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1 Si tiene alguna pregunta al llenar este formulario, puede comunicarse con un representante de Servicios de Vanguard para el participante de lunes a viernes, entre las 8:30 a.m. y 9:00 p.m. hora del Este, al If you have any questions while completing this form, you may contact a Vanguard Participant Services associate Monday through Friday, between 8:30 a.m. and 9:00 p.m. Eastern time at Solicitud de transferencia de contribuciones Rollover Contribution Request Christian Brothers Retirement Savings Plan I. Información personal (Escribir la información con tinta) Personal Information (Please complete in ink.) Tenga presente que es responsabilidad del participante asegurarse de que Vanguard tenga la dirección más reciente en su cuenta para la jubilación. Comuníquese con Vanguard para determinar cómo actualizar su dirección. Please be aware that it is the participant's responsibility to ensure that Vanguard has the most current address on their retirement account. Please contact Vanguard to determine how to update your address. Número del Seguro Social: Social Security #: Nombre: (Apellidos, primer nombre, inicial de segundo nombre) Name: (Last, First, MI) Dirección: Address: Ciudad: City: de nacimiento: (mm/dd/aaaa) of Birth: (mm/dd/yyyy) de empleo: (mm/dd/aaaa) of Hire: (mm/dd/yyyy) Número de teléfono de contacto: Contact Phone #: ( ) / / / / II. Cantidad de la transferencia Estado: State: de localización: Location Code: postal: Zip: Plan # Rollover Amount Deseo depositar una transferencia en el Christian Brothers Retirement Savings Plan. Entiendo que la transferencia puede incluir contribuciones de reducción de salario (antes de impuestos o Roth), de impuestos y/o contribuciones del empleador, además de las ganancias que generen. Entiendo que si cualquier parte de una distribución Roth no está sujeta a impuestos, esa parte de la distribución solo se puede transferir a través de una transferencia directa. Los activos de una cuenta IRA Roth no se pueden transferir al plan. I elect to deposit a rollover into the Christian Brothers Retirement Savings Plan. I understand that the rollover may include salary reduction contributions (pre-tax and/or Roth), contributions, and/or employer contributions, and the earnings thereon. I understand that if any portion of a Roth distribution is not taxable, that portion of the distribution can only be rolled over through a direct rollover. Assets from a Roth IRA cannot be rolled into the plan. En efectivo: Cash: La cantidad de mi transferencia antes de impuestos es: The amount of my pre-tax rollover is: La cantidad de mi transferencia Roth es: The amount of my Roth rollover is: Cantidad total de mi transferencia es: Total amount of my rollover is: La base del costo Roth es: The Roth cost basis is: La fecha de inicio Roth es: (Obligatorio) The Roth start date is: (Required) *Si usted está transfiriendo activos 401(k) Roth, se necesita los documentos del encargado anterior de mantenimiento de los registros para confirmar la base del costo Roth y la fecha de inicio Roth. No se completará su transferencia Roth sin esta documentación. *If you are rolling over Roth 401(k) assets, documentation from your prior recordkeeper is required to confirm the Roth Cost Basis and Roth Start date. Your Roth Rollover will not be completed without this documentation. Nota: El cheque debe girarse a nombre de Vanguard Fiduciary Trust Company FBO "Su nombre", últimos 4 dígitos del Número de Seguro Social. Envíe el cheque y el formulario lleno siguiendo las instrucciones de envío por correo. El pago se debe realizar con un cheque institucional o patronal, cheque de caja o giro. No se acepta cheques personales. Note: The check should be made payable to: Vanguard Fiduciary Trust Company FBO "Your Name", last 4 digits of Social Security Number. Mail check and completed form using the Mailing Instructions. Payment must be by employer or institutional check, cashier's check, or money order. Personal checks are not accepted. Guarde una copia para su archivo. Please make a copy for your records. (12/16/2015) 2015 The Vanguard Group, Inc. All rights reserved. Conéctese con Vanguard TM > vanguard.com > Connect with Vanguard T25870_ *XXXXXXXXXXXXXX *
2 III. Tipo de plan anterior (Marque uno:) Prior Plan Type (Please select one.) Plan calificado Qualified Plan Plan gubernamental 457 Governmental 457 Plan 403(b) 403(b) IRA de conducto/ transferencia Rollover/Conduit IRA IV. Selección de inversión Investment Election Invertir el dinero de mi transferencia calificada utilizando mi asignación actual de fondos. Please invest my eligible rollover money using my current fund allocations. O Or Elegir nuevas asignaciones de fondos para sus transferencias en las siguientes casillas. Choose new fund allocations for your rollover in the boxes below. Target Retirement Funds Si usted elige este enfoque de inversión, podría ser conveniente que considerara invertir el 100% de Target Retirement Funds sus contribuciones