WASTE MANAGEMENT INC. RETIREMENT SAVINGS PLAN
WASTE MANAGEMENT INC. RETIREMENT SAVINGS PLAN
Rollover Contribution Form
Please print or type the following information:
Part 1
Last Name
First
Middle
Social Security Number
Birth Date
Daytime Phone Number
Home Phone Number
Home Address
City
State
Zip Code
( )
( )
Part 2 I hereby elect to make a rollover contribution to the Waste Management Retirement Savings Plan in the amount of:
$______________
As evidenced by the attached documentation, this amount does not exceed the taxable amount which I received within the past 60 days from my former employer's qualified plan or from the conduit IRA to which I rolled over the amount originally received from my former employer's qualified plan.
Part 3 I hereby direct that this rollover contribution be invested in one or more of the following funds:
Investments must be in 1% increments. The total investment must equal 100%.
_____________% SSgA Age-Based Income Fund _____________% SSgA Age-Based 2010 Fund _____________% SSgA Age-Based 2020 Fund _____________% SSgA Age-Based 2030 Fund _____________% SSgA Age-Based 2040 Fund _____________% Stable Value Fund
_____________% Bond Market Fund _____________% S&P 500 Index Fund _____________% Active Large Cap Equity Fund _____________% Small Cap Equity Fund _____________% International Equity Fund _____________% Waste Management Stock Fund
Please Note: If you do not make a fund election, your total rollover contribution deposit will be invested in the Stable Value Fund.
Part 4 Please attach a copy of the distribution statement from your prior plan (and, if applicable, a withdrawal statement from my conduit IRA) and a check made payable to: "State Street Bank and Trust Company, for the benefit of (your full name)" for the full amount of the rollover contribution and mail with this completed form to the following address:
CitiStreet Waste Management Plan Administration
P.O. Box 5166 Boston, MA 02206-5166
Please call the Waste Management Retirement Savings Plan Information Line at 1-877-WMI-401K if you have questions about this form. Customer Service Representatives are available Monday through Friday, 9a.m. to 8p.m. Eastern Time, except on New York Stock Exchange holidays.
Part 5 TO BE COMPLETED BY PRIOR RECORDKEEPER I hereby certify that this distribution from ____________________________________ (name of qualified plan or IRA) qualifies as an eligible rollover distribution under IRC section 402(c).
________________________________________________________________ Authorized Signature and Title
_____________________________________ Date
Rev. 05/16/06 ROLINFRM5-16-06.doc
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