Fillable T. Rowe Price Simple Ira Transfer-In Form (Page 2 of 2) in pdf

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

4. Select Your Investments

6. Signature Authorizing Transfer

When you transfer SIMPLE IRA assets to T. Rowe Price, there

I hereby authorize this transfer and certify that I have established

are three ways you can invest for your retirement savings goal.

a T. Rowe Price SIMPLE IRA. Please liquidate the assets and send

Please choose only one investment option.

the proceeds to T. Rowe Price as instructed below.

T. Rowe Price Retirement Funds: I want the convenience

and simplicity of a ready-made portfolio. Invest my transfer

Your Signature

Date

in the T. Rowe Price Retirement Fund with the target date

(If a signature guarantee is needed, wait to sign in front of a

closest to the year I reach age 65.

Signature Guarantor. Sign exactly as your name appears on your

T. Rowe Price SIMPLE IRA account.)

T. Rowe Price Funds: I want to build a diversified retirement

7. Signature Guarantee (if required)

portfolio from a selection of over 70 no-load T. Rowe Price

Ask your current custodian if a signature guarantee is required to

funds appropriate for retirement investing. (Need help? Please

process the transfer. (Transfer-in-kind requests often require a sig-

call a T. Rowe Price investment specialist to discuss the most

nature guarantee.)

appropriate funds for your savings goals.)

To obtain a signature guarantee, sign above while in the presence of

Invest my transfer in the mutual funds I have selected below.

an authorized guarantor, who will affix and sign a signature guar-

New Fund Name

antee stamp. Most custodians accept Medallion guarantees obtained

from banks or brokerage firms that are members of either the

Securities Transfer Agents Medallion Program (STAMP); the New

York Stock Exchange, Inc., Medallion Signature Program (MSP); or

(total must be 100%)

the Stock Exchanges Medallion Program (SEMP). A notary public

I have selected more than two investments and have

is not an acceptable guarantor.

attached additional investment instructions.

If you are transferring assets into an existing T. Rowe Price

Name of Bank or Broker

SIMPLE IRA account, write the fund name. If you are transfer-

ring assets into new funds, check the “new” box and write the

fund name. If you are adding money to a fund you already own,

Authorized Signature (Bank or Broker Representative)

the minimum investment per fund is $50. If you are establishing

a new mutual fund account, the minimum investment per fund is

Signature Guarantee Stamp Here:

$1,000. Summit funds have higher minimum investments: $25,000

initial investment and $1,000 for subsequent investments.

T. Rowe Price Prime Reserve Fund: I would like to invest

in a money market* fund now and reallocate my assets by

contacting T. Rowe Price at a later time.

* Note that an investment in a money market fund is not insured

or guaranteed by the FDIC or any other government agency.

Although a money market fund seeks to preserve the value of

your investment at $1.00 per share, it is possible to lose money by

investing in a money market fund.

5. Initial SIMPLE IRA Plan Participation

Your initial SIMPLE IRA plan participation date is used to

determine the tax consequences of certain transactions during

the first two years of your SIMPLE IRA. T. Rowe Price will use

the date your SIMPLE IRA account was established at T. Rowe

Price as your initial participation date unless the resigning custo-

dian provides a different date as requested by T. Rowe Price in

the payment instructions at the end of this form.

Payment Instructions to Resigning Custodian

(T. Rowe Price will complete this section)

Liquidate any non-T. Rowe Price investments. Transfer in kind any T. Rowe Price fund investments unless the customer has

instructed you otherwise. T. Rowe Price maintains a SIMPLE IRA for this individual created pursuant to a SIMPLE IRA plan and

will accept this transfer. For wiring instructions call 1-800-492-7670.

Remember to:

1. Make check payable to: T. Rowe Price Trust Co. TOA for:

Authorized Signature

Date

Send redemption proceeds by check to:

Account Owner’s Name

T. Rowe Price

2. Indicate the following on the check:

P.O. Box 17150

Baltimore, MD 21297-1150

Account Owner’s Tax ID Number

Please note: T. Rowe Price cannot serve as custodian for

SIMPLE IRA assets held at other institutions.

Plan ID Number

Tracking Number

t . r o w e P r i c e

1 - 8 0 0 - 4 9 2 - 7 6 7 0

K56-082

04934-64.wbi

5/09

84762

Page 2 of 2

T. Rowe Price Simple Ira Transfer-In Form Page 2

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