Fillable T. Rowe Price Simple Ira Transfer-In Form printable pdf download

S I M P L E i r a P L A n

a c c o u n t f o r m s

XXXXXXX 029300

T. Rowe Price SIMPLE IRA Transfer-In Form

Return the completed form in the envelope provided or mail it to: T. Rowe Price Retirement Operations, P.O. Box 17479, Baltimore,

MD 21297-1479.

For overnight/express mail only: T. Rowe Price Retirement Operations, Mail Code 17479, 4515 Painters Mill Road, Owings Mills, MD

21117-4903.

Use this form to transfer SIMPLE IRA assets to your T. Rowe Price SIMPLE IRA. Complete Sections 1–3 as it appears on your account at

the custodian (financial institution) currently holding the assets. A separate form must be completed for each custodian from which you are

transferring SIMPLE IRA assets. Please note that the SIMPLE IRA can only accept assets from other SIMPLE IRA plans.

Do not use this form if you do not have a SIMPLE IRA at T. Rowe Price. To establish a SIMPLE IRA plan or new account, to transfer

inherited assets, to claim inherited SIMPLE IRA assets, or to transfer assets awarded in a divorce settlement, call 1-800-492-7670.

1. Your Information

2. Name and Address of Current Custodian

To transfer your existing SIMPLE IRA to T. Rowe Price, we

Please confirm the address with your current custodian. T. Rowe

need to know how it is registered with your current custodian.

Price needs to forward this form to the appropriate address.

Name: First, Middle Initial, Last (please print)

Name of Current Custodian/Financial Institution

Social Security Number

Date of Birth

Address

Residential Street Address

City

State

ZIP

City

State

ZIP

Account Representative

Phone Number

Daytime Phone

Evening Phone

3. Transfer Instructions

List the assets you are transferring to T. Rowe Price. We will contact your current custodian to arrange the transfer. Any non-T. Rowe

Price investments will be liquidated, transferred to T. Rowe Price, and invested according to your instructions on the next page. Shares of

T. Rowe Price mutual funds held at another custodian will be transferred in kind unless you instruct the custodian to liquidate the shares before

transferring the assets. If you want to transfer individual securities, please call us at 1-800-492-7670 for the appropriate form.

Check only one:

I have called my current custodian and liquidated my account in advance.

I have called my current custodian and verified that preliquidation is NOT required.

Current Custodian: Liquidate any non-T. Rowe Price investments listed below. Transfer in kind any T. Rowe Price investments unless

the customer has instructed otherwise.

Certificate of Deposit (CD)

Mutual Fund

CD Account Number

Maturity Date

Mutual Fund Name

Account Number

Amount

or % of Account

Amount

or % of Account

Liquidate upon maturity*

Liquidate immediately**

Mutual Fund Name

Account Number

CD Account Number

Maturity Date

Amount

or % of Account

Amount

or % of Account

Mutual Fund Name

Account Number

Liquidate upon maturity*

Liquidate immediately**

Amount

or % of Account

Check box if additional transfer instructions are attached.

*We must receive this form at least 15 days (but not more than one month) prior to the maturity date of the CD.

** Some institutions charge a withdrawal penalty for early liquidation of a CD. Check with your current custodian to verify whether this

penalty applies to you.

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T. Rowe Price Simple Ira Transfer-In Form

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