Please remember to sign Print Clear Form

form after printing.

Solo 401(k)® Beneficiary Transfer/Distribution Form

Use this form to request a transfer or distribution from a deceased participant’s Solo 401(k)
account or existing beneficiary status Solo 401(k) account. We recommend that you speak
with a tax advisor or financial professional regarding the distribution options available to
the beneficiary.
● A separate Solo 401(k) Beneficiary Transfer/Distribution Form must be submitted for
each beneficiary.
● A medallion signature guarantee is required for the Employer/Plan Administrator/Trustee or
Successor Plan Administrator/Trustee’s signature in section 9.
● For more information, including information for Required Minimum Distribution (RMD),
please see the Additional Information section at the end of the form.
*Required
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1 | Participant and Plan Information

Note: If this is a Beneficiary status Solo 401(k), please provide the beneficial owner’s information then proceed to section
4 or 5, as applicable.
Social Security Number* Invesco Account Number or Plan ID
Start >
Here
- -
Use
"Tab" Participant’s Full Name (Please print name as it appears on account.)
key to
move to
next
field.
Date of Birth (mm/dd/yyyy) Date of Death (mm/dd/yyyy)
/ / / /
Plan Name

Employer/Plan Administrator/Trustee Primary Phone Number Employer/Plan Administrator/Trustee Email Address

- -

2 | Beneficiary Information (Complete A or B, and C.)

A. Individual Beneficiary
Relationship to account owner at time of death:* (Select one.)
n Spouse   n Adult Child of Account Owner   n Minor Child of Account Owner   n Former Spouse

n Disabled or Chronically Ill   n Small Estate Beneficiary/Declarant/Heir/Affiant  n Other

Beneficiary’s Full Name*

Beneficiary’s Social Security Number* Date of Birth* (mm/dd/yyyy)

- - / /

Parent/Guardian Name if Beneficiary is a Minor Child

Beneficiary Information section continues on the next page. *DEFKRSSDEATH*

SOLO-FRM-12 01/25 1 of 9
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B. Entity Beneficiary
Name of Entity*

Entity’s Tax Identification Number* Date of Trust* (If applicable) (mm/dd/yyyy)

- / /

 xecutor/Trustee/Personal Representative/Controlling Owner or Individual with responsibility to control, manage,

E
or direct the entity/organization Name*

Social Security Number* Date of Birth* (mm/dd/yyyy)

- - / /
Important: For an entity beneficiary that is a privately held corporation, partnership, LLC, charity, foundation,
organization, or statutory trust with a beneficial owner(s) that owns 25% or more of the entity, the Beneficial Ownership
Information Form located at the end of this form must be completed. Please indicate below.
(Select one.)*
n Yes, there is a beneficial owner(s) that owns 25% or more of the entity and a completed Beneficial Ownership
Information Form is attached.
n No, there is not a beneficial owner that owns 25% or more of the entity.

C. Beneficiary’s Address and Contact Information

Mailing Address* (Account statements and confirmations will be mailed to this address.)

City State ZIP

Primary Phone Number Email Address

- -
Residential Address* (Required if different from mailing address or if a P.O. Box was given above.)

City State ZIP

3 | Outstanding Participant Loan (Please complete this section if the deceased participant has an outstanding
loan on the account.)
An outstanding participant loan is treated as an asset of the Plan. Any outstanding loan balance remaining at the time of
the participant’s death will become the responsibility of the beneficiary, and the beneficiary will be treated as the borrower
with respect to the Invesco Loan Policy and Procedures and Promissory Note agreed to by the participant. Refer to the
Additional Information section at the end of the form.
Select one.
n ­O
 ffset the loan. The outstanding loan balance will be reported as a distribution to the IRS on form 1099-R as a death
distribution and will be taxable to the beneficiary.
n ­R
 epay the outstanding loan balance prior to taking a distribution, transferring or rolling over the assets to an eligible
retirement plan.
n ­T
 ransfer the outstanding loan balance with the remaining assets to a beneficiary status account in the plan and
continue loan repayments. (Beneficiary must attach a completed Invesco Solo 401(k) and 403(b)(7) Loan Repayment
Change Form.)
n ­D
 isclaim the portion of the assets attributable to the loan by providing a Qualified Disclaimer.

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4 | Transfer Instructions

The beneficiary identified in section 2 should receive % of the deceased participant’s account value on the
date IIS receives the request in good order.
Beneficiary Options (Select one.):
n Transfer and immediately distribute all. (Proceed to section 6.)
n Transfer all to an Invesco Solo 401(k) beneficiary account within the same plan.
(Transfers will retain the same fund selection.)
n Rollover all to my employer’s retirement plan at Invesco. (Available to a spouse beneficiary only. The account must already be
established, and the acceptance from the receiving plan administrator/trustee attached. Provide the Invesco Plan ID below.)

Invesco Plan ID
n Rollover to an Invesco IRA. (Beneficiary must attach a completed Invesco Traditional or Roth IRA Application or provide
the IRA account number below. Additionally, if the account contains both pre-tax and Roth contributions you will need to
submit an account application for each.)

Invesco Traditional IRA Account Number

Invesco Roth IRA Account Number

n Rollover pre-tax contributions to an Invesco Roth IRA. (A taxable Qualified Rollover Contribution (QRC). Beneficiary must
attach a completed Invesco Traditional or Roth IRA Application or provide the Roth IRA account number below.)
Amount Percentage

Amount to be converted $ , . or %

Invesco Roth IRA Account Number

Important: An RMD is not eligible to rollover. If the deceased participant’s current year of death RMD has not been
distributed, IIS will distribute this amount under the beneficiary’s Social Security Number, the withholding election in
section 6 will apply to this distribution and a check payable to the beneficiary will be mailed to the address in section 2.
Note: IIS will not automatically distribute deceased participant’s RMDs not removed for past years.

5 | Beneficiary Solo 401(k) Distribution Instructions (Complete A, B and C if applicable.)

I authorize IIS to distribute my RMD as indicated below. I understand and agree to the terms listed below.
● If I do not select a distribution frequency below, I am directing IIS to process an immediate, one-time distribution.
● If the selected payment date for a monthly or quarterly draft has already passed, I am directing IIS to establish the plan for
the next scheduled payment date.
● If the selected payment date for an annual draft has already passed, I am directing IIS to process the current year payment
as of the date the request was received in good order.
● If I do not provide a periodic payment day below, I am directing IIS to distribute on the 10th of the selected payment schedule.
A. Frequency: (Select one.)
n I wish to take an immediate, one-time distribution.
n I wish to establish a series of periodic distributions. (Select one option below.)

n Monthly - One draft per month on the following date:

n Quarterly- One draft per quarter on the following date:

n Annually - One draft per year on the following date:

Beginning in (month) (year).

Beneficiary Solo 401(k) Distribution Instructions section continues on the next page.

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B. Amount: (Select one.)

n ­All - I would like to distribute the entire account. (Proceed to section 6.)
n ­Invesco to calculate - (Refer to the Additional Information section before making a selection.)
I would like Invesco to calculate my RMD as indicated below and distribute the shares of each fund proportionate to
the total value of my account.
(Select one then proceed to section 6.)
n Single Life Expectancy. (Available to an Eligible Designated Beneficiary (EDB) only.)
If selecting this option based on the oldest beneficiary of the qualifying trust, please provide the beneficiary’s
date of birth below.
Date (mm/dd/yyyy) / /
n 10-Year declining balance. (Available to all Designated Beneficiaries.)
n 5-Year declining balance. (Available to Non-Designated Beneficiaries.)
n ­Participant to calculate - (Enter dollar amount and proceed to section 5C.)
Note: The amount of your RMD will change each year based on your December 31 account value of the prior year.
You are responsible for recalculating the amount of your RMD and providing IIS with new distribution instructions
as applicable.
I have calculated the amount of my RMD and would like to distribute the following dollar amount from the account:

$ , . .
I understand the amount of the distribution I receive will be reduced by any applicable contingent deferred sales
charges and federal income tax withholding. (If you select the one-time distribution frequency, this will be the amount
of your one-time distribution. If you select periodic distribution frequency, this will be the amount of each installment.)
C. Allocation of Distribution (Complete only if requesting a specific dollar amount in section 5B.)
If I do not select an allocation of distribution method, I am directing IIS to distribute using the proportionate method.
Note: If redeeming from multiple funds, then multiple checks, wires or Automated Clearing House (ACHs) will be sent.
n Proportionate - Shares will be redeemed from each fund proportionate to that fund’s value with respect to the total
value of your account on the day IIS receives your request in good order.
n Distribution From Specific Fund(s) - Please indicate the fund(s) and redemption amount(s) below.
Fund Number Fund Name Percentage Amount

% or $ , .

% or $ , .

% or $ , .

6 | Federal Income Tax Withholding 

Please read the attached “Rollover Explanation for Qualified Plans, 403(b) Plans and Governmental 457(b) Plans” and
the IRS “Form W-4R” documents for additional information regarding withholding requirements for your distribution. Your
withholding rate is determined by whether your payment is an “eligible rollover distribution”.
● For an “eligible rollover distribution”, the default withholding rate is 20%, and Invesco Investment Services, Inc.
(IIS) will automatically withhold this amount. You can choose a rate greater than 20% by entering the rate in the box
below. You may not choose a rate less than 20%. Note: The following are generally exempt from the 20% mandatory
withholding: distributions for direct rollovers, transfers of assets, RMD, return of excess contributions, financial hardship
and Substantially Equal Periodic Payments. Note: Indirect rollovers are subject to 20% withholding.
● For distributions other than eligible rollover distributions, the default withholding rate is 10%. You can choose to have a
different rate by entering a rate between 0% and 100% in the box below. Generally, you can’t choose less than 10% for
payments to be delivered outside the United States and its possessions, or if your only address of record is a P.O. Box.
● Withholding may apply to gains distributed from your designated Roth contribution account.
By providing a withholding percentage below and signing this distribution form, you acknowledge that you have read the
attached IRS Form W-4R, including the complete instructions on pages 1 & 2, the Marginal Rate Tables, and you would like
a rate of withholding different from the default withholding rate.

