Asset Transfer Request Form
Download a blank fillable Asset Transfer Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.
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Complete Asset Transfer Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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3For use with:
Multi-Fund
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Multi-Fund
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Lincoln Life Group Fixed Annuity
Asset transfer request form
You may use this form to request (1) a contract exchange within a 403(b) plan, (2) a plan to plan transfer between 403(b) plans, (3) a transfer
between 401(a), 401(k), 457(b) governmental plans or between 457(b) non-profit plans, or (4) a direct rollover to a 401(a), 401(k), 403(b) or
457(b) governmental plan.
1. Participant information
Name (first, MI, last, suffix)___________________________________________________________________________________
Address _______________________________________________________________________________________________
City___________________________________________________ State______________________ Zip__________________
Email address __________________________________________________________________________________________
Social security number _________-_________-____________
Daytime phone number _________-_________-____________
Date of birth _________ /________ /______________(mm, dd, year)
Evening phone number _________-_________-____________
Recipient employer/plan sponsor ___________________________________________________________________________
Actively employed with recipient employer/plan sponsor named above:
Yes
No
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Is The Lincoln National Life Insurance Company (Lincoln) contract:
New
Existing Contract #______________________
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2. Releasing vendor* information
Previous employer/plan sponsor name______________________________________________________________________
If same as Section 1, check here
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*Vendor refers to the investment provider.
Releasing vendor’s name _________________________________________________________________________________
Address _______________________________________________________________________________________________
City___________________________________________________ State______________________ Zip__________________
Contract #____________________________
Phone number _________-_________-____________
Is the employee fully vested?
Yes
No
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3. Request instructions
You want to:
Request an asset transfer of the full value of this contract. Approximate value of account $ ________________
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(Transfers in-kind are not acceptable. Securities should be liquidated, redeemed or sold.)
Request a partial asset transfer of this contract. Asset transfer value is $ _________________
h
Request an asset transfer via an annuity option. Choose frequency of payments:
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Monthly
Quarterly
Semi-annually
Annually
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Indicate duration: ______ years ______ months
4. Plan information
FROM type of plan:
401(k)
401(a)
IRA
457(b) Governmental
Pension
457(b) Non-profit (Transfer only)
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h
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403(b)(1) annuity contract
403(b)(7) custodial account (Mutual fund)
h
h
TO type of plan:
403(b)(1) Annuity Contract
457(b) Governmental
401(k)
401(a)
h
h
h
h
457(b) Non-Profit (Transfer only)
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Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.
PAD-1174423-041515
Page 1 of 3
RPS22135-MF9
05/15
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Parent category: Business