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Retirement services employee rollover form

FOSTER, KENNETH - 9141 Retirement services employee rollover form Page 1 of 2 ACCOUNT OWNER INFO

FOSTER, KENNETH

TOTAL CHECK AMOUNT

$

ROTH BALANCE DETAILS

Establishment date: N/A

Contribution amount: N/A

Earnings amount: N/A

Email address: ****************@*****.***

Company name: MEMPHIS HORIZONS ENTERPRISES

Phone number: 901-***-****

Social Security Number: ** 9141

Address: 3750 HILLBROOK, MEMPHIS, TN 38109

IMPORTANT INFORMATION

Receipt of this form by Paychex does not initiate the rollover of prior plan assets. Contact your prior plan administrator to initiate the transfer of assets to Paychex. Funds rolled into the plan become subject to the terms of the plan sponsored by your employer. Your rollover contribution will be invested according to your investment fund allocations at the time of processing. If you have not made any investment choices prior to processing, your rollover contribution will be invested in the Participant Default Fund as selected by your plan administrator. Authorization

I hereby certify that this rollover represents an eligible rollover distribution from a qualified retirement plan and that I understand the terms of the recipient plan as they apply to my rollover account. The authorizations outlined in this form shall become effective as soon as administratively practicable after the earliest time permitted by the terms of the plan. I acknowledge that I have received, reviewed, and understand the plan's fee disclosure statement for participants.

I certify that any COVID-19 distribution repayment, as described in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, is being recontributed within three years after the date that I received the distribution. I understand that it is solely my responsibility for determining my eligibility for any recontribution under the CARES Act and for all related tax or other consequences. Participant Signature: Date: Retirement services employee rollover form

FOSTER, KENNETH - 9141 Retirement services employee rollover form Page 2 of 2 COMPLETING YOUR ROLLOVER

To complete your rollover transaction, follow the steps listed below. 1. Sign and date your form.

2. Initiate the rollover with your prior plan administrator Ensure the check is made payable to:

Paychex FBO your name/last 4 digits of social security number 3. Once your rollover check arrives, verify the check total matches the amount on the rollover form provided, place in envelope along with this form and depending on your preferred method, send to one of the following addresses: Using Regular Mail (No Tracking or Signature Required): Paychex Retirement Services

PO Box 844815

Boston, MA 02284-4815

Using FedEx, UPS or USPS (Signature or Certified Mail with Tracking): PNC Bank C/O Paychex Retirement Services

Attn: Lockbox 844815

20 Commerce Way, Suite 800

Woburn, MA 01801-1057

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