Federal Income Tax Withholding section continues on the next page.

SOLO-FRM-12 01/25 4 of 9
 *Required
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Important: The instructions and Marginal Rate Tables on the attached sample IRA Form W-4R are valid for the tax year
shown in the upper right corner of the Form W-4R. If you are submitting this distribution form in a subsequent calendar
year, please see irs.gov for the most current version of Form W-4R.
*
I want federal income tax withholding at a rate of %.
Important: If you do not provide a rate in the box above, the applicable default withholding rate will be applied to
your distribution.

7 | Delivery Options (Complete this section if taking a distribution or rolling assets over to a new custodian.)
Note: Your distribution will be mailed to the beneficiary’s address referenced in section 2 (or the address of record
for an existing beneficiary status account, unless specified below. U.S. Postal Service will not forward checks to a
forwarding address.
Select only one payment option (A or B).
A. Deliver Distribution Proceeds by Check:
n ­M
 ake check payable to the beneficiary and mail check to the address in section 2.
n ­M
 ake check payable to new custodian or plan trustee and mail to the address given below.
This is a: n
 Direct rollover contribution to a qualifying retirement plan or IRA.
n Qualified rollover contribution (QRC) conversion to a Roth IRA.
n ­M
 ail check to third party address.
Make check payable to:

Account Number at New Custodian

Mailing Address (Including apartment or P.O. Box number.)

City State ZIP

B. Deliver Distribution Proceeds To My Bank Account: (If banking information is provided and a single delivery option
is not selected, proceeds will be sent via Automated Clearing House (ACH).)
n Wire proceeds to my bank account. (An incoming wire fee may be assessed by your financial institution.)
n ACH Transfer to the beneficiary’s bank account. (Allow 2-3 business days to receive your proceeds.)
Account Type: n Checking n Savings

Name(s) on Bank Account

Pay to the order of $

Please tape your voided check here.

Routing Number Account Number

SOLO-FRM-12 01/25 5 of 9
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8 | Authorization and Signature of Beneficiary (Please sign and date below.)

If you are a Non-Resident Alien you must cross out the Substitute Form W-9 section below and instead attach a
completed IRS Form W-8 to this form.
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER (Substitute Form W-9)
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been
notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report
all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien), and
4. The requirement to provide FATCA exemption codes does not apply.
Certification instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently
subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real
estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property,
cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than
interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN.
I acknowledge that I have read the attached IRS Form W-4R, including the complete instructions on pages 1 and 2,
including the Marginal Rate Tables. I authorize and direct IIS to distribute assets from my account in the plan in accordance
with the instructions set forth above. Additionally, I certify the information I have provided is true and accurate.
If signing on behalf of a minor child include your title of parent or guardian.
Signature* Date (mm/dd/yyyy)

x / /

Name (Please print) Title (Required if beneficiary is an entity.)

9 | Authorization and Signature of Employer/Plan Administrator/Trustee or Successor Plan Administrator/

Trustee (Please sign and date below.)
Employer/Plan Administrator/Trustee/Successor Plan Administrator/Trustee’s Authorization:
I authorize and direct IIS to distribute assets from the Plan’s account in accordance with the instructions set forth
above. I certify that the information provided is true and accurate, and that the beneficiary has been provided with a
written explanation of the rules permitting direct rollover of eligible rollover distribution amounts and mandating a 20%
withholding on distributions that are not directly rolled over, and has also complied with any other notice requirements to
the beneficiary that are applicable to this distribution. The Plan agrees to indemnify and hold harmless Invesco Investment
Services, Inc., its parents, affiliates, each of their respective employees, officers, trustees, directors, successors, assigns,
and each of the Invesco Funds from and against any and all actions, suits, claims, costs, losses, liabilities, damages
and expenses of any kind or character that may be incurred directly or indirectly as a result of your actions taken in
accordance with the instructions and other provisions set forth herein.
Signature* Date (mm/dd/yyyy)

x / /

Name (Please print) Title

A signature guarantee for the Employer/Plan Administrator/Trustee/Successor Plan Administrator/Trustee is required.

Signature Guarantee: (Please place signature guarantee stamp below.) Each signature must be guaranteed by a bank,
broker-dealer, savings and loan association,
credit union, national securities exchange or any
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.
Note: Endorsement guarantee is not acceptable.
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10 | Checklist and Mailing Instructions

Please review checklist before submitting the form.
Important: Please submit all pages (1 thru 6) regardless if all sections were applicable or not.
n ­C
 omplete beneficiary information is provided in section 2.
n ­R
 eviewed and provided a federal income tax withholding percentage in section 6. Applicable only if 20% mandatory
withholding does not apply.
n The percentage of the deceased participant’s account the beneficiary named in section 2 should receive is provided
in section 4.
n ­T
 he beneficiary signed in section 8 if taking a distribution or rolling over assets to another custodian.
n The employer, plan administrator/trustee or successor plan administrator/trustee signed in section 9 and a medallion
signature guarantee provided.
n If applicable, a state inheritance tax waiver is attached.
n If you are rolling over assets into a new Invesco account, the appropriate account application is completed and attached.
n If there is an outstanding loan on this account, complete section 3 and attached a completed Invesco Solo 401(k) and
403(b) Repayment Change Form if applicable.
n If there is a beneficial owner(s) that owns 25% or more of the entity as indicated in section 2C, complete the attached
Beneficial Ownership Information form.

Please send completed and signed form to:

(Direct Mail) (Overnight Mail)
Invesco Investment Services, Inc. Invesco Investment Services, Inc.
P.O. Box 219078 801 Pennsylvania Ave
Kansas City, MO 64121-9078 Suite 219078
Kansas City, MO 64105-1307
For additional assistance please contact an Invesco Client Services representative at 800 959 4246, weekdays,
7 a.m. to 6 p.m. Central Time.

Visit our website at invesco.com/us to:

● Check your account balance ● Check the current fund price, yield and total return on any fund
● Confirm transaction history ● Process transactions
● View account statements and tax forms ● Retrieve account forms and investor education materials
● Sign up for eDelivery of statements, daily transaction
statements, tax forms, prospectuses, and reports

Call the 24-Hour Automated Investor Line 800 246 5463 to:

● Obtain fund prices ● Check your account balance

● Confirm your last three transactions ● Process transactions
● Order a recent account statement(s)

To use the system, please have your account numbers and Social Security number available.

