IRA Direct Rollover - Chase Online | Chase.com
J.P. Morgan Securities LLC Member FINRA and SIPC
Direct Rollover Instruction from an Employer-Sponsored Retirement Plan
JPMS Account Number
If your current employer-sponsored qualified retirement plan Custodian requires IRA Custodian acceptance and such provider's rollover paperwork does not include an IRA Custodian acceptance signature block, please submit a new Secure Message via or contact us at (800) 392-5749 before completing this form.
This form is FOR REFERENCE USE ONLY. The information is intended to assist participants in an employer-sponsored qualified retirement plan when completing the Disbursing Custodian's rollover paperwork.
1. Participant/Beneficiary Information
ACCOUNT HOLDER NAME (PLEASE PRINT IN ALL CAPITAL LETTERS)
I am the (select one):
Participant
Spouse Beneficiary
Non-Spouse Beneficiary
Legal/Residential Address (no P.O. Box or "Care Of" address)
City
State
Zip Code
2. J.P. Morgan Securities LLC -- Receiving Custodian Account Information
JPMS Retirement Account Number
Receiving Retirement Account Type (select one)
Traditional IRA Roth IRA
SEP-IRA
Traditional Beneficiary IRA
Roth Beneficiary IRA
3. J.P. Morgan Securities LLC Direct Rollover Delivery Options
Send by Check:
Check Instructions:
Make check payable to:
J.P. Morgan Securities LLC FBO: (Client's Name) Include Account Number, state "Direct Rollover" on check memo line
Overnight Delivery: JPMorgan Chase - Lockbox Processing Attention: JPMS LOCKBOX 21002 7th Floor East 4 Chase Metrotech Center Brooklyn, NY 11245
Regular Mail: J.P. Morgan Securities LLC P.O. Box 21002 New York, NY 10087-1002
Send by Wire:
Wire Instructions:
J.P. Morgan Securities LLC ABA 021000021 DDA 066001633 For Further Credit to:
(Client's Name) (Acct #) Further Instructions/Reference Details: "Direct Rollover"
33482_C v1.0
INVESTMENT AND INSURANCE PRODUCTS ARE: ? NOT A DEPOSIT ? NOT FDIC INSURED ? NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY
? NO BANK GUARANTEE ? MAY LOSE VALUE
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