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Nationwide 457 Rollover Form. Save time and file a claim online. Rollover contributions are subject to the
Web action needed for rollover accounts. C phone c email rollover funds from plan type (select one): 457(b) to 457(b) under the same employer C all c 457(b) c 401(a) c 403(b) c 401(k) 403(b) to 403(b) under the same employer c roth 403(b) exchange: C partial dollar amount $ c total balance Please complete a separate form for each plan you are exchanging, transferring, or rolling from. Box 183150 columbus, oh 43218 amount to rollover/transfer: Nationwide retirement solutions fbo (participant name, ssn) p.o. Nationwide retirement solutions mail check to:
Web distribution request for 457(b) governmental plans page 1 of 4 you may be able to submit and track the status of your distribution request online! Web rollover contributions to governmental 457(b) plans that originated from qualified plans, iras and 403(b) plans are subject to the early distribution tax that applies to 401(a) / 401(k) plans unless an exception applicable to 401(a) / 401(k) plans applies. Web download and print the nationwide form you need. Web rollover funds from (select plan type): Confirm the information required under the provisions of the patriot act of 2001. How would you like to be contacted if additional information is required? Box 183150 columbus, oh 43218 amount to rollover/transfer: Web rollover and transfer funds 402 (f) special tax notice (pdf) review this form for information regarding special tax information for plan payments. We need a completed application on file so we can: Nationwide neither endorses nor recommends the rollover of your existing account. If you haven’t already done so, please complete our automatic rollover application.