SOLO-FRM-12 01/25 7 of 9
 Additional Information
Additional Documentation Requirements the participant. The beneficiary’s options are:
If you are not able to obtain medallion signature guarantee, ● Take a full distribution of the available balance and
a signature guarantee is required in section 9 of this form offset the loan: The distribution of account assets will be
along with the following documentation: reported as a death distribution. The loan offset will be
● A certified copy of the participant’s death certificate, and reported as a distribution to the IRS on form 1099-R,
● A notarized copy of the Plan’s Adoption Agreement or as a death distribution also and will be taxable to the
Plan Amendment identifying the plan administrator or Beneficiary. Withholding of 20% will be assessed on the
successor plan administrator combined value of the account balance plus the current
value of the outstanding loan.
If you are rolling assets into a new Invesco IRA, a ● Directly rollover the account assets to an eligible
completed Traditional or Roth IRA Application is required. retirement plan and offset the loan: The direct rollover
If your inherited assets contain both pre-tax contributions of assets in the account will be reported to the IRS as a
and Roth contributions, complete an application for each, a direct rollover. No withholding will be assessed on either
Traditional IRA and a Roth IRA. the account balance or the outstanding loan amount. The
loan offset will be reported as a death distribution to the
If there is an outstanding loan on the account and you elect IRS on form 1099-R in the year of the distribution and is
to make payments toward the loan, a completed Invesco taxable to the beneficiary.
Solo 401(k) and 403(b)(7) Loan Repayment Change Form ● Repay the outstanding loan balance prior to
is required. distributing, transferring, or rolling over the assets
to an eligible retirement plan.
Federal Income Tax Withholding ● Transfer the outstanding loan balance with the
remaining assets to a beneficiary status account in
Please read the attached “Rollover Explanation for Qualified the plan: Continue to pay the outstanding loan balance
Plans, 403(b) Plans and Governmental 457(b) Plans” and according to the original payment schedule. If the loan
the IRS “Form W-4R” documents for additional information is not repaid by the beneficiary in accordance with the
regarding withholding requirements for your distribution. Solo 401(k) and 403(b)(7) Loan Policy and Procedures,
the loan will be deemed distributed. The amount of the
deemed distribution will be reported to the IRS on form
Mandatory withholding: 20% mandatory withholding 1099-R and is taxable to the beneficiary.
applies to any portion of your distribution that is eligible to ● Disclaim the portion of the assets attributable to the
be rolled over and you do not elect to make a direct rollover. loan by providing a Qualified Disclaimer, described
The distributions you receive from your 401(k) plan are in section 2515 of the Internal Revenue Code, and
generally subject to 20% mandatory withholding except rolling over the remaining assets to an eligible
for direct rollovers, transfer of assets, required minimum retirement plan: The disclaimed assets will be treated
distributions, return of excess contributions, financial as assets of the participant’s estate. IIS will establish a
hardship and periodic distributions of equal size distribute beneficiary status account for the estate and initiate loan
at least annually over a 10 year period (Substantially Equal repayments in accordance with the original repayment
Periodic Payments). schedule. If the loan is not repaid into the estate account
according to the Solo 401(k) and 403(b)(7) Loan Policy
Voluntary withholding: 10% voluntary withholding only and Procedures, the loan will be deemed distributed.
applies to the portion of your distribution that is not eligible The deemed amount will be reported to the IRS on form
to be rolled over to another employer plan or IRA, unless 1099‑R and is taxable to the estate.
you provide an alternate election in section 6. If no election
is made, or your only address of record is a P.O. Box or a A Qualified Disclaimer must:
non-U.S. address, IIS is required to withhold at the rate of ● State the disclaimer is irrevocable, and unqualified
10%. If you elect not to have voluntary withholding applied ● Identify the portion of the assets being disclaimed
to your distributions or if you do not have enough federal ● Signed by the beneficiary with notary stamp
income tax withheld from your distributions, you may be ● The letter must be received by IIS within 9 months from
responsible for payment of estimated taxes. You may incur the date of death of the participant or 9 months from the
penalties under the estimated tax rules if your withholding date in which the disclaimant attains age 21.
and estimated tax payments are not sufficient. If you elect
to receive periodic distributions, your withholding election Required Minimum Distribution (RMD)
for this series of payments will remain on file with IIS. You
may change or revoke your withholding election at any time As beneficiary, you must begin taking RMDs by
by contacting an Invesco Client Services representative. December 31 of the year following the year of the
participant’s death, unless you were the participant’s
Designated Roth Account Withholding: Does not apply spouse, or you have elected the 10-year or 5-year rule.
to distributions due to death of the participant. A spousal beneficiary may postpone taking RMD until the
date the participant would have attained 72.
Treatment of an Outstanding Participant Loan
Important: If any beneficiary electing to take periodic
An outstanding participant loan is treated as an asset of distributions fails to take the RMD in any tax year or
the Plan. Any outstanding loan balance remaining at the electing the 10-year rule or 5-year rule fails to fully distribute
time of a participant’s death will become the responsibility the account withing the 10-year or 5-year period, such
of the beneficiary of the account and the beneficiary will be beneficiary may be subject to a 50% excess accumulations
treated as the borrower with respect to the Invesco Loan tax imposed by the IRS.
Policy and Procedures and Promissory Note agreed to by

SOLO-FRM-12 01/25 8 of 9
Beneficiary Types Distribution Options
Eligible Designated Beneficiary (EDB) is a: Single Life Expectancy: Periodic distribution must begin
● surviving spouse by December 31 of the year following the account owner’s
● account owner’s child who has not reached age of death using the beneficiary’s single life expectancy. The
majority factor will be reduced by one each year for a non-spouse
● an individual that is disabled under section 72(m)(7) of beneficiary. A spouse as sole beneficiary may delay taking
the Internal Revenue Code or chronically ill as defined distribution until December 31 of the year the account
under section 7702B(c)(2) individual, or owner would have attained the age of 72. A beneficiary that
● an individual who is not more than 10 years younger than is the minor child of the account owner may use their single
the shareholder. life expectancy until reaching the age of majority, normally
age 18. Any remaining assets must be fully distributed
Designated Beneficiary is an individual that is not within the next 10 years, normally by their 28th birthday.
considered an EDB.
10-year Rule: Assets must be distributed by December 31 of
Non-Designated Beneficiary is a non-person, estate, the year containing the 10th anniversary of the account owner’s
charity, corporation or non-qualifying trust. death.

2nd Generation Beneficiary is the beneficiary of assets 5-year Rule: Assets must be distributed by December 31 of
held in a beneficiary status account or decedent IRA. the year containing the 5th anniversary of the account owner’s
death.

Note: A qualified trust with a “look through” provision will use

the option available to the oldest beneficiary of the trust.

Distribution Options for Distribution Options for

Deaths Occurring Deaths Occurring
Before 12/31/2019 After 12/31/2019
Beneficiary Type Before RBD1 After RBD1 Before and After RBD2
Surviving Spouse ● Single Life Expectancy of ● Single Life Expectancy ● Single Life Expectancy of
surviving Spouse of surviving spouse or surviving spouse
● 5-Year Rule account owner ● 10-Year Rule
● May transfer to own IRA ● May transfer to own IRA ● May transfer to own IRA
Eligible Designated Benefi- N/A N/A ● Single Life Expectancy of
ciary (EDB) beneficiary
● 10-Year Rule
Designated Beneficiary ● 5-Year Rule Single Life Expectancy 10-Year Rule
● Single Life Expectancy of of beneficiary or account
beneficiary owner
Non-Designated 5-Year Rule Single Life Expectancy of 5-Year Rule
Beneficiary account owner
2nd Generation Benefi- ● Single Life Expectancy of Single Life Expectancy of Single Life Expectancy of
ciary of an original account 1st generation beneficiary 1st generation beneficiary 1st generation beneficiary
owner dying prior to 2020 or 2nd generation
beneficiary
● 5-Year Rule
2nd Generation Benefi- N/A N/A 10-Year Rule
ciary of an original account
owner dying after 2019
The above is provided for informational purposes only and believe to be accurate. Final regulations regarding options
available to the beneficiary have not been issued by the IRS. Please consult with your tax advisor regarding payout
options specific to your situation.
1 Required Beginning Date (RBD) for:
− Non-5% owner is April 1 of the calendar year following the later of the calendar year in which the participant attains age 70 1/2 or the calendar year
in which the participant retires from employment with the employer maintaining the plan.
− 5% owner is April 1 of the calendar year following the calendar year in which the participant attains age 70 1/2.
2 Required Beginning Date (RBD) for:
− Non-5% owner is April 1 of the calendar year following the later of the calendar year in which the participant attains age 72 or the calendar year in
which the participant retires from employment with the employer maintaining the plan.
− 5% owner is April 1 of the calendar year following the calendar year in which the participant attains age 72.

SOLO-FRM-12 01/25 9 of 9
 Please remember to sign Print Clear Form

form after printing.

Beneficial Ownership Information Form

Use this form to provide controlling and beneficial owner(s) information for privately held
corporations, partnerships, LLC’s, charities, foundations, organizations, and statutory trust with
a beneficial owner(s) that owns 25% or more of the entity.
IMPORTANT INFORMATION: To help the government fight financial crime, federal regulation requires Invesco to obtain,
verify, and record information about the beneficial owners of legal entity customers. Legal entities can be abused to
disguise involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes.
Requiring the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law
enforcement investigates and prosecute these crimes. If you fail to provide the requested information and/or if any of
the information cannot be confirmed, Invesco Investment Services, Inc. (IIS) reserves the right to redeem the account.
The Invesco Privacy Notice, which conforms with applicable law, is located at the end of the form.
*Required
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1 | Invesco Account Information

Start > Invesco Account Number (If applicable)

Here
Use
"Tab"
key to
move to
Account Registration (Please print name(s) as it appears on account.)
next
field.

2 | Legal Entity Information

Name of Entity*

Entity’s Tax Identification Number* Date of Trust (If applicable) (mm/dd/yyyy)

-
Mailing Address*

City* State* ZIP*

3 | Control/Significant Responsible Individual Information

Please provide information for one individual with significant responsibility for managing the legal entity to be listed as the
subscriber/investor, such as an executive officer or senior manager (i.e., Chief Executive Officer, Chief Financial Officer,
Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer; or any other individual
who regularly performs similar functions). If appropriate, an individual listed here may also be a Beneficial Owner.
Full Name*

Social Security Number* Date of Birth* (mm/dd/yyyy)

- -
Address* (Residential or Business Street Address)

City* State* ZIP*

AIM-FRM-65 01/25 1 of 3
PLEASE USE BLUE OR BLACK INK PLEASE PRINT CLEARLY IN BLOCK CAPITAL LETTERS

4 | Beneficial Owner(s) Information

Please provide information for every natural person who is directly or indirectly through intermediaries, the beneficial
owner of 25% or more of any voting or non-voting class of equity interests of the subscriber/investor.
1. Full Name

Social Security Number Date of Birth (mm/dd/yyyy)

- -
Residential Address

City State ZIP

2. Full Name

Social Security Number Date of Birth (mm/dd/yyyy)

- -
Residential Address

City State ZIP

3. Full Name

Social Security Number Date of Birth (mm/dd/yyyy)

- -
Residential Address

City State ZIP

4. Full Name

Social Security Number Date of Birth (mm/dd/yyyy)

- -
Residential Address

City State ZIP

AIM-FRM-65 01/25 2 of 3
 *Required
PLEASE USE BLUE OR BLACK INK PLEASE PRINT CLEARLY IN BLOCK CAPITAL LETTERS

5 | Authorization and Signature (Please sign and date below.)

