Fillable Qualified Retirement Plan Transfer/rollover Form (Page 3 of 4) in pdf

Qualified Retirement Plan Transfer/rollover Form Page 3

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PLEASE USE BLUE OR BLACK INK

PLEASE PRINT CLEARLY IN BLOCK CAPITAL LETTERS

Investment Allocation:

Please indicate fund(s) and investment percentages, rounded to whole percentages. Total percentages MUST equal 100%.

All investments must be made in the same class of shares previously selected by the Plan.

Please Note: If transfer “in kind” was selected above, your fund selection will remain the same. You may request an exchange

separately. If no fund is selected, IIS will default to fund allocations on file for the account. If there are no fund allocations on file

and no fund is selected, IIS will place the proceeds into the Plan’s default fund.

Fund Number

Fund Name

Whole Percent

1 0 0

TOTAL

Please attach an extra sheet if further allocations are necessary.

5 | Authorization and Signature (Both the participant and the Trustee must authorize the rollover.

Please sign and date below.)

To the current trustee/custodian/employer: I have enrolled as a participant in a non-Invesco sponsored qualified plan account

with Invesco Distributors, Inc. Please accept this as your authorization and instruction to liquidate and/or transfer “in kind” the

assets noted in sections 2 and 3 of this form, which your company holds for me.

Participant’s Signature (Required)

Date (mm/dd/yyyy)

Note: The current trustee/custodian/employer may require signature to be guaranteed. Call that institution for their

requirements.

Each signature must be guaranteed by a bank,

Signature Guarantee:

(Please place signature guarantee stamp below.)

broker-dealer, savings and loan association, credit

union, national securities exchange or other

“eligible guarantor institution” as defined in rules

adopted by the Securities and Exchange Commission.

Signatures may also be guaranteed with a medallion

stamp of the STAMP program or the NYSE Medallion

Signature Program, provided that the amount of

the transaction does not exceed the relevant surety

coverage of the medallion. A signature guarantee

may NOT be obtained through a notary public.

I acknowledge that I am solely responsible for determining whether the rollover indicated above is a qualified rollover, or

transfer, eligible for acceptance into the plan identified in section 4. As trustee of the receiving plan, said proceeds are hereby

accepted into this plan accordance with the investment elections provided in section 4.

This section must be signed and dated by the trustee, even if the participant and the trustee are the same individual.

Trustee (Required)

Date (mm/dd/yyyy)

Name (Please print.)

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QRP-FRM-1-E 06/15

Qualified Retirement Plan Transfer/rollover Form Page 3

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