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HEALTH SAVINGS ACCOUNT
ROLLOVER CERTIFICATION
Account Holder Information (please print)Spending Account ID #
Last NameFirst NameMiddle InitialStateZipASocial Security # (if SA# is not known)Street
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How to fill out rollover certification
How to fill out rollover certification
01
To fill out rollover certification, follow these steps:
02
Obtain the rollover certification form from the relevant financial institution or retirement plan administrator.
03
Fill in your personal information, including your name, address, and social security number.
04
Indicate the type of retirement account you are rolling over from and provide the necessary details, such as the account number and the name of the financial institution or plan administrator.
05
Specify the type of retirement account you are rolling over to and provide the required information, such as the account number and the name of the financial institution or plan administrator.
06
Review the form to ensure all information is accurate and complete.
07
Sign and date the rollover certification form.
08
Submit the completed form to the relevant financial institution or plan administrator.
Who needs rollover certification?
01
Rollover certification is needed by individuals who are transferring funds from one retirement account to another. This may include individuals who are changing jobs and want to roll over their 401(k) or individuals who are consolidating multiple retirement accounts into a single account. It is important to consult with a financial advisor or tax professional to determine if rollover certification is necessary in your specific situation.
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What is rollover certification?
Rollover certification is a form that certifies that an individual has properly rolled over retirement funds to another qualifying account.
Who is required to file rollover certification?
Individuals who have rolled over retirement funds to another qualifying account are required to file rollover certification.
How to fill out rollover certification?
Rollover certification can be filled out by providing information about the original retirement account, the new qualifying account, and certifying that the rollover was done correctly.
What is the purpose of rollover certification?
The purpose of rollover certification is to confirm that retirement funds were rolled over properly to maintain their tax-deferred status.
What information must be reported on rollover certification?
Information such as account numbers, amounts rolled over, dates of rollover, and confirmation of eligibility for tax-deferred rollovers must be reported on rollover certification.
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