By signing this form, (i) I certify the information provided is true and accurate, and (ii) I agree to indemnify and hold
harmless Invesco Investment Services, Inc., its parents, affiliates, each of their respective employees, officers, trustees,
directors, successors, assigns, and each of the Invesco Funds from and against any and all actions, suits, claims, costs,
losses, liabilities, damages and expenses of any kind or character that may be incurred directly or indirectly as a result of
your actions taken in accordance with the instructions and other provisions set forth herein.
Signature* Date (mm/dd/yyyy)

x
Name (Please print)

Title

6 | Mailing Instructions
Please send completed and signed form to:
(Direct Mail) (Overnight Mail)
Invesco Investment Services, Inc. Invesco Investment Services, Inc.
P.O. Box 219078 801 Pennsylvania Ave
Kansas City, MO 64121-9078 Suite 219078
Kansas City, MO 64105-1307
For additional assistance please contact an Invesco Client Services representative at 800 959 4246, weekdays,
7 a.m. to 6 p.m. Central Time.

Additional Information
Important Information Regarding Privacy
By completing and providing this form, you consent to IIS using the confidential information/personal data provided
herein for the purpose of servicing your account. IIS shall take all reasonable steps to protect the confidentiality of such
information and shall use the same standard of care used to protect its own confidential information in accordance with
applicable privacy regulations. IIS may manage or service your account from international locations.

AIM-FRM-65 01/25 3 of 3
 Rev. March 5, 2020

FACTS WHAT DOES INVESCO DO WITH YOUR PERSONAL INFORMATION? *

Financial companies choose how they share your personal information. Federal law gives

Why? consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we
collect, share, and protect your personal information. Please read this notice carefully to understand
what we do.

The types of personal information we collect and share depend on the product or service you
have with us. This information can include:

● Social Security number and income

What? ● Transaction history and investment experience
● Investment experience and assets

When you are no longer our customer, we continue to share information about you according to our
policies.

All financial companies need to share customers’ personal information to run their everyday
How? business. In the section below, we list the reasons financial companies can share their customers’
personal information; the reasons Invesco chooses to share; and whether you can limit this sharing.

Reasons we can share your personal

Does Invesco share? Can you limit this sharing?
information
For our everyday business purposes—such as to
process your transactions, maintain your account(s),
Yes No
respond to court orders and legal investigations, or
report to credit bureaus
For our marketing purposes— to offer our products
No We do not share
and services to you
For joint marketing with other financial companies No We do not share
For our affiliates’ everyday business purposes—
No We do not share
information about your transactions and experiences
For our affiliates’ everyday business purposes—
No We do not share
information about your credit worthiness
For our affiliates to market to you No We do not share
For non-affiliates to market to you No We do not share

Questions? Call 1-800-959-4246 (toll free).

* This privacy notice applies to individuals who obtain or have obtained a financial product or service from the Invesco family of
companies. For a complete list of Invesco entities, please see the section titled “Who is providing this notice” on page 2.
Page 2

Who we are
Invesco Advisers, Inc., Invesco Private Capital, Inc., Invesco Senior Secured
Who is providing this notice? Management, Inc., WL Ross & Co. LLC, Invesco Distributors, Inc., Invesco Managed
Accounts, LLC, and the Invesco family of mutual funds.

What we do
How does Invesco protect To protect your personal information from unauthorized access and use, we use
my personal information? security measures that comply with federal law. These measures include computer
safeguards and secured files and buildings.
How does Invesco collect We collect your personal information, for example, when you
my personal information?
● Open an account or give us your contact information
● Make deposits or withdrawals from your account or give us your income information
● Make a wire transfer

We also collect your personal information from others, such as credit bureaus,
affiliates or other companies.
Why can’t I limit all sharing? Federal law gives you the right to limit only

● Sharing for affiliates’ everyday business purposes—information about your

creditworthiness
● Affiliates from using your information to market to you
● Sharing for nonaffiliates to market to you

Definitions
Affiliates Companies related by common ownership or control. They can be financial and
nonfinancial companies.

Invesco does not share with our affiliates so that they can market to you.
Nonaffiliates Companies not related by common ownership or control. They can be financial and
nonfinancial companies.

Invesco does not share with non-affiliates so that they can market to you.
Joint marketing A formal agreement between nonaffiliated financial companies that together market
financial products or services to you.

Invesco doesn’t jointly market.

 Rollover Explanation for Qualified Plans,
403(b) Plans, and Governmental 457(b) Plans

PART I: S
 PECIAL TAX NOTICE REGARDING PLAN If you do a direct rollover, the Plan will make the payment directly to your IRA
PAYMENTS or an employer plan. You should contact the IRA sponsor or the administrator
For Payments Not From a Designated Roth Account of the employer plan for information on how to do a direct rollover.
Your Rollover Options If you do not do a direct rollover, you may still do a rollover by making a
You are receiving this notice because all or a portion of a payment you are deposit into an IRA or eligible employer plan that will accept it. Generally,
receiving from your Employer’s Plan (the “Plan”) is eligible to be rolled over you will have 60 days after you receive the payment to make a deposit. If
to an IRA or an employer plan. This notice is intended to help you decide you do not do a direct rollover, the Plan is required to withhold 20% of the
whether to do such a rollover. payment for federal income taxes (up to the amount of cash and property
received other than employer stock). This means that, in order to roll over
This notice describes the rollover rules that apply to payments from the Plan the entire payment in a 60-day rollover, you must use other funds to make
that are not from a designated Roth account (a type of account in some up for the 20% withheld. If you do not roll over the entire amount of the
employer plans that is subject to special tax rules). If you also receive a payment, the portion not rolled over will be taxed and will be subject to the
payment from a designated Roth account in the Plan, please refer to Part II of 10% additional income tax on early distributions if you are under age 59½
this Rollover Explanation which serves as a different notice for that payment, (unless an exception applies).
and the Plan administrator or the payor will tell you the amount that is being
paid from each account. How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the amount eligible
Rules that apply to most payments from a plan are described in the “General for rollover. Any payment from the Plan is eligible for rollover, except:
Information About Rollovers” section. Special rules that only apply in certain ● Certain payments spread over a period of at least 10 years or over your
circumstances are described in the “Special Rules and Options” section. life or life expectancy (or the joint lives or joint life expectancies of you
and your beneficiary);
Your Right to Waive the 30-Day Notice Period ● Required minimum distributions after age 70½ if you were born before
Generally, neither a direct rollover nor a payment can be made from the plan July 1, 1949; or age 72 if you were born after June 30, 1949; or after
until at least 30 days after your receipt of this notice. Thus, after receiving death;
this notice, you have at least 30 days to consider whether or not to have ● Hardship distributions;
your withdrawal directly rolled over. If you do not wish to wait until this 30-day ● Payment of employee stock ownership plan (ESOP) dividends;
notice period ends before your election is processed, you may waive the ● Corrective distributions of contributions that exceed tax law limitations;
notice period by making an affirmative election indicating whether or not ● Loans treated as deemed distributions (for example, loans in default due
you wish to make a direct rollover. Your withdrawal will then be processed in to missed payments before your employment ends);
accordance with your election as soon as practical after it is received by the ● Cost of life insurance paid by the Plan;
Plan Administrator. ● Payments of certain automatic enrollment contributions that you request
to withdraw within 90 days of your first contribution;
General Information about Rollovers ● Amounts treated as distributed because of a prohibited allocation of S
corporation stock under an ESOP (also, there will generally be adverse
How can a rollover affect my taxes? tax consequences if you roll over a distribution of S corporation stock to
You will be taxed on a payment from the Plan if you do not roll it over. If you an IRA); and
are under age 59½ and do not do a rollover, you will also have to pay a 10% ● Distributions of certain premiums for health and accident insurance.
additional income tax on early distributions (generally, distributions made
before age 59½), unless an exception applies. However, if you do a rollover, The Plan administrator or the payor can tell you what portion of a payment is
you will not have to pay tax until you receive payments later and the 10% eligible for rollover.
additional income tax will not apply if those payments are made after you are
age 59½ (or if an exception to the 10% additional income tax applies). If I don’t do a rollover, will I have to pay the 10% additional income tax
on early distributions?
What types of retirement accounts and plans may accept my rollover? If you are under age 59½, you will have to pay the 10% additional income
You may roll over the payment to either an IRA (an individual retirement tax on early distributions for any payment from the Plan (including amounts
account or individual retirement annuity) or an employer plan (a tax-qualified withheld for income tax) that you do not roll over, unless one of the
plan, section 403(b) plan, or governmental section 457(b) plan) that will exceptions listed below applies. This tax applies to the part of the distribution
accept the rollover. The rules of the IRA or employer plan that holds the that you must include in income and is in addition to the regular income tax
rollover will determine your investment options, fees, and rights to payment on the payment not rolled over.
from the IRA or employer plan (for example, IRAs are not subject to spousal
consent rules and IRAs may not provide loans). Further, the amount rolled The 10% additional income tax does not apply to the following payments from
over will become subject to the tax rules that apply to the IRA or employer the Plan:
plan.
● Payments made after you separate from service if you will be at least
Even if a plan accepts rollovers, it might not accept rollovers of certain types age 55 in the year of the separation;
of distributions, such as after-tax amounts. If this is the case, and your ● Payments that start after you separate from service if paid at least annually
distribution includes after-tax amounts, you may wish instead to roll your in equal or close to equal amounts over your life or life expectancy (or the
distribution over to a traditional IRA or split your rollover amount between joint lives or joint life expectancies of you and your beneficiary);
the employer plan in which you will participate and a traditional IRA. If an ● Payments from a governmental plan made after you separate from
employer plan accepts your rollover, the plan may restrict subsequent service if you are a qualified public safety employee and you will be at
distributions of the rollover amount or may require your spouse's consent least age 50 in the year of the separation;
for any subsequent distribution. A subsequent distribution from the plan that ● Payments made due to disability;
accepts your rollover may also be subject to different tax treatment than ● Payments after your death;
distributions from this Plan. Check with the administrator of the plan that is to ● Payments of employee stock ownership plan (ESOP) dividends;
receive your rollover prior to making the rollover. ● Corrective distributions of contributions that exceed tax law limitations;
● Cost of life insurance paid by the Plan;
How do I do a rollover? ● Payments made directly to the government to satisfy a federal tax levy;
There are two ways to do a rollover. You can do either a direct rollover or a ● Payments made under a qualified domestic relations order (QDRO;
60-day rollover.

