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For Individuals
Bank of America Corporation
PLAN PARTICIPANTS: Complete this form and give it to your Employer/Plan Administrator/Plan Trustee
Please retain a second copy of this form for your records.
You have choices for what to do with your employer sponsored retirement plan accounts. Depending on your financial
circumstances, needs and goals, you may choose to rollover to an IRA or convert to a Roth IRA, rollover an employer sponsored
plan from a prior employer to an employer sponsored plan at your new employer, take a distribution, or leave the account
where it is. Each choice may offer different investment options and services, fees and expenses, withdrawal options, required
minimum distributions, tax treatment, and may provide different protection from creditors and legal judgments. Please contact
your Merrill Lynch financial advisor or Merrill Edge Representative and refer to the Merrill Making the most of your retirement
assets brochure for your reference. These are complex choices and should be considered with care, you should consult with
your legal and tax advisor regarding your options.
TO: _____________________________________________________ ______________________________________________________
Employer/Plan Administrator/Plan Trustee Name of Plan
Employer’s Address Name and Telephone Number of Employer/Plan Contact
RE: _____________________________________________________ _____________________________________________________
Name of Participant Social Security Number
Participant Plan Account Number (if applicable)
Dear Employer/Plan Administrator/Trustee:
Please deliver the cash and/or securities eligible for direct rollover that I have requested be distributed from the plan
referenced above as a direct rollover to my account at Merrill as described below. My Merrill Account Number (referenced
below) and my Social Security Number must be indicated on any check or security to be transferred in as a direct rollover
to Merrill, and the check must be made payable to:
Merrill Lynch, Pierce, Fenner & Smith Inc. as Custodian FBO -
Merrill Traditional IRA/IRRA Merrill BASIC Account
Merrill SEP/IRA Merrill Inherited IRA/IRRA
Merrill Roth IRA (Only designated Roth 401(k) contributions can be rolled into a Roth IRA)
FBO - ________________________________________________________________________________
Merrill Account Number: ______________________________________________________________________________
Give the check to me for delivery to Merrill.
Deliver checks and securities to Merrill by following the instructions printed on the back of this form.
Date Participant/Beneficiary Signature
To Employer/Plan Administrator/Trustee
The above mentioned Merrill custodial account is established for receipt of a direct rollover of an eligible rollover distribu-
tion to the participant/spousal beneficiary named above. Merrill’s acceptance of this direct rollover
distribution is contingent upon our review of the assets distributed from the plan and their compatibility with our
operational and procedural guidelines.
Date Merrill Authorized Signature
00-63-0791NSB 05-2016 (Formerly Code 1252i)
For Eligible Rollover Distributions
Participant/Beneficiary Merrill Account Number And Customer Name
And Social Security Number Must Be Affixed to All Checks And Securities
(If any of the following deliveries included securities, please include a Distribution Statement)
Checks: Make checks payable to:
Merrill Lynch, Pierce, Fenner & Smith Incorporated as custodian FAO/FBO
Client Name and 8 digit Merrill account number
Attn: Cash Management Services
Mail Code: FL9-801-01-02
4802 Deer Lake Drive East
Jacksonville, FL 32246-6484
Federal Funds Wire: Bank of America, N.A.
100 West 33rd Street
New York, NY
ABA Routing # 026009593
International Banks can use SWIFT Address: BOFAUS3N
Account #: 6550113516
Name: Merrill Lynch, Pierce, Fenner & Smith, New York, NY
Reference: 8 digit Merrill account number and full name
DTC Eligible Free Delivery to: Merrill Lynch, Pierce, Fenner & Smith Incorporated
DTC Clearing #8862 and 8 digit Merrill Account Number
Physical Security Deliveries:
(A Copy of this form must be attached to the certificates
being delivered.)
570 Washington Boulevard
Jersey City, NJ 07310
Attn: Central Delivery 5th floor
Customer Name/Merrill A/C#
U.S. Treasury Bills, Notes, Bonds & Strips, Cats Zero
CPN & Cubes:
ABA# 021000018
Further credit to client name and 8 digit Merrill account number
All MBS products (FHLMC, FNMA, GNMA, CMO, etc.): BK OF NYC/MLPFS
ABA# 021000018
Further credit to client name and 8 digit Merrill account number
Merrill Lynch, Pierce, Fenner & Smith Incorporated (also referred to as “MLPF&S” or “Merrill”) makes available certain investment
products sponsored, managed, distributed or provided by companies that are affiliates of Bank of America Corporation (“BofA Corp.”).
MLPF&S is a registered broker-dealer, registered investment adviser, Member SIPC and a wholly owned subsidiary of BofA Corp.
Investment products:
Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value
© 2019 Bank of America Corporation. All rights reserved.
00-63-0791NSB 09-2019 (Formerly Code 1252i)