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WellsTrade IRA/ESA Rollover Certification

Customer Information (Indicate plan type)
Traditional IRA Roth IRA Plan Education Savings Account
Name Social Security Number Date of Birth

Address City State ZIP Code

Rollover Qualification (Complete A, B, C, or D)

A. Traditional IRA to a Traditional IRA Rollover
1) Are the funds or property you received being deposited within 60 calendar days? Yes No
2) Is this the first distribution from the same IRA rolled over in the past 12 months? Yes No
3) If you are over age 70½, have you satisfied your minimum distribution requirement? Yes No

B. Roth IRA to a Roth IRA Rollover
1) Are the funds or property you received being deposited within 60 calendar days? Yes No
2) Is this the first distribution from the same IRA rolled over in the past 12 months? Yes No

C. Education Savings Account to an Education Savings Account Rollover
1) Are the funds or property you received being deposited within 60 calendar days? Yes No
2) Is this the first distribution from the same IRA rolled over in the past 12 months? Yes No
3) Are the funds being deposited into an ESA for the same individual in which the
distributing ESA was registered, or that individual's children/stepchildren/siblings
and their descendants, parents/grandparents/step-parents or a spouse of one of the foregoing? Yes No

D. Rollover or Direct Rollover from a Qualified Plan into a Traditional IRA
1) Are you an eligible participant (participant, spouse beneficiary or former spouse due to divorce)? Yes No
2) Did you receive these funds from an eligible qualified retirement plan? Yes No
3) If you are over age 70½, have you satisfied your minimum distribution requirement? Yes No
4) Does the rollover consist only of funds or property distributed from the qualified plan or the proceeds
from the sale of property distributed from the qualified plan? Yes No
5) Are all the funds included eligible to be rolled over (see back of this form for further information)? Yes No

If you have answered "NO" to any applicable questions above, then you should not proceed with this rollover
transaction. There are likely reasons that your contribution is not qualified to be rolled over into an IRA.
Please consult your professional tax advisor prior to completing your rollover.

Agreement
I have read and understand the rollover rules and conditions on both sides of this form and I have met the requirements
for making a rollover contribution. Due to the important tax consequences of rolling over funds or property to an IRA or
ESA, I understand that I should seek guidance from a professional tax advisor. I understand that Wells Fargo Bank cannot
and has not provided tax advice. I release, indemnify and hold Wells Fargo Bank harmless against any liabilities I may
incur as a result of this transaction. By signing this agreement, I understand that I have irrevocably designated this
contribution as a rollover contribution.

Customer's Signature Date

Signature of Custodian or Witness Date

Investment and Insurance Products:
Not Insured by FDIC or any Federal Government Agency May Lose Value Not a Deposit of or Guaranteed by a Bank or Any Bank Affiliate
Wells Fargo Advisors, LLC is a registered broker-dealer and separate non-bank affiliate of Wells Fargo & Company
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Distributions from a certain plan (Traditional. you are certifying to the Custodian/Trustee that you are aware of and have satisfied the rules & conditions applicable to this transaction. Education and Qualified Retirement Plan) may be rolled over to a like plan. Attention: H0004-014. or Fax to 800-433-0738 Should you reqire assistance with this form. father-in-law. a sibling or step-brother or step-sister. Distributions from a qualified plan are eligible for roll over only when the distribution is made from an eligible plan.Submit your completed form to: Wells Fargo Advisors. daughter-in-law. Qualified Retirement Plan) to another eligible retirement plan.certain IRA plans limit rollover transactions to one rollover distribution per year per IRA (Traditional IRAs. please call 1-800-TRADERS (1-800-872-3377) 588193 Page 2 of 2 . In addition. the surviving spouse beneficiary of a deceased participant. If this rollover is made during or after the year in which you turn age 70½. MO 63166-9954. Eligible Deposits Qualified plan distributions . St.an eligible person is defined as the plan participant. or an ancestor of either. or the spouse of any of these family members. Family member is defined as a son or daughter. Eligible plans include defined benefit plans. brother-in-law. Louis. mother-in-law. a son or daughter of a brother or sister. General Information Regarding Rollovers Rules and Conditions A rollover is a way to move money or property from one eligible retirement plan (Traditional IRA. Frequency of Rollovers Twelve month restriction . Roth IRAs and Education Savings Accounts). There are no exceptions to the 60 day rule. An eligible plan is one that is qualified under IRC Section 401 (a). By completing this form. the mother or father. how quickly rollovers must be completed and how the Custodian/Trustee must report the transaction.a distribution from an ESA may be rolled over to another ESA for the benefit of the same child designee or a family member designee. or a descendant of either. a son-in-law. distributions from Traditional IRAs may be rolled over to a Roth IRA or to a Qualified Retirement Plan and distributions from a Qualified Retirement Plan may be rolled over to a Traditional IRA. Required Minimum Distributions Certain retirement plans require that minimum distributions are made from the plan beginning the year in which the participant turns age 70½. Eligible Persons Education Savings Account . The focus is on rollover distributions out of an IRA plan. a step-child. Eligible Plans Rollover contributions may only be made to eligible plans. tax sheltered annuities. a brother or sister of the father or mother.if property other than cash is distributed. 401(k) plans. or sister-in-law. Timeliness The funds/assets you receive from the distributing Retirement Plan must be deposited into an eligible IRA or ESA within 60 calendar days from the day you receive them. profit sharing plans. Twelve (12) months must pass after receipt of one rollover distribution from an IRA plan before any additional distribution from that same plan is eligible for rollover. money purchase plans. Qualified Retirement Plans . The Internal Revenue Code (IRC) limit show many rollovers may be taken. PO Box 66535. YOU SHOULD CONSULT WITH A PROFESSIONAL TAX ADVISOR BEFORE MAKING A ROLLOVER CONTRIBUTION TO ANY IRA OR ESA WellsTrade® . if employee non-deductible contributions are rolled over to your traditional IRA to such amounts may not be rolled. or the alternate payee identified in a Qualified Domestic Relations Order (QDRO). you cannot rollover any distribution to the extent that it is a required minimum distribution from the distributing plan. Education Savings Account. 403 or 457. only the same property or the proceeds from the sale may be rolled over. Also. certain governmental plans and employee stock ownership plans. Roth. a step-father or step-mother. Roth IRA.