TEF-SAF-INS-1 01/25
● Payments of up to $5,000 made to you from a defined contribution plan receiving the $8,000, you may roll over the entire $10,000 to an IRA or an
if the payment is a qualified birth or adoption distribution; eligible employer plan. To do this, you roll over the $8,000 you received from
● Payments up to the amount of your deductible medical expenses the Plan, and you will have to find $2,000 from other sources (your savings,
(without regard to whether you itemize deductions for the taxable year); a loan, etc.). In this case, the entire $10,000 is not taxed until you take it out
● Certain payments made while you are on active duty if you were a of the traditional IRA or an eligible employer plan. If you roll over the entire
member of a reserve component called to duty after September 11, $10,000, when you file your income tax return you may get a refund of part or
2001 for more than 179 days; all of the $2,000 withheld.
● Payments of certain automatic enrollment contributions that you request
to withdraw within 90 days of your first contribution; If, on the other hand, you roll over only $8,000, the $2,000 you did not roll
● Payments excepted from the additional income tax by federal legislation over is taxed in the year it was withheld. When you file your income tax
relating to certain emergencies and disasters; and return, you may get a refund of part of the $2,000 withheld. (However, any
● Phased retirement payments made to federal employee. refund is likely to be larger if you roll over the entire $10,000.)

If I do a rollover to an IRA, will the 10% additional income tax apply to Will I owe State income taxes?
early distributions from the IRA? This notice does not address any State or local income tax rules (including
If you receive a payment from an IRA when you are under age 59½, you withholding rules).
will have to pay the 10% additional income tax on early distributions on part
of the distribution that you must include in income, unless an exception Special Rules and Options
applies. In general, the exceptions to the 10% additional income tax for
early distributions from an IRA are the same as the exceptions listed above If your payment includes after-tax contributions
for early distributions from a plan. However, there are a few differences for After-tax contributions included in a payment are not taxed. If you receive a
payments from an IRA, including: partial payment for your total benefit, an allocable portion of your after-tax
contributions is included in the payment, so you cannot take a payment
● The exception for payments made after you separate from service if of only after-tax contributions. However, if you have prre-1987 after-tax
you will be at least age 55 in the year of the separation (or age 50 for contributions maintained in a separate account, a special rule may apply to
qualified public safety employee) does not apply; determine whether the after-tax contributions are included in the payment. In
● The exception for qualified domestic relations orders (QDROs) does not addition, special rules apply when you do a rollover, as described below.
apply (although a special rule applies under which, as part of a divorce
or separation agreement, a tax-free transfer may be made directly to an You may roll over to an IRA a payment that includes after-tax contributions
IRA of a spouse or former spouse; and through either a direct rollover or a 60-day rollover. You must keep track of
● The exception for payments made at least annually in equal or close to the aggregate amount of the after-tax contributions in all of your IRAs (in
equal amounts over a specified period applies without regard to whether order to determine your taxable income for later payments from the IRAs).
you have had a separation from service. If you do a direct rollover of only a portion of the amount paid from the Plan
Additional exceptions apply for payments from an IRA, including; and at the same time the rest is paid to you, the portion rolled over consists
first of the amount that would be taxable if not rolled over. For example,
● Payments for qualified higher education expenses; assume you are receiving a distribution of $12,000, of which $2,000 is
● Payments up to $10,000 used in a qualified first-time home purchase; and after-tax contributions. In this case, if you directly roll over $10,000 to an IRA
● Payments for health insurance premiums after you have received that is not a Roth IRA, no amount is taxable because the $2,000 amount
unemployment compensation for 12 consecutive weeks (or would have not directly rolled over is treated as being after-tax contributions. If you
been eligible to receive unemployment compensation but for self- do a direct rollover of the entire amount paid from the Plan to two or more
employed status). destinations at the same time, you can choose which destination receives
the after-tax contributions.
Does Federal income tax withholding apply to my distribution?
● Mandatory Withholding. If any portion of your payment can be rolled Similarly, if you do a 60-day rollover to an IRA of only a portion of a payment
over and you do not elect to make a DIRECT ROLLOVER, the Plan is made to you, the portion rolled over consists first of the amount that would
required by law to withhold 20% of the taxable amount. This amount is be taxable if not rolled over. For example, assume you are receiving a
sent to the IRS as federal income tax withholding. For example, if you distribution of $12,000, of which $2,000 is after-tax contributions, and no part
can roll over a taxable payment of $10,000, only $8,000 will be paid to of the distribution is directly rolled over. In this case, if you roll over $10,000
you because the Plan must withhold $2,000 as income tax. However, to an IRA that is no a Roth IRA in a 60-day rollover, no amount is taxable
when you prepare your income tax return for the year, unless you make because the $2,000 amount not rolled over is treated as being after-tax
a rollover within 60 days (see "Sixty-Day Rollover Option" below), you contributions.
must report the full $10,000 as a taxable payment from the Plan. You
must report the $2,000 as tax withheld, and it will be credited against Once you roll over your after-tax contributions to a traditional IRA, those
any income tax you owe for the year. There will be no income tax amounts CANNOT later be rolled over to an employer plan.
withholding if your payments for the year are less than $200.
● Voluntary Withholding. If any portion of your payment is taxable but You may roll over to an employer plan all of a payment that includes after-tax
cannot be rolled over, the mandatory withholding rules described above contributions, but only through a direct rollover (and only if the receiving plan
do not apply. In this case, you may elect not to have withholding apply to separately accounts for after-tax contributions and is not a governmental
that portion. If you do nothing, an amount will be taken out of this portion section 457(b) plan). You can do a 60-day rollover to an employer plan of part
of your payment for federal income tax withholding. To elect out of of a payment that includes after-tax contributions, but only up to the amount
withholding, ask the Plan Administrator for the election form and related of the payment that would be taxable if not rolled over.
information.
● Sixty-Day Rollover Option. If you receive a payment that can be rolled If you miss the 60-day rollover deadline
over, you can still decide to roll over all or part of it to an IRA or to an Generally, the 60-day rollover deadline cannot be extended. However,
eligible employer plan that accepts rollovers. If you decide to roll over, the IRS has the limited authority to waive the deadline under certain
you must contribute the amount of the payment you received to an IRA extraordinary circumstances, such as when external events prevented you
or eligible employer plan within 60 days after you receive the payment. from completing the rollover by the 60-day rollover deadline. Under certain
The portion of your payment that is rolled over will not be taxed until you circumstances, you may claim eligibility for a waiver of the 60-day rollover
take it out of the traditional IRA or the eligible employer plan. deadline by making a written self-certification. Otherwise, to apply for a
waiver from the IRS, you must file a private letter ruling request with the IRS.
You can roll over up to 100% of your payment that is an eligible rollover Private letter ruling requests require a payment of a nonrefundable user fee.
distribution, including an amount equal to the 20% of the taxable portion that For more information, see IRS Publication 590-A, Contributions to Individual
was withheld. If you choose to roll over 100%, you must find other money Retirement Arrangements (IRAs).
within the 60-day period to contribute to the IRA or the eligible employer plan,
to replace the 20% that was withheld. On the other hand, if you roll over only If your payment includes employer stock that you do not roll over
the 80% of the taxable portion that you received, you will be taxed on the If you do not do a rollover, you can apply a special rule to payments of
20% that was withheld. employer stock (or other employer securities) that are either attributable to
after-tax contributions or paid in a lump sum after separation from service (or
Example: The taxable portion of your payment that can be rolled over is after age 59½, disability, or the participant’s death). Under the special rule,
$10,000, and you choose to have it paid to you. You will receive $8,000, and the net unrealized appreciation on the stock will not be taxed when distributed
$2,000 will be sent to the IRS as income tax withholding. Within 60 days after from the Plan and will be taxed at capital gain rates when you sell the stock.

