shares:
shares of Invesco
Fund.
OPTION 2: Liquidate — Please liquidate the account(s) listed in section 2 and issue a check payable to Invesco Investment
Services, Inc. (IIS).
Liquidate All
Partial liquidation of $
,
.
Liquidate immediately
Liquidate at maturity (mm/dd/yyyy)
4 | Assets Are Moving to The Following non-Invesco Sponsored Qualified Plan Account
Plan Type:
401(k)
Profit Sharing
Money Purchase Pension Plan
Plan Name
Invesco Plan ID
Plan’s Mailing Address
City
State
ZIP
Plan Contact Full Name
Primary Phone Number
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QRP-FRM-1-E 06/15
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