Fillable IRA ACCOUNT MAINTENANCE FORM

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IRA ACCOUNT MAINTENANCE FORM

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The IRA ACCOUNT MAINTENANCE FORM form is 3 pages long and contains:

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  • 44 other fields

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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
Page 2 of 3
IRA Account Maintenance - CalSavers (6/2019) ©2019 Ascensus, LLC
3. UPDATE IRA OWNER INFORMATION
If you are changing your name and/or contact information, provide the new information exactly as you would like it to appear on your
CalSavers IRA.
If you are changing your name, you must also provide a Medallion Signature Guarantee below or legal document(s) verifying the name change.
IRA Owner Legal Name (First) (M.I.)
IRA Owner Legal Name (Last)
Email Address
Physical Address (We cannot accept a PO Box)
—
City State Zip Code
Mailing Address if different from above (This address will be used as the address of record and for all mailings)
—
City State Zip Code
—
—
Telephone Number
Medallion Signature Guarantee — REQUIRED FOR NAME CHANGES TO THE ACCOUNT OWNER OF AN EXISTING
ACCOUNT ONLY
• You must provide the following information as underwritten certification that the new signature is genuine.
• You can obtain a Medallion Signature Guarantee from an authorized officer of a bank, broker, or other qualified financial institution. A
notary public cannot provide a Medallion Signature Guarantee, nor can you guarantee your own signature.
• Do not sign below until you are in the presence of the authorized officer providing the signature guarantee.
By signing here I certify that the information provided herein is true and complete in all respects.
Former Signature of Account Owner (For name change only)
Current Signature of Account Owner
Signature of Guarantor
Title
Name of Institution
—
—
Date (mm/dd/yyyy)
Authorized Officer to Place Stamp Here
Page 3 of 3
IRA Account Maintenance - CalSavers (6/2019) ©2019 Ascensus, LLC
4. UPDATE BANK INFORMATION
Important: By signing this form, you agree and confirm that your ACH transaction will not involve the branches or offices of a bank or other
financial services company located outside the territorial jurisdiction of the United States.
Add
Delete Bank Information Indicated Below
Delete All Current Bank Information and Add New Bank Information Below
Financial Organization Name
Financial Organization Routing Number Financial Organization Account Number
ACCOUNT TYPE (Select one)
Checking
Savings
Note: The routing number is usually located on the bottom left corner of your checks. You can also ask your financial organization for the
routing number.
Add
Delete Bank Information Indicated Below
Delete All Current Bank Information and Add New Bank Information Below
Name
Financial Organization Routing Number Financial Organization Account Number
ACCOUNT TYPE (Select one)
Checking
Savings
Note: The routing number is usually located on the bottom left corner of your checks. You can also ask your financial organization for the
routing number.
5. UPDATE CONTRIBUTION RATE
If you wish to change your contribution rate, enter the percentage of your pay check you wish to contribute as a whole number. Note: Your
contributions to all of your Roth IRA are limited to $5,500 ($6,500 if 50 or older) for 2018 depending on your income. See IRS Publication 590A
for more information.
New Contribution Rate
%
6. AUTOMATIC ANNUAL INCREASE
Contributions for accounts open at least 180 days will automatically increase by 1% on January 1 of each year, with the first increase scheduled
for January 1, 2020.
I wish to have my contribution rate automatically increased by 1% each year until it reaches 8%.
I DO NOT wish to have my contribution rate automatically increased each year.
7. SIGNATURE
I certify that I am the account owner and verify the information above is accurate. I assume responsibility for any consequences that may result
from these changes and I agree that CalSavers, the custodian, or the program administrator are not responsible for any consequences that may
arise from executing the changes outlined in this form.
—
—
Signature of IRA Owner Date (mm/dd/yyyy)
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IRA ACCOUNT MAINTENANCE FORM

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Completed 10 November 2021

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