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Other Names: 401k Rollover
401k Rollover Request document preview

What is a 401k Rollover Request?

You've left your job - but your 401k doesn't follow automatically. Take control with a 401k Rollover Request. Maybe you want to roll it into an IRA. Maybe you just want to let a different company manage it. People have a knack for leaving these accounts behind. Bring yours up to speed with a 401k Rollover Request. 
Your 401k probably isn't doing you much good sitting stagnant in an old account. But a 401k Rollover Request can help get your retirement really rolling again. Maybe you're in a new job and are getting matching funds from your employer. Nice work! You'll gather even more interest if you roll over old accounts into this one. Or maybe it's time for retirement. There's more to it than dusting off the golf clubs and volunteering to babysit grandkids. Don't forget about your retirement account from your working days. It can still be going to work for you - even if your work is now relaxing, traveling, and volunteering. A 401k Rollover Request helps make managing your retirement funds easy.

When to use a 401k Rollover Request:

  • You want to provide notice of an election to "roll over" a 401k account balance.

Sample 401k Rollover Request

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401k Rollover Request


To: Plan Administrator of the (the "Plan").




Social Security Number:


After reviewing the notices that you have provided to me regarding distributions and income taxes, I hereby elect a "direct rollover" of my entire vested account balance in the Plan. Further, I hereby request that you transfer my account balance as a direct rollover to the IRA or the Plan designated as follows ( the "Receiving Plan"). I represent that the Receiving Plan is a proper recipient plan for a direct rollover. My account balance should be sent to the address as shown.


Name of IRA:

Name of Trustee or Custodian:




I hereby consent to an immediate distribution of my vested account balance, and I waive any unexpired portion of any minimum notice period that might otherwise apply to this distribution.




Effective Date:   _______________________________________


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