en un Vanguard Target Retirement Fund. If you choose this investment approach, you may want to consider investing 100% of your contributions in one Vanguard Target Retirement Fund. del fondo Nombre del fondo del fondo Nombre del fondo Fund Code Fund Name Fund Code Fund Name Vanguard Target Retirement Income Fund Vanguard Target Retirement 2010 Fund Vanguard Target Retirement 2015 Fund Vanguard Target Retirement 2020 Fund Vanguard Target Retirement 2025 Fund Vanguard Target Retirement 2030 Fund Vanguard Target Retirement 2035 Fund Vanguard Target Retirement 2040 Fund Vanguard Target Retirement 2045 Fund Vanguard Target Retirement 2050 Fund Vanguard Target Retirement 2055 Fund Vanguard Target Retirement 2060 Fund Fondos Medulares O bien, en la siguiente lista de fondos, especifique porcentajes en incrementos de 1%. El total tiene que sumar 100%. Core Funds Or for the following list of funds, specify percentages in 1% increments. The total must equal 100%. del fondo Fund Code XJ Nombre del fondo Fund Name Vanguard Prime Money Market Fund Vanguard International Growth Fund Vanguard Wellington Fund Vanguard U.S. Growth Fund Vanguard 500 Index Fund Vanguard Total International Bond Index Fund Vanguard Total Stock Market Index Fund Vanguard FTSE Social Index Fund Vanguard Short -Term Inflation-Protected Securities Index Fund Les agradeceré inviertan el cheque de transferencia adjunto de la siguiente forma. Las asignaciones tienen que efectuarse en incrementos del 1%. El total tiene que sumar 100%. Seleccione una de las dos opciones a continuación. Please invest the enclosed rollover check in the following manner. s must be in increments of 1%. The total must equal 100%. Make one of the two choices below. del Fondo Fund Code S Nombre del fondo Fund Name Vanguard Total Bond Market Index Fund Sus asignaciones tienen que sumar 100% Your allocations must total 100% *Hay un cargo de compra o por redención para este fondo. Consulte el prospecto del fondo para obtener más detalles. *There is a purchase and/or a redemption fee for this fund. Please review the fund's prospectus for further details. Nota: Si no completa la elección de inversiones anterior, su contribución se invertirá automáticamente en el Vanguard Target Retirement Fund adecuado a su edad. Note: If you fail to complete the investment elections above, your contribution will automatically be invested in the age appropriate Vanguard Target Retirement Fund. V. Autorización y certificación del empleado Authorization and Employee Certification Certificaciones del empleado para transferencias directas e indirectas. Employee certifications for direct and indirect rollovers. Fidelity Blue Chip Growth Fund Vanguard Extended Market Index Fund Vanguard Windsor II Fund Aquinas Value Fund Ave Maria Bond Fund Ave Maria World Equity Fund LKCM Aquinas Small Cap Fund* Por este medio certifico que el plan tipo I anterior seleccionado en la sección III cumple con los requisitos correspondientes descritos arriba. I hereby certify that the prior plan type I selected in section III satisfies the applicable requirements described below. 1. Plan calificado. El plan recibió una carta de determinación del IRS favorable o el plan tiene previsto satisfacer los requisitos de la sección 401(a) del de Rentas Internas. El administrador del plan no sabe de ninguna cláusula u operación del plan que pudiera resultar en la descalificación. 1. Qualified Plan. The plan has received a favorable IRS determination letter or the plan is intended to satisfy the requirements of section 401(a) of the Internal Revenue Code. The plan administrator is not aware of any provision or operation of the plan that would result in disqualification. 2. Plan 403(b). El plan tiene previsto cumplir con los requisitos de la sección 403(b) del de Rentas Internas y el administrador del plan no sabe de ninguna cláusula u operación del plan que pudiera resultar en la pérdida del estado de exención de impuestos (b) Plan. The plan is intended to satisfy the requirements of section 403(b) of the Internal Revenue Code and the plan administrator is not aware of any provision or operation of the plan that would result in loss of tax exempt status. 3. Plan gubernamental 457(b). El plan (i) recibió una resolución del IRS en carta privada confirmando que el plan cumple con los requisitos de la sección 457(b) del de Rentas Internas, o (ii) el plan tiene previsto cumplir con los requisitos de la sección 457(b) del de Rentas Internas y el administrador del plan no sabe de ninguna cláusula que pudiera resultar en la pérdida del estado de exención de impuestos. 3. Governmental 457(b) Plan. The plan has (i) received a private letter ruling from the IRS confirming that the plan meets the requirements of section 457(b) of the Internal Revenue Code; or (ii) the plan is intended to satisfy the requirements of section 457(b) of the Internal Revenue Code and the plan administrator is not aware of any provision or operation of the plan that would result in the loss of tax exempt status.