TEF-SAF-INS-1 01/25
Net unrealized appreciation is generally the increase in the value of employer take required minimum distributions from a Roth IRA during your lifetime.
stock after it was acquired by the Plan. If you do a rollover for a payment that For more information, see IRS Publication 590-A, Contributions to Individual
includes employer stock (for example, by selling the stock and rolling over Retirement Arrangements (IRAs), and IRS Publication 590-B, Distributions
the proceeds within 60 days of the payment), the special rule relating to the from Individual Retirement Arrangements (IRAs).
distributed employer stock will not apply to any subsequent payments from
the IRA or generally the Plan. The Plan administrator can tell you the amount If you do a rollover to a designated Roth account in the Plan
of any net unrealized appreciation. You cannot roll over a distribution to a designated Roth account in another
employer's plan. However, you can roll the distribution over into a designated
If you have an outstanding loan that is being offset Roth account in the distributing Plan. If you roll over a payment from the Plan
If you have an outstanding loan from the Plan, your Plan benefit may be to a designated Roth account in the Plan, the amount of the payment rolled
offset by the outstanding amount of the loan, typically when your employment over (reduced by any after-tax amounts directly rolled over) will be taxed. In
ends. The offset amount is treated as a distribution to you at the time of the general, the 10% additional income tax on early distributions will not apply.
offset. Generally, you may roll over all or any portion of the offset amount. However, if you take the amount rolled over out of the Roth IRA within the
Any offset amount that is not rolled over will be taxed (including the 10% 5-year period that begins on January 1 of the year of the rollover, the 10%
additional income tax on early distributions, unless an exception applies). You additional income tax will apply (unless an exception applies).
may roll over offset amounts to an IRA or an employer plan (if the terms of
the employer plan permit the plan to receive plan loan offset rollovers). If you roll over the payment to a designated Roth account in the plan, later
payments from the designated Roth account that are qualified distributions
How long you have to complete the rollover depends on what kind of plan will not be taxed (including earnings after the rollover). A qualified distribution
loan offset you have. If you have a qualified plan loan offset, you will have from a designated Roth account is a payment made both after you attain age
until your tax return due date (including extensions) for the tax year during 59½ (or after your death or disability) and after you have had a designated
which the offset occurs to complete your rollover. A qualified plan loan offset Roth account in the plan for a period of at least 5 years. In applying this
occurs when a plan loan in good standing is offset because your employer 5-year rule, you count from January 1 of the year your first contribution was
plan terminates, or because you sever from employment. If you plan loan made to the designated Roth account. However, if you made a direct rollover
offset occurs for any other reason (such as failure to make level loan to a designated Roth account in the plan from a designated Roth account
repayments that results in a deemed distribution), then you have 60 days in a plan of another employer, the 5-year period begins on January 1 of
from the date of the offset occurs to complete your rollover. the year your first contribution was made to the designated Roth account
in the plan or, if earlier, to the designated Roth account in the plan of the
If you were born on or before January 1, 1936 other employer. Payments from the designated Roth account that are not
If you were born on or before January 1, 1936 and receive a lump sum qualified distributions will be taxed to the extent allocable to earnings after
distribution that you do not roll over, special rules for calculating the amount the rollover, including the 10% additional tax on early distributions (unless an
of the tax on the payment might apply to you. For more information, see IRS exception applies).
Publication 575, Pension and Annuity Income.
If you are not a Plan participant
If your payment is from a governmental section 457(b) plan Payments after death of the participant. If you receive a distribution after the
If the Plan is a governmental section 457(b) plan, the same rules described participant’s death that you do not roll over, the distribution generally will be
elsewhere in this notice generally apply, allowing you to roll over the payment taxed in the same manner described elsewhere in this notice. However, the
to an IRA or an employer plan that accepts rollovers. One difference is that, if 10% additional income tax on early distributions and the special rules for
you do not do a rollover, you will not have to pay the 10% additional income public safety officers do not apply, and the special rule described under the
tax on early distributions from the Plan even if you are under age 59½ (unless section “If you were born on or before January 1, 1936” applies only if the
the payment is from a separate account holding rollover contributions that deceased participant was born on or before January 1, 1936.
were made to the Plan from a tax-qualified plan, a section 403(b) plan, or an
IRA). However, if you do a rollover to an IRA or to an employer plan that is not If you are a surviving spouse
a governmental section 457(b) plan, a later distribution made before age 59½ If you receive a payment from the Plan as the surviving spouse of
will be subject to the 10% additional income tax on early distributions (unless a deceased participant, you have the same rollover options that the
an exception applies). Other differences include that you cannot do a rollover participant would have had, as described elsewhere in this notice. In
if the payment is due to an "unforeseeable emergency" and the special rules addition, if you choose to do a rollover to an IRA, you may treat the IRA as
under "If your payment includes employer stock that you do not roll over" and your own or as an inherited IRA.
"If you were born on or before January 1, 1936" do not apply.
An IRA you treat as your own is treated like any other IRA of yours, so that
If you are an eligible retired public safety officer and your payment is payments made to you before you are age 59½ will be subject to the 10%
used to pay for health coverage or qualified long-term care insurance additional income tax on early distributions (unless an exception applies)
If the Plan is a governmental plan, you retired as a public safety officer, and and required minimum distributions from your IRA do not have to start until
your retirement was by reason of disability or was after normal retirement after you are age 70½ if you were born before July 1, 1949, or age 72 if
age, you can exclude from your taxable income Plan payments paid directly you were born after June 30, 1949.
as premiums to an accident or health plan (or a qualified long-term care
insurance contract) that your employer maintains for you, your spouse or your If you treat the IRA as an inherited IRA, payments from the IRA will not be
dependants, up to a maximum of $3,000 annually. For this purpose, a public subject to the 10% additional income tax on early distributions. However, if
safety officer is a law enforcement officer, firefighter, chaplain, or member of a the participant had started taking required minimum distributions, you will
rescue squad or ambulance crew. have to receive required minimum distributions from the inherited IRA. If
the participant had not started taking required minimum distributions from
If you roll over your payment to a Roth IRA the Plan, you will not have to start receiving required minimum distributions
If you roll over a payment from the Plan to a Roth IRA, a special rule applies from the inherited IRA until the year the participant would have been
under which the amount of the payment rolled over (reduced by any after-tax age 70½ if the participant was born before July 1, 1949, or age 72 if the
amounts) will be taxed. In general, the 10% additional income tax on early participant was born after June 30, 1949.
distributions will not apply. However, if you take the amount rolled over out
of the Roth IRA within the 5-year period that begins on January 1 of the year If you are a surviving beneficiary other than a spouse
of the rollover, the 10% additional income tax will apply (unless an exception If you receive a payment from the Plan because of the participant’s death
applies). and you are a designated beneficiary other than a surviving spouse, the
only rollover option you have is to do a direct rollover to an inherited IRA.
If you roll over the payment to a Roth IRA, later payments from the Roth IRA Payments from the inherited IRA will not be subject to the 10% additional
that are qualified distributions will not be taxed (including earnings after the income tax on early distributions. You will have to receive required
rollover). A qualified distribution from a Roth IRA is a payment made after minimum distributions from the inherited IRA.
you are age 59½ (or after your death or disability, or as a qualified first-time
homebuyer distribution of up to $10,000) and after you have had a Roth IRA Payments under a qualified domestic relations order (QDRO). If you are the
for at least 5 years. In applying this 5-year rule, you count from January 1 of spouse or former spouse of the participant who receives a payment from the
the year for which your first contribution was made to a Roth IRA. Payments Plan under a qualified domestic relations order (QDRO), you generally have
from the Roth IRA that are not qualified distributions will be taxed to the the same options and the same tax treatment that the participant would have
extent of earnings after the rollover, including the 10% additional income (for example, you may roll over the payment to your own Roth IRA or to a
tax on early distributions (unless an exception applies). You do not have to designated Roth account in an eligible employer plan that will accept it).

TEF-SAF-INS-1 01/25
 this notice, you have at least 30 days to consider whether or not to have
If you are a nonresident alien your withdrawal directly rolled over. If you do not wish to wait until this 30-day
If you are a nonresident alien and you do not do a direct rollover to a U.S. notice period ends before your election is processed, you may waive the
IRA or U.S. employer plan, and the payment is not a qualified distribution, notice period by making an affirmative election indicating whether or not
the Plan is generally required to withhold 30% (instead of withholding 20%) you wish to make a direct rollover. Your withdrawal will then be processed in
of the earnings for federal income taxes. If the amount withheld exceeds the accordance with your election as soon as practical after it is received by the
amount of tax you owe (as may happen if you do a 60-day rollover), you may Plan Administrator.
request an income tax refund by filing Form 1040NR and attaching your Form
1042-S. See Form W-8BEN for claiming that you are entitled to a reduced General Information about Rollovers
rate of withholding under an income tax treaty. For more information, see
also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, How can a rollover affect my taxes?
Withholding of Tax on Nonresident Aliens and Foreign Entities. After-tax contributions included in a payment from a designated Roth account
are not taxed, but earnings might be taxed. The tax treatment of earnings
Other special rules included in the payment depends on whether the payment is a qualified
If a payment is one in a series of payments for less than 10 years, your distribution. If a payment is only part of your designated Roth account, the
choice whether to do a direct rollover will apply to all later payments in the payment will include an allocable portion of the earnings in your designated
series (unless you make a different choice for later payments). Roth account.

