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FBC - Outgoing Exchange Form

This form allows FBC/Nationwide participants to move money OUT of the Nationwide plan (403(b)). The FBC as of 7/23/2009 refuses to post this form and requires you to talk with one of their "reps" before moving the money.

Uploaded by

Scott Dauenhauer, CFP, MSFP, AIF
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
678 views1 page

FBC - Outgoing Exchange Form

This form allows FBC/Nationwide participants to move money OUT of the Nationwide plan (403(b)). The FBC as of 7/23/2009 refuses to post this form and requires you to talk with one of their "reps" before moving the money.

Uploaded by

Scott Dauenhauer, CFP, MSFP, AIF
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Outgoing Exchange Form

SDCOE / Fringe Benefits Consortium (FBC)


Instructions • Submission of this form initiates a Exchange from your FBC Nationwide account, an approved vendor, to another
approved vendor within the Fringe Benefits Consortium 403(b) Program.
• The receiving vendor must be listed as a current approved vendor (authorized investment company) on fbcretire.com.
• Please allow 14-21 days for delivery assets after form has been received and determined to be in good order.
• Upon completion of this form please fax a copy to 1-800-597-8206
Employee Employee Name Social Security Number Current Date
Information
Mailing Address School District Home Phone Number
(Street)

Date of Birth Marital Status


(City,State,Zip) Married Single

Total withdrawal (all funds and all sources)


Amount of Partial withdrawal:
Withdrawal Plan: 457(b) 403(b) 401(a) Roth 403(b) Fund / ID $
Plan: 457(b) 403(b) 401(a) Roth 403(b) Fund / ID $
Plan: 457(b) 403(b) 401(a) Roth 403(b) Fund / ID $

Receiving Name of Financial Institution:


Vendor
Attention of: Please contact the
Information
Plan / IRA Account Number: receiving financial
i tit ti to
institution t ensure
Address: correct address and
City/State/Zip Code: acceptance.
Phone:
Delivery If no delivery method is indicated, funds will be sent via regular US Mail. Please note that P.O. Boxes cannot receive
Method overnight deliveries.

US Mail
Overnight delivery - An additional $20.00 fee will be deducted from my Nationwide account per occurrence.
Wire* - An additional $20.00 fee will be deducted from my Nationwide account per occurrence.

Bank Name: *Bank account


Bank City and State: information must be
completed for wire
Name on account:
deposit. Please
Routing Number: attach a voided check
Account Number: or deposit slip.

Employee By executing this form I hereby request and consent to the above withdrawal.
Signature

Employee Signature (required) Date

Signature Guarantee (required) Date


For FBC Use
Only

FBC Authorized Signature (required) Date


County Schools Fringe Benefits Consortium - 6401 Linda Vista Road, Room 506, San Diego, CA. 92111

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