Rollover Contribution Request

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 p.m. Eastern time at 800-523-1188.

Rollover Contribution Request

Columbia University Voluntary Retirement Savings Plan

Plan # 096141

I. Personal Information (Please complete in ink.)

Please be aware that it is your responsibility to ensure that Vanguard has the most current address on your retirement account. Please contact Vanguard to determine how to update your address.

Social Security #: Name:

(Last, First, MI)

Address:

--

--

City:

Date of Birth:

(mm/dd/yyyy)

Date of Hire:

(mm/dd/yyyy)

Contact Phone #: (

/

/

/

/

)

State:

Zip:

--

II. Rollover Amount

I elect to deposit a rollover into the Columbia University Voluntary Retirement Savings Plan. I understand that the rollover may include salary reduction contributions (pre-tax and/or Roth), plan loan offset payments, 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.

Cash:

The amount of my pre-tax rollover is: $

The amount of my Roth rollover is: $

Total amount of my rollover is:

$

The Roth cost basis is:

$

The Roth start date is:

(Required)

*If you are rolling over Roth 401(k) assets, documentation from your prior record keeper is required to confirm the Roth cost basis and Roth start date. Your Roth rollover will not be completed without this documentation.

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.

III. Prior Plan Type (Please select one.)

Qualified Plan

Governmental 457

403(b)

IRA

Note: The plan does not permit rollovers from SEP or SIMPLE IRAs.

Prior Plan Name ________________________________________________________

Please make a copy for your records.

(07/21/2020)

Connect with Vanguard?

800-523-1188

T39896_072020

?2020 The Vanguard Group, Inc. All rights reserved.

*XXXXXXXXXXXXXX096141301*

IV. Investment Election Please invest the enclosed rollover check in the following manner. Allocations must be in increments of 1%. Make one of the two choices below.

Please invest my eligible rollover money using my current fund allocations.

-OR-

Choose new fund allocations for your rollover in the boxes below.

Target Retirement Funds If you choose this investment approach, you may want to consider investing 100% of your

contributions in one Vanguard Target Retirement Fund.

Fund Code Fund Name

Allocation Fund Code Fund Name

Allocation

001673 Vanguard Institutional Target Retirement Income Fund

001668 Vanguard Institutional Target Retirement 2040 Fund

001663 Vanguard Institutional Target Retirement 2015 Fund

001669 Vanguard Institutional Target Retirement 2045 Fund

001664 Vanguard Institutional Target Retirement 2020 Fund

001670 Vanguard Institutional Target Retirement 2050 Fund

001665 Vanguard Institutional Target Retirement 2025 Fund

001671 Vanguard Institutional Target Retirement 2055 Fund

001666 Vanguard Institutional Target Retirement 2030 Fund

001672 Vanguard Institutional Target Retirement 2060 Fund

001667 Vanguard Institutional Target Retirement 2035 Fund

001792 Vanguard Institutional Target Retirement 2065 Fund

Core Funds Or for the following list of funds, specify percentages in 1% increments.

