ORIGINAL DOCUMENTS ARE REQUIRED TO PROCESS ALL TRANSFERS
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2 Transfer Use this form to move assets from a previous custodian account to your Vantage Self-Directed Retirement Account without taking possession of the funds/assets. Do not use this form for direct or indirect rollovers. To avoid the potential delay in your transfer of cash, ensure the liquidation process is completed PRIOR to submitting this form. The terms and conditions of this document are incorporated into the Account Owner s account application (the Account Application ), and the terms and conditions of the Account Application are incorporated herein. Account Owner Information (As it appears on your account application) Legal Name: Vantage Account #: Legal Address: Phone: Date of Birth: Social Security Number: Resigning Custodian Information PLEASE INCLUDE A RECENT STATEMENT FROM THE RESIGNING CUSTODIAN ACCOUNT Name of Custodian/Trustee: Resigning Account #: Office Address: Phone: Contact Name: Type of Account Being Transferred (The transfer must be to the same type of account at Vantage) I am transferring FROM the following type of plan: (Check One) I am transferring TO the following type of plan: (Check One) Type of Asset Being Transferred (The transfer must be to the same type of account at Vantage) Please indicate what you would like to transfer by indicating CASH and/or IN-KIND. If you need to liquidate investments, please contact your resigning Custodian to ensure the liquidation process is completed PRIOR to submitting this form. Option 1: Complete Transfer CASH Send cash to Vantage FBO [your name] IRA # IN-KIND Additional transaction documents are required to facilitate this Transfer. Please reference the Incoming In-Kind Transfer Checklist and complete next section on form. Option 2: Partial Transfer please select one below CASH Send cash to Vantage FBO [your name] IRA # Amount Being Transferred: $ IN-KIND Additional transaction documents are required to facilitate this Transfer. Please reference the Incoming In-Kind Transfer Checklist and complete next section on form. *Please allow five business days for checks and one business day for wires to clear Page 1 of 2
3 Asset Description Delivery Instructions How Would You Like Us To Send This Transfer Request To Your Resigning Custodian? USPS Mail Overnight Express ($30 Fee) - Cannot express to a PO Box - Please select how you would like to pay the fee: Check (Made payable to Vantage) Credit Card On File Credit Card Authorization Form Attached How Would You Like Your Cash Sent From Your Resigning Custodian To Vantage? Check/USPS Mail Wire (Please note fees may apply from your resigning custodian) Please allow five business days for checks to clear Please allow one business day for wires to clear Signature and Acknowledgement 1. I understand the rules and conditions applicable to the Account Transfer set forth herin. 2. I qualify for the account transfer of assets listed in the Asset Description above and authorize such transfer. 3. I understand that no person affiliated with Administrator has any authority to agree to anything different than as set forth herein. 4. I hereby agree to the terms and conditions set forth in this Transfer Form and my Account Application. ORIGINAL DOCUMENTS ARE REQUIRED TO PROCESS ALL TRANSFERS Account Owner s Signature: (Name of Account Holder) Date: PRIOR TO SIGNING, PLEASE CONSULT YOUR RESIGNING CUSTODIAN TO DETERMINE IF A MEDALLION GUARANTEE STAMP IS REQUIRED (Medallion Guarantee Stamp) For Office Use Only - Acceptance of receiving custodian Pursuant to a limited written delegation, First Trust Company of Onaga, as Custodian ( Custodian ), has authorized Vantage Retirement Plans, LLC to sign this form on Custodian s behalf to verify Custodian s acceptance of the transfer described above and in agreement to apply the proceeds upon receipt to the Account established by Vantage Retirement Plans, LLC on the account holders behalf. Custodian ASSUMES NO TRUST OR FIDUCIARY OBLIGATIONS TO ACCOUNT HOLDER AS IT HAS NO INVESTMENT CONTROL OVER ACCOUNT HOLDER S FUNDS AND ACTS ONLY AS A CUSTODIAN OF ACCOUNT HOLDER S FUNDS. Vantage Retirement Plans, LLC on behalf of Custodian, First Trust Company of Onaga. By: Date: Account #: Type Of Account (Check One): Page 2 of 2