3 V. Autorización y certificación del empleado (continúa) Authorization and Employee Certification (continued) Certificación adicional del empleado para transferencias de una cuenta IRA de conducto/transferencia Additional Employee Certification for rollovers from a Rollover/Conduit IRA Si la transferencia es de una cuenta IRA de conducto, por este medio además certifico que: If the rollover is from a Conduit IRA, I hereby further certify that: 1. No se contribuyó a la cuenta IRA ningún monto que no fuera una contribución por transferencia de un plan calificado. 1. No amount other than a rollover contribution from a qualified plan was contributed to the IRA. Certificación adicional del empleado para transferencias de una cuenta IRA SIMPLE Additional Employee certification for rollovers from a SIMPLE IRA Si la transferencia es de una cuenta IRA SIMPLE, por este medio certifico que: If the rollover is from a SIMPLE IRA, I hereby certify that: 1. Ha transcurrido por lo menos dos años a partir de la fecha en que se realizó la primera contribución a la cuenta IRA SIMPLE. 1. It has been at least two years from the date the first contribution was made to the SIMPLE IRA. Nota: Es importante que todas las certificaciones correspondientes que usted haya hecho sean verdaderas y exactas. Si alguna de las certificaciones no es exacta, no intente transferir su distribución al Plan. Note: It is important that all of the applicable certifications you have made above are true and accurate. If any of the certifications are not accurate, please do not attempt to roll over your distribution to the Plan. He leído y acepto las certificaciones anteriores. Entiendo que si alguna de las certificaciones indicadas anteriormente es incorrecta, mi distribución no es elegible para la transferencia y puedo estar sujeto a consecuencias fiscales adversas como resultado de una transferencia incorrecta. Acepto notificar rápidamente a mi empleador si después descubro que cualquier certificación es incorrecta. I have read and acknowledge the certifications above. I understand that if any of the certifications made above are incorrect, my distribution is not eligible for rollover and I may be subject to adverse tax consequences as a result of the improper rollover. I agree to promptly notify my employer if I later discover that any certifications are incorrect. Firma del Participante Signature of Participant Instrucciones para envío por correo Mailing Instructions Servicio postal de EE.UU. Entrega inmediata U.S. Mail Overnight Vanguard Vanguard P.O. Box Devon Park Drive Valley Forge, PA Wayne, PA 19087
4 V. Autorización Authorization Nota: su empleador puede necesitar algunos documentos relacionados con la contribución por transferencia antes de autorizarla. Note: Your employer may require certain documentation related to the rollover contribution prior to authorizing it. Firma del Participante Signature of Participant Correro de Estados Unidos U.S. Mail Christian Brothers Services 1205 Windham Pkwy. Romeoville, IL Yo autorizo una contribución por transferencia al plan de acuerdo con las instrucciones anteriores. I authorize a rollover contribution to the plan in accordance with the instructions above. Firma del Administrador del Plan Signature of Plan Administrator. I
5 Fund Code Fund Name Fund Code Fund Name Vanguard Target Retirement Income Fund Vanguard Target Retirement 2010 Fund Vanguard Target Retirement 2015 Fund Vanguard Target Retirement 2020 Fund Vanguard Target Retirement 2025 Fund Vanguard Target Retirement 2030 Fund Vanguard Target Retirement 2035 Fund Vanguard Target Retirement 2040 Fund Vanguard Target Retirement 2045 Fund Vanguard Target Retirement 2050 Fund Vanguard Target Retirement 2055 Fund Vanguard Target Retirement 2060 Fund Core Funds Or for the following list of funds, specify percentages in 1% increments. Fund Code Fund Name Fund Code Fund Name XJ S Vanguard Total Bond Market Index Fund Fidelity Blue Chip Growth Fund Vanguard Extended Market Index Fund Vanguard Windsor II Fund Aquinas Value Fund Ave Maria Bond Fund Ave Maria World Equity Fund LKCM Aquinas Small Cap Fund* Your allocations must total 100%
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