Rollover Form

IRA Rollover Recommendation Form

Document #369

"*" indicates required fields

Advisor Name*
Client Name*
Describe briefly
Rollover or Transfer?*

Reason the rollover or transfer is being considered:*
Does the Client have an established relationship with A & I?*
For example, leaving the account assets in the employer’s plan.
Is the source account a 401k/403b/401a?*
This question refers to the account where it is coming from.
What benefits or services would be gained by having the assets managed in a rollover IRA?*
Check all that apply.
List the fees and costs paid in the account where it is coming from.
List fees associated with the destination account (R/O IRA or Roth IRA account). AUM fee, other fees and expenses.
Received from client*
Any other compensation?*
Is our company, any individual advisor including yourself, or any affiliate of our company receiving any direct or indirect compensation in addition to the advisory fee charged by the company for the rollover?
Client needs and considerations:*
Check all that apply.
Recommendations: Investment Options*
Investment reasons why an IRA would be beneficial to the client.
Recommendations: Service*
Service reasons that an IRA would be beneficial to the client.
Client will be able to make penalty-free withdrawals from the new account?*
Client has confirmed that he or she has already attained age 59-½ and, therefore, may be immediately eligible to take penalty-free withdrawals from an IRA.
Client has confirmed that there is no reasonably foreseeable need for him or her to seek protection from creditors and lawsuit judgments?*
Client has confirmed that he or she does not beneficially own any employer stock through his or her existing account?*
Reasonable compensation?*
The advisory fee being charged in connection with the rollover or transfer is consistent with industry norms and is reasonable for the services proposed.
To the best of my knowledge, the client will benefit from rolling over their plan assets or IRA into the proposed IRA.*