If your payments for the year are less than $200 (not including payments If the payment from the Plan is not a qualified distribution and you do not do
from a designated Roth account in the Plan), the Plan is not required to allow a rollover to a Roth IRA or a designated Roth account in an employer plan,
you to do a rollover and is not required to withhold federal income taxes. you will be taxed on the portion of the payment that is earnings. If you are
However, you may do a 60-day rollover. under age 59½, a 10% additional income tax on early distributions (generally,
distributions made before age 59½) will also apply to the earnings (unless
Unless you elect otherwise, a mandatory cashout of more than $1,000 (not an exception applies). However, if you do a rollover, you will not have to pay
including payments from a designated Roth account in the Plan) will be taxes currently on the earnings and you will not have to pay taxes later on
directly rolled over to an IRA chosen by the Plan administrator or the payor. payments that are qualified distributions.
A mandatory cashout is a payment from a plan to a participant made before
age 62 (or normal retirement age, if later) and without consent, where the If the payment from the Plan is a qualified distribution, you will not be taxed on
participant’s benefit does not exceed $5,000 (not including any amounts held any part of the payment even if you do not do a rollover. If you do a rollover,
under the plan as a result of a prior rollover made to the plan). you will not be taxed on the amount you roll over and any earnings on the
amount you roll over will not be taxed if paid later in a qualified distribution.
You may have special rollover rights if you recently served in the U.S. Armed
Forces. For more information on special rollover rights related to the U.S. A qualified distribution from a designated Roth account in the Plan is a
Armed Forces, see IRS Publication 3, Armed Forces’ Tax Guide. You also payment made after you are age 59½ (or after your death or disability) and
may have special rollover rights if you were affected by a federally declared after you have had a designated Roth account in the Plan for at least 5 years.
disaster (or similar event), or if you received a distribution on account of a In applying the 5-year rule, you count from January 1 of the year your first
disaster. For more information on special rollover rights related to disaster contribution was made to the designated Roth account. However, if you did
relief, see the IRS website at www.irs.gov. a direct rollover to a designated Roth account in the Plan from a designated
Roth account in another employer plan, your participation will count from
For More Information January 1 of the year your first contribution was made to the designated Roth
account in the Plan or, if earlier, to the designated Roth account in the other
You may wish to consult with the Plan administrator or payor, or a employer plan.
professional tax advisor, before taking a payment from the Plan. Also, you
can find more detailed information on the federal tax treatment of payments What types of retirement accounts and plans may accept my rollover?
from employer plans in: IRS Publication 575, Pension and Annuity Income; You may roll over the payment to either a Roth IRA (a Roth individual
IRS Publication 590-A, Contributions to Individual Retirement Arrangements retirement account or Roth individual retirement annuity) or a designated
(IRAs); Publication 590-B, Distributions from Individual Retirement Roth account in an employer plan (a tax-qualified plan, section 403(b)
Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans plan, or governmental section 457(b) plan) that will accept the rollover. The
(403(b) Plans). These publications are available from a local IRS office, on rules of the Roth IRA or employer plan that holds the rollover will determine
the web at www.irs.gov, or by calling 1-800-TAX-FORM. your investment options, fees, and rights to payment from the Roth IRA or
employer plan (for example, Roth IRAs are not subject to spousal consent
PART II: S
 UPPLEMENTAL SPECIAL TAX NOTICE rules, and Roth IRAs may not provide loans). Further, the amount rolled
REGARDING PLAN PAYMENTS over will become subject to the tax rules that apply to the Roth IRA or the
For Payments From a Designated Roth Account designated Roth account in the employer plan. In general, these tax rules are
similar to those described elsewhere in this notice, but differences include:
If the payment you are receiving is NOT from a designated Roth account
under your Employer’s Plan, this Part II of the Rollover Explanation does ■ If you do a rollover to a Roth IRA, all of your Roth IRAs will be considered
not apply to you and you can disregard the following section. for purposes of determining whether you have satisfied the 5-year rule
(counting from January 1 of the year for which your first contribution was
made to any of your Roth IRAs);
Your Rollover Options ■ If you do a rollover to a Roth IRA, you will not be required to take a
You are receiving this notice because all or a portion of a payment you are distribution from the Roth IRA during your lifetime and you must keep
receiving from your Employer’s Plan (the “Plan”) is eligible to be rolled over track of the aggregate amount of the after-tax contributions in all of your
to a Roth IRA or designated Roth account in an employer plan. This notice is Roth IRAs (in order to determine your taxable income for later Roth IRA
intended to help you decide whether to do a rollover. payments that are not qualified distributions); and
■ Eligible rollover distributions from a Roth IRA can only be rolled over to
This notice describes the rollover rules that apply to payments from another Roth IRA.
the Plan that are from a designated Roth account. If you also receive a
payment from the Plan that is not from a designated Roth account, please How do I do a rollover?
refer to Part I of this Rollover Explanation which serves as a different notice There are two ways to do a rollover. You can either do a direct rollover or a
for that payment, and the Plan administrator or the payor will tell you the 60-day rollover.
amount that is being paid from each account.
If you do a direct rollover, the Plan will make the payment directly to your
Rules that apply to most payments from a designated Roth account are Roth IRA or designated Roth account in an employer plan. You should
described in the “General Information About Rollovers” section. Special rules contact the Roth IRA sponsor or the administrator of the employer plan for
that only apply in certain circumstances are described in the “Special Rules information on how to do a direct rollover.
and Options” section.
If you do not do a direct rollover, you may still do a rollover by making a
Your Right to Waive the 30-Day Notice Period deposit (generally within 60 days) into a Roth IRA, whether the payment
Generally, neither a direct rollover nor a payment can be made from the plan is a qualified or nonqualified distribution. In addition, you can do a rollover
until at least 30 days after your receipt of this notice. Thus, after receiving by making a deposit within 60 days into a designated Roth account in an
employer plan if the payment is a nonqualified distribution and the rollover
TEF-SAF-INS-1 01/25
does not exceed the amount of the earnings in the payment. You cannot do If I do a rollover to a Roth IRA, will the 10% additional income tax apply
a 60-day rollover to an employer plan of any part of a qualified distribution. to early distributions from the IRA?
If you receive a distribution that is a nonqualified distribution and you do not If you receive a payment from a Roth IRA when you are under age 59½, you
roll over an amount at least equal to the earnings allocable to the distribution, will have to pay the 10% additional income tax on early distributions on the
you will be taxed on the amount of those earnings not rolled over, including earnings paid from the Roth IRA, unless an exception applies or the payment
the 10% additional income tax on early distributions if you are under age 59½ is a qualified distribution. In general, the exceptions to the 10% additional
(unless an exception applies). income tax for early distributions from a Roth IRA listed above are the same
as the exceptions for early distributions from a plan. However, there are a few
If you do a direct rollover of only a portion of the amount paid from the Plan differences for payments from a Roth IRA, including:
and a portion is paid to you at the same time, the portion directly rolled over
consists first of earnings. ● The exception for payments made after you separate from service if
you will be at least age 55 in the year of the separation (or age 50 for
If you do not do a direct rollover and the payment is not a qualified qualified public safety employees) does not apply;
distribution, the Plan is required to withhold 20% of the earnings for federal ● The exception for qualified domestic relations orders (QDROs) does not
income taxes (up to the amount of cash and property received other than apply (although a special rule applies under which, as part of a divorce
employer stock). This means that, in order to roll over the entire payment in or separation agreement, a tax-free transfer may be made directly to a
a 60-day rollover to a Roth IRA, you must use other funds to make up for the Roth IRA of a spouse or former spouse); and
20% withheld. ● The exception for payments made at least annually in equal or close to
equal amounts over a specified period applies without regard to whether
How much may I roll over? you have had a separation from service.
If you wish to do a rollover, you may roll over all or part of the amount eligible
for rollover. Any payment from the Plan is eligible for rollover, except: Additional exceptions apply for payments from an IRA, including;
● Payments for qualified higher education expenses;
● Certain payments spread over a period of at least 10 years or over your
life or life expectancy (or the joint lives or joint life expectancies of you ● Payments up to $10,000 used in a qualified first-time home purchase;
and your beneficiary); and
● Payments for health insurance premiums after you have received
● Required minimum distributions after age 70½ (or after death);
unemployment compensation for 12 consecutive weeks (or would have
● Hardship distributions;
been eligible to receive unemployment compensation but for self-
● Payments of employee stock ownership (ESOP) dividends;
employed status).
● Corrective distributions of contributions that exceed tax law limitations;
● Loans treated as deemed distributions (for example, loans in default due
Will I owe State income taxes?
to missed payments before your employment ends);
This notice does not address any State or local income tax rules (including
● Cost of life insurance paid by the Plan;
State/local withholding rules).
● Payments of certain automatic enrollment contributions that you request
to withdraw within 90 days of your first contribution;
● Amounts treated as distributed because of a prohibited allocation of S Special Rules and Options
corporation stock under an ESOP (also, there generally will be adverse
If you miss the 60-day rollover deadline
tax consequences if S corporation stock is held by an IRA); and
Generally, the 60-day rollover deadline cannot be extended. However,
● Distribution of certain premiums for health and accident insurance. the IRS has the limited authority to waive the deadline under certain
extraordinary circumstances, such as when external events prevented you
The Plan administrator or the payor can tell you what portion of a payment is from completing the rollover by the 60-day rollover deadline. Under certain
eligible for rollover. circumstances, you may claim eligibility for a waiver of the 60-day rollover
deadline by making a written self-certification. Otherwise, to apply for a
If I don’t do a rollover, will I have to pay the 10% additional income tax waiver from the IRS, you must file a private letter ruling request with the
on early distributions? IRS. Private letter ruling requests require the payment of a nonrefundable
If a payment is not a qualified distribution and you are under age 59½, you user fee. For more information, see IRS Publication 590-A, Contributions to
will have to pay the 10% additional income tax on early distributions with Individual Retirement Arrangements (IRAs).
respect to the earnings allocated to the payment that you do not roll over
(including amounts withheld for income tax), unless one of the exceptions If your payment includes employer stock that you do not roll over
listed below applies. This tax is in addition to the regular income tax on the If you receive a payment that is not a qualified distribution and you do not roll
earnings not rolled over. it over, you can apply a special rule to payments of employer stock (or other
employer securities) that are paid in a lump sum after separation from service
The 10% additional income tax does not apply to the following payments from (or after age 59½, disability, or the participant’s death). Under the special
the Plan: rule, the net unrealized appreciation on the stock included in the earnings in
● Payments made after you separate from service if you will be at least the payment will not be taxed when distributed to you from the Plan and will
age 55 in the year of the separation; be taxed at capital gain rates when you sell the stock. If you do a rollover to
● Payments that start after you separate from service if paid at least annually a Roth IRA for a nonqualified distribution that includes employer stock (for
is equal or close to equal amounts over your life or life expectancy (or the example, by selling the stock and rolling over the proceeds within 60 days of
joint lives or joint life expectancies of you and your beneficiary); the distribution), you will not have any taxable income and the special rule
● Payments from a governmental plan made after you separate from relating to the distributed employer stock will not apply to any subsequent
service if you are a qualified public safety employee and you will be at payments from the Roth IRA or generally, the Plan. Net unrealized
least age 50 in the year of the separation; appreciation is generally the increase in the value of the employer stock after
● Payments made due to disability; it was acquired by the Plan. The Plan administrator can tell you the amount of
● Payments after your death; any net unrealized appreciation.
● Payments of employee stock ownership (ESOP) dividends;
● Corrective distributions of contributions that exceed tax law limitations; If you receive a payment that is a qualified distribution that includes employer
● Cost of life insurance paid by the Plan; stock and you do not roll it over, your basis in the stock (used to determine
● Payments made directly to the government to satisfy a federal tax levy; gain or loss when you later sell the stock) will equal the fair market value of
● Payments made under a qualified domestic relations order (QDRO); the stock at the time of the payment from the Plan.
● Payments of the $5,000 made to you from a defined contribution plan if
the payment is a qualified birth or adoption distribution; If you have an outstanding loan that is being offset
● Payments up to the amount of your deductible medical expenses If you have an outstanding loan from the Plan, your Plan benefit may be
(without regard to whether you itemize deductions for the taxable year); offset by the outstanding amount of the loan, typically when your employment
● Certain payments made while you are on active duty if you were a ends. The offset amount is treated as a distribution to you at the time of the
member of a reserve component called to duty after September 11, offset. Generally, you may roll over all or any portion of the offset amount.
2001 for more than 179 days; If the distribution attributable to the offset is not a qualified distribution and
● Payments of certain automatic enrollment contributions that you request you do not roll over the offset amount, you will be taxed on any earnings
to withdraw within 90 days of your first contribution; and included in the distributions (including the 10% additional income tax on early
● Payments excepted from the additional income tax by federal legislation distributions, unless an exception applies). You may roll over the earnings
relating to certain emergencies and disasters. included in the loan offset to a Roth IRA or designated Roth account in an

