Roth Ira Conversion Request Form - (External) Convert A Traditional Ira From Another Institution To A Sterling Capital Funds Roth Ira Page 2

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ROTH IRA CONVERSION REQUEST FORM – (EXTERNAL) Continued
1) Investment to Convert: _________________________________________________________
Account Number:___________________________________
Distributing Account Type:
Traditional/Rollover IRA
SEP IRA
SIMPLE IRA – (after the required two year holding period)
Amount to be Distributed:
Liquidate Entire Account
Partial $ ________________
For Certificates of Deposit:
Immediately*
At Maturity Date _________________
2) Investment to Convert: _________________________________________________________
Account Number:___________________________________
Distributing Account Type:
Traditional/Rollover IRA
SEP IRA
SIMPLE IRA – (after the required two year holding period)
Amount to be Distributed:
Liquidate Entire Account
Partial $ ________________
For Certificates of Deposit:
Immediately*
At Maturity Date _________________
*Note: if you wish to have certificates of deposit transferred immediately and they have not matured, you may incur a redemption penalty. We cannot accept
requests to convert certificates of deposit more than 60 days before their maturity.
PARTICIPANT AUTHORIZATION
I authorize the current custodian or trustee of my IRA to distribute the amount(s) indicated for the purpose of converting them to a Roth IRA with Sterling Capital
Funds and to issue a check as indicated below. I understand it is my responsibility to insure the prompt conversion of assets by the current custodian or trustee. I
understand that I am solely responsible for all tax consequences and agree that neither Sterling Capital Funds nor their Custodian shall have responsibility for any tax
consequences resulting from my instructions. I authorize Sterling Capital Funds and BNY Mellon Investment Servicing Trust Company to process this request on my
behalf.
I have read this form and understand and agree to be legally bound by the terms of this form. I also understand that the Custodian, Sterling Capital Funds and their
agents will rely on my instructions within this form when accepting my conversion contribution. I understand this conversion is irrevocable.
X
Participant’s Signature:
Date:
Medallion Signature Guarantee Stamp and Signature (If required by your current custodian or transfer agent): An eligible guarantor is a domestic bank or trust
company, securities broker/dealer, clearing agency or savings association that participates in a medallion program recognized by the Securities Transfer Agents
Association. The three recognized medallion programs are the Securities Transfer Agents Medallion Program (known as STAMP), Stock Exchanges Medallion Program
(SEMP), and the Medallion Signature Program (MSP). A notarization from a notary public is NOT an acceptable substitute for a signature guarantee.
INTERNAL USE ONLY – RESIGNING CUSTODIAN INSTRUCTIONS
Issue check payable to: BNY Mellon Investment Servicing Trust Company as custodian for the Sterling Capital Funds Roth IRA.
Participant Name:__________________________________________________________________ Roth IRA Conversion A/C # ______________________________
Mail to the following:
First Class Mail:
Overnight Mail:
Sterling Capital Funds
Sterling Capital Funds
P.O. Box 9762
4400 Computer Drive
Providence, RI 02940-9762
Westborough, MA 01581-1722
1-800-228-1872
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ERCF2012

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