Page 1 of 3
IRA Account Maintenance - CalSavers (6/2019) ©2019 Ascensus, LLC
1. IRA OWNER INFORMATION (All fields required)
If you are updating your information, enter the information that is currently on file in this section and the new information in Section 3.
Account Number
IRA Owner Legal Name (First) (If you are changing your name, enter the name you have on file in this section.) (M.I.)
IRA Owner Legal Name (Last)
—
—
Telephone Number (In case we have a question about your Account. If you are updating your phone number, enter the number you have on
file in this section and the new number in Section 3.)
Employer Name (If you contribute through more than one employer and want to change your contribution rate or automatic annual increase
election, you must submit a separate form for each employer.)
2. ACCOUNT UPDATES OR CHANGES
Check the box(es) to indicate which section(s) you plan to update or change.
IRA Owner Information – Section 3
Bank Information – Section 4
Contribution Rate – Section 5
Automatic Annual Increase – Section 6
IRA ACCOUNT MAINTENANCE FORM
Complete this form to change your name, permanent and/or mailing address, phone number, email address, contribution rate, annual increase,
or bank information. You may also update this information online by logging into your account at saver.calsavers.com.
If you are changing your legal name, your signature with your old name and your signature with your new name are required to be Medallion
Signature Guaranteed in Section 3 by an authorized officer of a bank, broker, or other qualified financial institution. In place of a Medallion
Signature Guarantee, you have the option to submit a signed letter of instruction with supporting legal documentation (i.e. marriage certificate,
court order, divorce documentation) for this change.
The updates /changes on this form override all previous elections for this IRA.
Completed forms should be mailed to: CalSavers Overnight Address: CalSavers
PO Box 55759 95 Wells Avenue, Suite 155
Boston, MA 02205-5759 Newton, MA 02459
855-650-6918
saver.calsavers.com
8:00 am to 8:00 pm Pacific Standard Time M-F