Fillable A-17 REQUEST FOR PLAN TO PLAN TRANSFER PLEASE (Ministers and Missionaries Benefit Board — MMBB)

Fill Online, Printable, Fillable, Blank A-17 REQUEST FOR PLAN TO PLAN TRANSFER PLEASE (Ministers and Missionaries Benefit Board — MMBB) Form

Use Fill to complete blank online MINISTERS AND MISSIONARIES BENEFIT BOARD — MMBB pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

A-17 REQUEST FOR PLAN TO PLAN TRANSFER PLEASE (Ministers and Missionaries Benefit Board — MMBB)

On average this form takes 20 minutes to complete

The A-17 REQUEST FOR PLAN TO PLAN TRANSFER PLEASE (Ministers and Missionaries Benefit Board — MMBB) form is 3 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 78 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Ministers and Missionaries Benefit Board — MMBB forms online.

BROWSE MINISTERS AND MISSIONARIES BENEFIT BOARD — MMBB FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
REQUEST FOR
PLAN TO PLAN TRANSFER
PLEASE PRINT OR TYPE
Member: Please complete Sections A,B & C and return this form to MMBB at 475 Riverside Drive, Suite
1700, New York, NY 10115-0049 or fax at 800.986.6782.
Financial Institution:
Please complete Section D and E and return this form with a check for the
proceeds to The Ministers and Missionaries Benefit Board (MMBB) at the address on the reverse side.
Section A: Personal Information
1. Was the total amount of your 403(b) account you are transfering over to MMBB the result of contributions made
on your behalf by employers eligible to designate a portion of your compensation as housing allowance or rental
value of parsonage, plus utilities?
Yes No
2. If you are a participant applying to transfer your 403(b) account in a plan to plan transfer, are you an employee or
former employee of an employer participating in the MMBB Retirement Plan?
Yes No
3. If you are a beneficiary applying to transfer the 403(b) account of a decedent, in a plan to plan transfer, was the
decedent an employee or former employee of an employer participating in the MMBB Retirement Plan?
Yes No
Section B: Information Regarding the Funds to be Transferred
Name
Street or Box Number City State Zip
Name of Transferor Plan contact person (if known)
Phone number of contact person (if known)
A-17
1. Name of plan from which funds will be transferred:
2. Annuity contract or plan account number from which funds will be transferred, or other identifying information:
OVER
A17M0618
First Name
M.I.
Last Name
Social Security Number
MMBB Affiliated Organization (e.g. ABC, NBCUSA, etc.)
Home Address
Town/City State Zip Code
Date of Birth
Home Phone Work Phone
FOR OFFICE USE
Section C: Member Authorization
I hereby direct the Plan (or the Financial Institution agent of the plan) identified in Section B to transfer funds from my current annuity contract/account number (referenced in Section B above) to my retirement account
administered by MMBB and I understand that the funds will be placed in MMBB’s Retirement Plan Balanced Fund. To allocate these funds to one or more of MMBB’s other investment funds, I must contact ACS.
Signature of Member Date
Section D: Certification of Transferor Plan From Which Rollover is to be Made (“Transferor Plan”)
The Transferor Plan (or its Financial Institution agent) agrees and represents to MMBB and the Member that:
1. The existing 403(b) retirement account from which the transfer is to be made meets the requirements of
Code Section 403(b)(1), Code Section 403(b)(7), or Code Section 403(b)(9), and is from an employer-spon-
sored 403(b) retirement account.
2. The member is one hundred percent (100%) vested in all amounts to be transferred to MMBB.
3. The Transferor Plan certifies that the existing plan from which the transfer is to be made is subject to the
Required Minimum Distribution Rules, as set forth by the Internal Revenue Code, and the Transferor Plan
(or its Financial Institution agent) agrees to process any Required Minimum Distributions as set forth by
the Internal Revenue Code
prior to processing a Plan to Plan transfer to MMBB.
4. The Transferor Plan certifies that the existing plan from which the transfer is to be made has been, or will
be amended by January 1, 2009, to provide for this transfer to occur in compliance with Code Section
403(b) as amended.
5. The Transferor Plan (or its Financial Institution agent) agrees to transmit a check in the amount of the
transferred funds to MMBB, 475 Riverside Drive, Suite 1700, New York, NY 10115-0049. The check shall be
payable to MMBB, F.B.O., the member. Please indicate “Plan Transfer” on the check.
Transferor Plan
Transferor Financial Institution (Agent of Plan)
Authorized Signature
Date
Please Print Name
** Please complete Section E on the following page **
Approved by:
Date
A17M0618
Please return this completed form to:
The Ministers and Missionaries Benefit Board
475 Riverside Drive, Suite 1700 New York, NY 10115-0049
Phone: 800.986.6222 Fax: 800.986.6782 Web: www.mmbb.org
Member Name (please print)
The portion of the transfer that applies to each of the following types of contributions is indicated
below to the extent the information is available.
Section E:
A17M0618
CURRENT EMPLOYER PRIOR EMPLOYER
1. Total Amount of Plan to Plan Transfer
$ $
2. Total Employer (Nonelective) Contributions & Earnings
(Code section 403(b)(1) annuity/403(b)(9) retirement income account)
$ $
• Employer Contributions
$ $
• Earnings on Employer Contributions
$ $
3. Total Employer (Nonelective) Contributions & Earning
(Code section 403(b)(7) custodial account)
$ $
• Employer Contributions
$ $
• Pre-89 Employer Contributions & Earnings
$ $
• Post-88 Employer Contributions & Earnings
$ $
4. Total Salary Reduction (Elective) Contributions & Earnings
(Code section 403(b)(1) annuity/403(b)(9) retirement income account)
$ $
• Pre-89 Salary Reduction Contributions & Earnings
$ $
• Post-88 Salary Reduction Contributions
$ $
• Post-88 Salary Reduction Earnings
$ $
5. Total Salary Reduction (Elective) Contributions & Earnings
(Code section 403(b)(7) custodial account)
$ $
• Pre-89 Salary Reduction Contributions & Earnings
$ $
• Post-88 Salary Reduction Contributions
$ $
• Post-88 Salary Reduction Earnings
$ $
6. Total After-Tax (Tax Paid) Contributions & Earnings
$ $
• All Earnings on After-Tax Contributions
$ $
• Pre-87 After-Tax Contributions
$ $
• Post-88 After-Tax Contributions
$ $
7. Total Tax Deductible Contributions & Earnings
$ $
8. Total Amount of 12/31/86 Account Balance
$
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

A-17 REQUEST FOR PLAN TO PLAN TRANSFER PLEASE (Ministers and Missionaries Benefit Board MMBB)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document