Life and Death Planning for Retirement Benefits

Appendix B: Forms

517

I am the [ TITLE, SUCH AS EXECUTOR, ADMINISTRATOR, OR PERSONAL REPRESENTATIVE] of the estate of the Participant, who was a participant in the Plan. I enclose a certificate evidencing my appointment. In that capacity, I am transferring the Participant’s interest in the Plan to the beneficiary/ies of Participant’s estate who is/are entitled to receive it under [THE TERMS OF PARTICIPANT’S WILL/APPLICABLE INTESTACY LAW]. [Alt. 2: From trustee of trust named as beneficiary]: I am the Trustee of the [NAME OF TRUST] (the “Trust”) which was the named beneficiary of the Participant under the Plan. In my capacity as such Trustee, I am transferring the Participant’s interest in the Plan to the beneficiary/ies who is/are entitled to receive it under the terms of the Trust. [Alt. 1: transfer to one beneficiary] Accordingly, I hereby instruct and direct you to change the titling of this plan benefit to “[NAME OF BENEFICIARY TO WHOM THE BENEFIT IS BEING TRANSFERRED] as successor beneficiary of [NAME OF DECEASED PARTICIPANT].” [Alt. 2: transfer to several beneficiaries, in separate accounts] Accordingly, I hereby instruct and direct you to divide the benefit into [NUMBER OF SEPARATE ACCOUNTS TO BE ESTABLISHED] separate accounts, and to change the titling of each such account to the name of one of the beneficiaries to whom the benefit is being transferred “as successor beneficiary of [NAME OF DECEASED PARTICIPANT].” The names, addresses, and Social Security numbers of the individual beneficiaries of the separated accounts are: [INSERT]. In accordance with the instructions for IRS Form 1099-R, this transfer is a plan-to-plan transfer and is not to be treated or reported as a distribution from the Plan. Please advise what if any further information or documentation you require to complete this transfer. Yours truly, [SIGNATURE OF EXECUTOR OR TRUSTEE] To the Plan Administrator of the [NAME OF RETIREMENT PLAN] (hereinafter “the Plan”): Re: Benefits of [NAME OF DECEASED PARTICIPANT], deceased (hereinafter “the Participant”) I am the executor of the estate of the Participant, who was a participant in the Plan. I enclose a certificate evidencing my appointment. I have requested from you certain information in order that I may fulfill my responsibility to prepare and file a federal estate tax return for the Participant’s estate. You have informed me that you will provide no information regarding the Participant’s benefits under the Plan to anyone other than the Participant’s designated beneficiary. You will not tell me the name of the Participant’s designated beneficiary. As required by § 6018(b) of the Internal Revenue Code, I will include with the estate tax return I will file for the Participant’s estate a statement that I am unable to make a complete return regarding the Participant’s interest in the Plan, and I will submit your name and address as the person holding legal title to this property. The Internal Revenue Service will then require you to prepare and file an estate tax return regarding this asset on behalf of the Participant’s estate. Very truly yours, 5.5 Letter to Administrator Who Won’t Provide Information See ¶ 4.3.01 .

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