Retirement Plan Action Form

When we provide investment advice to you regarding your retirement plan account (eg. 401k, 403b, etc.) or individual retirement account (“IRA”), we are fiduciaries under the laws that govern retirement accounts. The way we make money creates some conflicts with your interests, so we operate under a rule that requires us to act in your best interest and not put our interest ahead of yours. This Rollover Analysis Form is being presented to you for review and signature as result of such laws and rules.

Name

First

Last

Email

What best represents your family status?

Single
Married / Long term partnership

What's your spouse / partner's name?

First

Last

What's your spouse / partner's email?

What kind of retirement account action are we taking?

Rollover from IRA to Employer Plan
Rollover from Employer Plan to IRA
Employer Plan Investment Change

How did we work together on this action?

Client-Directed Action: you acknowledge and agree that: You have unilaterally instructed us to take certain action(s) with respect to your retirement plan and/or IRA assets; You have not sought, and have not received, any advice or recommendations from us regarding your predetermined decision to take the action you have directed us to take; You have undertaken your own independent analysis of the factors applicable to the action(s) you have directed us to take, and have had the opportunity to consult with any other professional advisors as you see fit; and Our role shall be solely limited to that of an order-taker to facilitate or process the action you have directed us to take.

Advisor provided solely educational info: you acknowledge and agree that: We have limited our communications and consultations with you regarding your retirement plan and/or IRA assets to provide solely educational information designed to inform your independent decision-making; We have not rendered any investment advice or recommendations with respect to your retirement plan and/or IRA assets; and We have only provided educational information to you

Advisor Recommended course of action: we are rendering advice or otherwise making a recommendation regarding your retirement plan or IRA assets. Based on a variety of factors, our recommendation with respect to your retirement plan account and/or IRA is below.

Reasoning FOR rollover or retirement account action

To gain lower-cost investment options
To gain professional management/higher level of service
To avoid record-keeping fees
To unlock the ability for penalty-free early withdrawals
To have preferable application of required minimum distributions (RMDs)
To have additional protection from creditors

Description of reasoning FOR rollover or retirement account action

Reasoning AGAINST rollover or retirement account action

Already have similar low-cost investment options
Higher level of service comes with additional fees/costs
Foregoing the ability for certain penalty-free early withdrawals
Less-preferable application of required minimum distributions (RMDs)
Less protection from creditors

Description of reasoning AGAINST rollover or retirement account action

Reasoning for employer plan investment change

Signature