4 Rollover Certification Account Owner Information (As it appears on your account application) Legal Name: Vantage Account #: Legal Address: Date of Birth: Social Security Number: Phone: Fax: Mobile: Name of Resigning Custodian / Plan Sponsor Company Name: Account #: Office Address: Contact Name: Phone: Type of Plan You Are Rolling Over From Traditional ROTH SEP SIMPLE HSA 401K Other Rollover Instructions To Rollover CASH: Rollover Amount: $ By CHECK - Make check payable to Vantage FBO [your name] IRA # Please allow five business days for checks clear By WIRE - Please contact our office for wiring instructions Please allow one business day for wires to clear To Rollover In-Kind Assets: Please complete the section below and contact our office regarding the re-registration of your asset. Asset Description: Amount: Asset Description: Amount: Acknowledgment Please print this form first, then sign and mail the document to your Vantage office. Please note: Your resigning Custodian may require additional documentation. Please read the following statement carefully. Vantage Retirement Plans, L.L.C. ( Administrator ) performs recordkeeping and administration duties in connection with Account Owner s self-directed retirement account (the Account ) on behalf of the custodian ( Custodian ) as set forth in Account Owner s account application (the Account Application ). The terms and conditions of this document are incorporated into the Account Application, and the terms and conditions of the Account Application are incorporated herein. I hereby agree to the terms and conditions set forth in this Rollover Certification and acknowledge having established an Account through execution of the Account Application. I understand the rules and conditions applicable to a (check one) Rollover Direct Rollover. I qualify for the Rollover or Direct Rollover of assets listed in the Asset Liquidation above and authorize such transactions. If this is a Rollover or Direct Rollover, I have been advised to see a tax advisor due to the important tax consequences of rolling assets into a self-directed account. If this is a Rollover or Direct Rollover, I assume full responsibility for this Rollover or Direct Rollover transaction and will not hold Administrator or Custodian of either the distributing or receiving plan liable for any adverse consequences that may result. I understand that no one at Admistrator or any of its licensees or franchisees has authority to agree to anything different as set forth herin. If this is a Rollover or Direct Rollover, I irrevocably designate this contribution of assets with a value of $ as a rollover contribution. By signing this form, I certify that I am completing this rollover within 60 calendar days following the day I received the assets. I have not performed a rollover from an IRA within the last 12 months and the rollover DOES NOT contain my Required Minimum Distribution. If I am a non-spouse beneficiary, this is a direct rollover from an employer plan and the rollover contribution DOES NOT contain my Required Minimum Distribution. Account Owner s Signature: Date: Page 1 of 1
5 Deposit Coupon Account Owner Information ( As it appears on your account application) Legal Name: Vantage Account Number: Deposit Amount: $ Deposit Type Please select a deposit type Check (Please allow five business days for checks to clear) Wire ACH (please provide transaction description in the notes section below) Deposit Frequency Please select a deposit frequency One Time Deposit Monthly Quarterly Semi-Annualy Annually Deposit Details Please provide the appropriate deposit details Contribution Current Year: Previous Year: Rental Income Rental Property Address: Incoming Loan Payment Interest Income: Loan Number: Principal Amount: Other Income: Notes: Participant s Signature Vantage Retirement Plans, L.L.C. ( Administrator ) performs recordkeeping and administration duties in connection with Account Owner s self-directed retirement account (the Account ) on behalf of the custodian ( Custodian ) as set forth in Account Owner s account application (the Account Application ). The terms and conditions of this document are incorporated into the Account Application, and the terms and conditions of the Account Application are incorporated herein. I hereby certify and acknowledge that it is my responsibility to correctly characterize the nature and purpose of the deposit being made hereunder. I understand that Administrator does not provide legal, tax, or investment advice and that it is my responsibility to obtain pertinent advice and counsel from qualified third party professionals with respect to the subject matter hereof. I hereby agree to release, indemnify, and hold Administrator and Custodian harmless from any and all liability that may arise as a consequence of Administrator processing this deposit as set forth herein. Account Owner s Signature: Date: Page 1 of 1
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