Fund Code Fund Name 0000XZ Vanguard Balanced Index Fund

Allocation Fund Code Fund Name 0000X5 Vanguard Total Stock Market Index Fund

Allocation

00001K Vanguard LifeStrategy Growth Fund

0000X6 Vanguard Extended Market Index Fund

000056 Vanguard STAR Fund

0000X7 Vanguard Small-Cap Index Fund

00007L Vanguard LifeStrategy Income Fund

00001D Vanguard Strategic Equity Fund

00007M Vanguard LifeStrategy Conservative Growth Fund

000057 Vanguard Dividend Growth Fund

00009D Vanguard LifeStrategy Moderate Growth Fund

000301 Vanguard Mid-Cap Growth Fund

000527 Vanguard Wellesley Income Fund

000523 Vanguard U.S. Growth Fund

00002K Vanguard Total Bond Market Index Fund

000559 Vanguard PRIMECAP Fund

000504 Vanguard Intermediate-Term Bond Index Fund

000565 Vanguard Equity Income Fund

000529 Vanguard High-Yield Corporate Fund

000573 Vanguard Windsor II Fund

000532 Vanguard Short-Term Treasury Fund

000593 Vanguard Growth and Income Fund

000535 Vanguard Intermediate-Term Treasury Fund

005022 Vanguard Windsor Fund

000536 Vanguard GNMA Fund

005024 Vanguard Explorer Fund

000545 Vanguard Long-Term Bond Index Fund*

005111 Vanguard Capital Opportunity Fund

000549 Vanguard Short-Term Federal Fund

00001R Vanguard Global Equity Fund

000568 Vanguard Long-Term Investment-Grade Fund

000046 Vanguard International Value Fund

000583 Vanguard Long-Term Treasury Fund

000137 Vanguard Developed Markets Index Fund

000732 Vanguard Short-Term Bond Index Fund

000235 Vanguard European Stock Index Fund

001190 Vanguard Inflation-Protected Securities Fund

000239 Vanguard Emerging Markets Stock Index Fund

0000XE Vanguard Mid-Cap Index Fund

000572 Vanguard Pacific Stock Index Fund

0000XF Vanguard Small-Cap Value Index Fund

000581 Vanguard International Growth Fund

0000XG Vanguard Small-Cap Growth Index Fund

001869 Vanguard Total International Stock Index Fund

0000XH Vanguard Value Index Fund

000033 Vanguard Federal Money Market Fund

0000XI Vanguard Growth Index Fund

000551 Vanguard Energy Fund

000513 Vanguard FTSE Social Index Fund

000552 Vanguard Health Care Fund

0000XV Vanguard U.S. Value Fund

003123 Vanguard Real Estate Index Fund

0000X4 Vanguard Institutional Index Fund

Your allocations must equal 100%

*There is a purchase and/or a redemption fee for this fund. Please review the fund's prospectus for further details.

Note: If you fail to complete the investment elections above, your contribution will automatically be invested in the appropriate Vanguard Target Retirement Fund based on your age.

V. Authorization and Employee Certification

Employee certifications for direct and indirect rollovers

I hereby certify that the prior plan type I selected in section III satisfies the applicable requirements described below. 1. Qualified Plan. I have confirmed that the plan has: (i) received a favorable IRS determination letter; or (ii) the plan is intended to satisfy the requirements of section 401(a) of the Internal Revenue Code and the plan administrator is not aware of any provision or operation of the plan that would result in disqualification. 2. 403(b) Plan. I have confirmed that 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. Governmental 457(b) Plan. I have confirmed that 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. 4. IRA/Conduit IRA. If the IRA includes any money from a previous employer-sponsored retirement plan, the prior plan was a qualified plan, 403(b) plan, or governmental 457(b) plan that meets the requirements to qualify for tax-favored status described above, and I originally rolled over the distribution from the prior plan to the IRA within 60 days of my receipt of the distribution. The rollover from the IRA consists of only pre-tax money and earnings (i.e., amounts that would otherwise be taxable), and does not include any after-tax amounts or Roth IRA amounts.

V. Authorization and Employee Certification

Additional Employee Certifications for Indirect Rollovers

If the rollover is an indirect rollover, in addition to the above certifications, I hereby certify the following: 1. I was entitled to the distribution from the prior plan or IRA as an employee, IRA owner, or spouse beneficiary; 2. The distribution was not one of a series of periodic payments; 3. I received the distribution from the prior plan or IRA not more than 60 days before the intended rollover contribution to the new plan, or if it is beyond the 60-day rollover deadline, I have completed and attached the IRS model Certification for Late Rollover Contribution letter found in the appendix to IRS Revenue Procedure 2016-47 (available at ); and 4. The entire amount of this rollover contribution would be taxable to me if it were not rolled over.

Additional Employee Certifications for Plan Loan Offset Payments

1. I have had a severance from employment or my retirement plan has terminated. 2. As a result of my severance from employment or plan termination, I defaulted on a plan loan. 3. I am making this rollover no later than the tax filing deadline (including extensions) for the year in which the loan offset amount was treated as distributed from my prior plan. 4. The entire amount of this rollover contribution would be taxable to me as a defaulted plan loan if it were not rolled over.

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.

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.

Signature of Participant

Date

Mailing Instructions

U.S. Mail Vanguard ATTN: DC Plan P.O. Box 982902 El Paso, TX 79998-2902

Overnight Vanguard ATTN: DC Plan 5951 Luckett Court Suite A2 El Paso, TX 79932

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