Tiaa Cref Financial Statement – Fill Out and Use This PDF

NEED HELP? 800-842-2252

Weekdays

8 a.m. – 10 p.m. (ET)

Saturday

9 a.m. – 6 p.m. (ET)

We will notify you of the rollover amount after we receive your completed forms. To avoid delays, be sure to complete all sections.

PLEASE NOTE: A rollover from your TIAA Traditional Account may not be available due to different plan rules and separate forms may be required. If you wish to make a rollover from your TIAA Traditional Account, please call us to obtain the correct form.

Federal or state taxes may apply for certain rollovers.

Tax information in this form is not intended as tax advice. If you have any questions about the impact of a requested rollover on your personal tax situation, you should consult a qualified tax adviser.

If you are paying off a loan (it is a taxable event), you must complete a cash withdrawal form before completing this rollover form.

Electronic Fund Transfers are not available for direct rollovers. We will send a check to the financial institution that you have designated on this rollover form.

Your account will be valued as of the date we receive this form in good order.

NOTE: If your rollover includes Roth 403(b)/401(k) contributions, they may be rolled over to another Roth 403(b)/401(k) that will accept them. They may also be rolled over to a Roth IRA.

If this plan is subject to ERISA, the spousal waiver section is only valid for 180 days from the date the Notary Public validates it. The signature on the withdrawal form is valid for 365 days.

Required Minimum Distribution (RMD): If you will be 70½ or older in this calendar year and you are separated from service, then the IRS requires that you receive your Required Minimum Distribution (RMD) amount prior to any rollover amount you request. If you have already satisfied your RMD for this calendar year, then you can continue with this rollover request. If you have not satisfied your RMD for this calendar year and you submit these rollover forms, then TIAA will pay your RMD amount for this calendar year prior to this rollover. TIAA will calculate your RMD amount using the IRS Uniform Life Expectancy table. Once the RMD amount is calculated, TIAA will pay this RMD amount out proportionately across all of your available funds. TIAA will send the RMD check to your address of record, withholding 10% for federal taxes and any applicable state taxes.

If you want different options, then you will need to call us to request cash forms to have your RMD amount satisfied and then you will need to submit a new set of rollover forms to TIAA.

NOTE: If this is a 403(b) plan and you have already satisfied your RMD for this calendar year with another 403(b) carrier, then you can attest to this in Step ONE and continue with your rollover request.

Please print using black or dark blue ink.

IMPORTANT: A full Social Security Number/Taxpayer Identification Number is required to process your request.

If you claim residence AND citizenship outside the U.S., you must complete Form W-8BEN in addition to this form to certify your foreign tax status. To print the W-8BEN form, go to TIAA.org/forms, and scroll to Find tax forms.

1. PROVIDE YOUR INFORMATION

*The Plan and Sub Plan Numbers should have been provided when you requested the form. If you don’t have them, please reference your quarterly statement.

2. PROVIDE YOUR CONTRACT NUMBERS

TIAA Number

Yes 

No

Do you have ROTH accumulations?

Are you requesting ONLY non-Roth accumulations in this rollover?

OR

Yes 

Yes 

No

No

Are you requesting ONLY Roth accumulations in this rollover?

OR

Yes 

No

Are you requesting BOTH Roth and non-Roth accumulations in this rollover?

Yes 

No

NOTE: Satisfied means that you have already received your Required Minimum Distribution (RMD) check and have cashed it.

If you want different options, please call us.

4. REQUIRED MINIMUM DISTRIBUTION

If you will be 70½ or older in this calendar year and you are separated from service, then the IRS requires that you receive your Required Minimum Distribution (RMD) amount prior to any rollover amount you request. If you have already satisfied your RMD for this calendar year, then you can continue with this rollover request. If you have not satisfied your RMD for this calendar year and you submit these rollover forms, then TIAA will pay your RMD amount for this calendar year prior to this rollover. TIAA will calculate your RMD amount using the IRS Uniform Life Expectancy table. Once the RMD amount is calculated, TIAA will pay this RMD amount out proportionately across all of your available funds. TIAA will send the RMD check to your address of record, withholding 10% for federal taxes and any applicable state taxes. If this rollover is coming out of a 403(b) plan and you have already satisfied your RMD for this calendar year from another alternate carrier, please check the box below and continue to Section 5.

I attest that I have already satisfied my 403(b) Required Minimum Distribution (RMD) from another 403(b) carrier for this calendar year.

(mm/dd/yyyy)

TAXCW/OTCPAYCSH

F11380 (9/16)

/

2 0

(mm/dd/yyyy)

/

2 0

TIAA Number

Plan Number

Plan Name

CREF Number

Yes, withhold

% (must be greater than 20%)

We will default to Allocations on File if no selection is made.

NOTE: If the amount you are rolling over includes funds currently invested in the TIAA Real Estate Account, please provide your investment allocations to the right.

A new Roth or Traditional IRA

Check here and attach enrollment form (call 800-842-2252 for form).

Another Tax-Deferred TIAA account

How would you like the funds allocated? (Choose only one)

Allocations on File (of the receiving plan).

Different Allocations – provide detail below.

Indicate either the dollar amount or percentage to each account/fund. Percentages must be whole numbers.

Yes, withhold

% (must be greater than 20%)

Please sign your full legal name with suffix, if applicable, using black or dark blue ink.

You authorize TIAA to make withdrawals from your account balances with TIAA, as stated in this form.

If you make a direct rollover into another employer’s plan, you understand your right to receive a distribution of these funds will be determined by the plan that is accepting the rollover and the funds in which your direct rollover are invested. You further understand that if you make a direct rollover to another employer’s plan that is subject to the Employee Retirement Income Security Act of 1974 (ERISA), spousal rights will apply to these funds and you may need a signed waiver from your spouse in order to receive a subsequent distribution of these funds.

For your protection, TIAA may require additional verification of your identity before accepting your transaction as in good order. You agree that your transaction will be valued as of the market close on the business

day that all of steps necessary to verify your identity and the transaction to be in good order have been completed. You also agree that in the event these steps are completed after the market close on a business day, then your transaction will be valued as of the market close on the next business day. The amount

of money that you receive will depend on the share or unit price on the day on which your transaction is deemed to be in good order. Due to market fluctuations, the price your shares or units ultimately receive could be less than the share or unit price when you initiated this transaction. It is also possible that if we are unable to reach you to verify this transaction it may result in the transaction being canceled.

Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and (2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen or other U.S. person; and (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Note: There are no FATCA code entries on this form, so please disregard item 4.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

/

/

2 0

This section must be completed by either a Notary Public or Plan Representative. If you reside outside the U.S., then

you need to go to a U.S. Embassy/U.S. Consulate or U.S. Bank Branch to obtain a Notary Public’s signature.

On the date noted below the subscriber known to me to be the person described in and who executed the foregoing instrument and he/she acknowledged to me that he/she executed the same.

Please contact your benefits office to complete the Plan Representative Certification instead of a Notary Public

FOR NOTARY PUBLICS IN MA

Indicate the type of identification:

Valid federal or state ID

Testimony of a credible witness

Personal knowledge of the subscriber

PLAN REPRESENTATIVE CERTIFICATION

By signing, you are certifying you witnessed the spouse’s signature.

Plan Representative’s Signature

In this space, the Notary Public must provide his/her notarial number and the date the appointment expires. Provide the notarial seal if outside New York state.

Today’s Date (mm/dd/yyyy)

Certification.