TEF-SAF-INS-1 01/25
employer plan (if the terms of the employer plan permit the plan to receive If you treat the Roth IRA as an inherited Roth IRA, payments from the
plan loan offset rollovers). You may also roll over the full amount of the offset Roth IRA will not be subject to the 10% additional income tax on early
to a Roth IRA. distributions. An inherited Roth IRA is subject to required minimum
distributions. If the participant had started taking required minimum
How long you have to complete the rollover depends on what kind of plan distributions from the Plan, you will have to receive required minimum
loan offset you have. If you have a qualified plan loan offset, you will have distributions from the inherited Roth IRA. If the participant had not started
until your tax return due date (including extensions) for the tax year during taking required minimum distributions, you will not have to start receiving
which the offset occurs to complete your rollover. A qualified plan loan required minimum distributions from the inherited Roth IRA until the year
offset occurs when a plan loan in good standing is offset because your the participant would have been age 70½ if the participant was born before
employer plan terminates, or because you sever from employment. If you July 1, 1949, or age 72 if the participant was born after June 30, 1949.
plan loan offset occurs for any other reason (such as a failure to make level
repayments that results in a deemed distribution), then you have 60 days If you are a surviving beneficiary other than a spouse
from the date the offset occurs to complete your rollover. If you receive a payment from the Plan because of the participant’s death
and you are a designated beneficiary other than a surviving spouse, the
If you receive a nonqualified distribution and you were born on or only rollover option you have is to do a direct rollover to an inherited Roth
before January 1, 1936 IRA. Payments from the inherited Roth IRA, even if made in a nonqualified
If you were born on or before January 1, 1936, and receive a lump sum distribution, will not be subject to the 10% additional income tax on early
distribution that is not a qualified distribution and that you do not roll over, distributions. You will have to receive required minimum distributions from
special rules for calculating the amount of the tax on the earnings in the the inherited Roth IRA.
payment might apply to you. For more information, see IRS Publication 575,
Pension and Annuity Income. Payments under a qualified domestic relations order (QDRO). If you are the
spouse or former spouse of the participant who receives a payment from the
If your payment is from a governmental section 457 (b) plan Plan under a qualified domestic relations order (QDRO), you generally have
If the Plan is a governmental section 457(b) plan, the same rules described the same options and the same tax treatment that the participant would have
elsewhere in this notice generally apply, allowing you to roll over the payment (for example, you may roll over the payment to your own Roth IRA or to a
to an IRA or an employer plan that accepts rollovers. One difference is that, designated Roth account in an eligible employer plan that will accept it).
if you receive a payment that is not a qualified distribution and you do not
roll it over, you will not have to pay the 10% additional income tax on early If you are a nonresident alien
distributions with respect to the earnings allocated to the payment that you If you are a nonresident alien, you do not do a direct rollover to a U.S. IRA
do not roll over, even if you are under age 59½ (unless the payment is from or U.S. employer plan, and the payment is not a qualified distribution, the
a separate account holding rollover contributions that were made to the Plan Plan is generally required to withhold 30% (instead of withholding 20%) of
from a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you the earnings for federal income taxes. If the amount withheld exceeds the
do a rollover to an IRA or to an employer plan that is not a governmental amount of tax you owe (as may happen if you do a 60-day rollover), you may
section 457(b) plan, a later distribution that is not a qualified distribution made request an income tax refund by filing Form 1040NR and attaching your Form
before age 59½ will be subject to the 10% additional income tax on earnings 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced
allocated include that you cannot do a rollover if the payment is due to an rate of withholding under an income tax treaty. For more information, see
"unforeseeable emergency" and the special rules under “If your payment also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515,
includes employer stock that you do not roll over” and “If you were born on or Withholding of Tax on Nonresident Aliens and Foreign Entities.
before January 1, 1936” do not apply.
Other special rules
If you receive a nonqualified distribution, are an eligible retired public If a payment is one in a series of payments for less than 10 years, your
safety officer, and your payment is used to pay for health coverage or choice whether to do a direct rollover will apply to all later payments in the
qualified long-term care insurance series (unless you make a different choice for later payments).
If the Plan is a governmental plan, you retired as a public safety officer, and
your retirement was by reason of disability or was after normal retirement If you payments for the year (only including payments from the designated
age, you can exclude from your taxable income nonqualified distributions Roth account in the Plan) are less than $200, the Plan is not required to
paid directly as premiums to an accident or health plan (or a qualified allow you to do a direct rollover and is not required to withhold federal income
long-term care insurance contract) that your employer maintains for you, taxes. However, you can do a 60-day rollover.
your spouse, or your dependents, up to a maximum of $3,000 annually. For
this purpose, a public safety officer is a law enforcement officer, firefighter, Unless you elect otherwise, a mandatory cashout from the designated Roth
chaplain, or member of a rescue squad or ambulance crew. account in the Plan of more than $1,000 will be directly rolled over to a Roth
IRA chosen by the Plan administrator or the payor. A mandatory cashout
If you are not a Plan participant is a payment from a plan to a participant made before age 62 (or normal
Payments after death of the participant. If you receive a distribution after retirement age, if later) and without consent, where the participant’s benefit
the participant’s death that you do not roll over, the distribution generally will does not exceed $5,000 (not including any amounts held under the plan as a
be taxed in the same manner described elsewhere in this notice. However, result of a prior rollover made to the plan).
whether the payment is a qualified distribution generally depends on when
the participant first made a contribution to the designated Roth account in You may have special rollover rights if you recently served in the U.S. Armed
the Plan. Also, the 10% additional income tax on early distributions and Forces. For more information on special rollover rights related to the U.S.
the special rules for public safety officers do not apply, and the special rule Armed Forces, see IRS Publication 3, Armed Forces’ Tax Guide. You also
described under the section “If you receive a nonqualified distribution and may have special rollover rights if you were affected by a federally declared
you were born on or before January 1, 1936” applies only if the deceased disaster (or similar event), or if you received a distribution on account of a
participant was born on or before January 1, 1936. disaster. For more information on special rollover rights related to disaster
relief, see the IRS website at www.irs.gov.
If you are a surviving spouse
If you receive a payment from the Plan as the surviving spouse of For More Information
a deceased participant, you have the same rollover options that the
participant would have had, as described elsewhere in this notice. In You may wish to consult with the Plan administrator or payor, or a
addition, if you choose to do a rollover to a Roth IRA, you may treat the professional tax advisor, before taking a payment from the Plan. Also, you
Roth IRA as your own or as an inherited Roth IRA. can find more detailed information on the federal tax treatment of payments
from employer plans in: IRS Publication 575, Pension and Annuity Income;
A Roth IRA you treat as your own is treated like any other Roth IRA IRS Publication 590-A, Contributions to Individual Retirement Arrangements
of yours, so that you will not have to receive any required minimum (IRAs); IRS Publication 590-B, Distributions from Individual Retirement
distributions during your lifetime and earnings paid to you in a nonqualified Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans
distribution before you are age 59½ will be subject to the 10% additional (403(b) Plans). These publications are available from a local IRS office, on
income tax on early distributions (unless an exception applies). the web at www.irs.gov, or by calling 1-800-TAX-FORM.

TEF-SAF-INS-1 01/25
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