Trustee Transfer/Direct Rollover Request at a glance
What it is: Trustee Transfer/Direct Rollover Request, with Transfer Instructions to Bank of America, as Successor Custodian.
Who signs: Depositor's Signature (Required) Date. BROKERAGE: In the case of a transfer from a brokerage account, the transferring firm may require signature authorization including but not limited to, signature guarantee, medallion guarantee or some other form of necessary stamp. Please contact the transferring firm for clarification.
A filled-in Trustee Transfer/Direct Rollover Request example: a Traditional IRA moved from a bank

How to fill out Trustee Transfer/Direct Rollover Request, box by box
Customer Information

Complete all sections in blue or black ink. For a Coverdell Education Savings Account (CESA) use the Contributor's information.
Enter Name, Social Security Number, Mailing Address, Country, City, State and Zip Code.
Enter Physical Address, Country, City, State and Zip Code.
Enter Country of Residency, Country of Citizenship and Date of Birth. Check Citizenship Status: U.S. Resident Alien, Non-Resident Alien or Dual Citizenship.
Enter Employer and Occupation. Check the Source of Income: Employment, Unemployment, Investment, Inheritance, Household/Family, Retirement or Social Security. Enter Daytime Telephone Number and Evening Telephone Number.
Enter (Y/N): Have you or any of your immediate family ever been elected, appointed or assumed any political position in a National, State or Provincial government? If yes, describe the position.
Existing Institution Information

Use a separate Form for each request.
Enter the Name of Institution/Employer, Mailing Address, City, State and Zip Code.
IRA Plan (check one) - Complete sections 3, 5 and 6: Traditional, Rollover, Roth or SEP. For Beneficiary IRAs, complete the following required information.
Enter Account Number for the IRA you check. For Beneficiary IRAs, check Traditional Beneficiary or Roth Beneficiary, and enter Decedent Name, Decedent Date of Birth, Year of Death and Beneficiary Relationship.
Coverdell Education Savings Account - Complete sections 3, 5 and 6: enter Account Number, Student's Name, Student's SSN and Student's Date of Birth. Qualified Retirement Plan - Complete sections 4, 5 and 6: enter Account Number and Indicate Plan Type (e.g. pension, profit sharing, 401k, Roth 401k).
Transfer Instructions to Bank of America, as Successor Custodian

For a transfer from a Bank IRA or CESA, I request you to liquidate the referenced IRA or CESA and transfer the cash as follows. Check one: immediately or upon maturity. Check one: all assets or partial assets in the amount.
Brokerage IRA: Brokerage account assets cannot be transferred in kind. Assets must be liquidated at current firm prior to submitting this form. Medallion Signature Guarantee stamp is also required for transfer under section 6.
For a transfer from a Brokerage IRA, check one: all available cash or partial cash amount.
Direct Rollover Instructions to Bank of America, as Successor Custodian

Ask your current Plan Administrator whether any additional documentation will be required to complete the transfer. You will be responsible for any early withdrawal fees or transfer fees charged by your current Plan.
Direct Rollover from a Qualified Plan: I request you to liquidate all assets in my referenced Qualified Retirement Plan, and process a direct rollover. Please follow these special instructions, if any.
For questions on processing direct rollovers contact the Retirement Help Desk at 1.888.827.1812.
Bank of America Plan/Account

If you do not make a selection, funds received will be credited to the Money Market IRA/CESA. Check the Type of Plan: Traditional, Roth, Rollover, SEP, CESA, Traditional Beneficiary or Roth Beneficiary.
Enter the IRA/CESA Plan Number. Enter Deposit in Existing Account Number, or check Deposit in a New Account.
Deposit in a New Account under the following product type: Money Market IRA/CESA (no term); Month-Variable Rate Account (18-23 months); Month-Fixed Term Account (6-120 months), each with Term, Interest Rate and Annual Percentage Yield; Risk Free Featured/Promotional.
The interest rate and annual percentage yield quoted are valid for 30 days from the date signed. If the funds are received after 30 days, the rate assigned will be the current rate at that time for the product.
Customer's Acceptance

Customer's Acceptance (read and complete): I have received, read and agree to the terms and conditions of the disclosure contained in the deposit agreement, fee schedule and plan document. I have read the instructions on this form and authorize the transaction described.
I understand if I transfer / rollover funds from a Qualified Plan and commingle them with other IRA funds, I might not be able to roll the funds over to another Qualified Plan later.
Bank of America may cancel my IRA if the direct rollover isn't received within 90 days and there are no funds in the account.
By signing you authorize the existing custodian/trustee to handle it according to the instructions on this form, if this is a custodian/trustee transfer. You also understand that this transaction is a transfer to a new custodian and not a taxable distribution to you. If you are 70½ or older, you are required to take your required minimum distribution, however, you do not have to take this year's required minimum distribution before the existing custodian/trustee can transfer the remaining funds to Bank of America.
Delivery Instructions to Bank of America
More rules for Trustee Transfer/Direct Rollover Request
Bank Information - For Internal Use Only (must be completed - required information). Bank of America will accept the transfer authorized on this form.
Sources
[1] Trustee Transfer/Direct Rollover Request (00-14-9031M 07-2015), Bank of America (the Official source link on this page).

