Please review for eligibility requirements.
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Name: First MI Last Sufx
Social Security Number IRA/ESA Account Number Transfer from Account (if applicable)
Navy Federal Representative Signature
(Please write in amount.)
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Navy Federal Credit Union
IRA/ESA Rollover Designation
Fax Number: (703) 206-4250 Toll-Free Number: (888) 842-6328
P.O. Box 3001, Merrield, VA 22119-3001
Rules and Conditions Applicable to Rollovers
General Information: A rollover is a way to move money from one IRA/ESA to another IRA/ESA plan. The Internal Revenue Code (IRC)
limits how many rollovers may be taken, how quickly rollovers must be completed, and how Navy Federal must report the transaction. By
properly completing this form, you are certifying to Navy Federal that you have satised the rules and conditions applicable to your rollover
and that you are making an irrevocable election to treat the transaction as a rollover. Navy Federal only accepts cash IRA assets. Stocks,
bonds, or coins will not be accepted. There are two types of rollovers:
• IRA/ESA Indirect Rollover. The distribution of funds were made payable to you. To qualify as a rollover, your distribution must be
rolled over not later than 60 days after you receive it. This form can be used for all indirect IRA/ESA rollovers.
• IRA/ESA Direct Rollover. A movement of funds from an eligible employer-sponsored retirement plan or Coverdell ESA plan directly to
Navy Federal Credit Union. Do not use this form for a direct rollover. If funds have not yet been distributed from the other retirement plan,
complete the Direct Transfer/Direct Rollover form (NFCU 624) or ESA Transfer form (NFCU 48) to complete the transfer.
Timeliness: The funds you receive from the distributing IRA/ESA must be deposited into another IRA/ESA within 60 days after you receive
them. However, this period is 120 days for certain rollovers relating to rst-home purchases. When counting the 60 (or 120) days, include
weekends and holidays. “Receipt” generally means the day you actually have the funds in hand. For example, the 60 days would begin on
the day following the day you receive the check from the Trustee or Custodian or you receive the check in the mail.
Rollover Limitations: Only one distribution from an IRA (Traditional, Roth, or SIMPLE) may be rolled over in a 12-month period, regardless
of the number of IRAs you own. You are also permitted to roll over only one distribution from a Coverdell ESA in a 12-month period, regardless
of the number of ESAs you own.
Tax Implications: IRS reporting requirements apply for any distribution in which the IRA/ESA holder takes possession of the funds.
Rollover distributions are reported as either a premature or normal distribution depending on age, via IRS Form 1099R or 1099Q (ESA
distributions). The IRS is notied that these funds have been applied to an IRA/ESA account within the 60-day period via IRA Form 5498 or
5498ESA; more specically, these transactions are identied as Rollover Contributions.
Required Minimum Distribution Rollover Restriction: If this rollover is being made during or after the year in which you turn 70½ (date
of birth on or before 6/30/1949) or age 72 (date of birth on or after 7/1/1949), the required minimum distribution must be withdrawn prior to
the rollover (Note: this restriction applies to Traditional and SEP IRAs only).
For more information on rollover limitations, you may wish to obtain IRS Publication 590-A, Contributions to Individual Retirement Arrangements
(IRAs) and IRS Publication 590-B, Distributions from Individual Retirement Arrangements (IRAs), from the IRS or refer to the IRS website
The member must complete and sign.
By signing this section, I certify:
1. I understand the rules and conditions applicable to a “rollover.”
2. I qualify for a rollover of these IRA funds.
3. I have been advised to see a tax advisor due to the important tax consequences of rolling funds between two IRAs or from a qualied
employee benet plan to an IRA.
4. I assume full responsibility for this rollover transaction and will not hold the Plan Administrator, Trustee, Custodian, or Issuer of either
the distributing or receiving plan liable for any adverse consequences that may result.
5. I irrevocably designate this contribution of funds with a value of $ as a Rollover Contribution.
6. This rollover is designated for a Traditional IRA SEP IRA Roth IRA Education Savings Account.
© 2014 Ascensus, Inc.
© 2020 Navy Federal NFCU 876 (2-20)