ROLLOVER CONTRIBUTION FORM - Voya Financial … - voya bny mellon 401k

---

• (1) bny mellon 401k plan
• (2) bny mellon employee 401k
• (3) voya bnym
• (4) voya bny mellon 401k access

The Bank of New York Mellon Corporation 401(k) Savings Plan
ROLLOVER CONTRIBUTION FORM
PERSONAL INFORMATION (please print clearly using black or blue ink)
NAME: ____________________________________________________________ SOCIAL SECURITY NUMBER: ____________________
ADDRESS: __________________________________________________________ APT:______________________________________
CITY:______________________________________________________________ STATE: _________ ZIP CODE: ____________________
DAY PHONE: ___________________________________________________ EVENING PHONE: __________________________________
E-MAIL: _______________________________________________________________________DATE OF BIRTH: _____ /_____ /______
INSTRUCTIONS
1. Contact your former employer, plan administrator, or financial institution to request and receive a rollover distribution check. You will need to
provide the correct payee information for your rollover. The rollover check should be mailed directly to you and payable as follows:
? The Bank of New York Mellon Corporation 401(k) Savings Plan for the benefit of (F.B.O.) (Your Name)
2. Obtain required documentation. Your former employer or financial institution should provide you with proof of plan qualification and taxability.
Proof of plan qualification status is typically documented in a copy of the plan's IRS Letter of Determination, a signed letter from your employer
or prior Plan Administrator and/or your rollover distribution statement. Proof of taxability is typically documented in your rollover distribution
statement.
3. Write the last four digits of your Social Security Number on the rollover check.
4. Personal checks will not be accepted and will be returned to you.
5. Rollovers from the BNY Mellon Pension Plan are acceptable. Write "BNYM Pension" on the rollover check.
6. The Plan will not accept a rollover of contributions of non-cash assets, non-Roth after-tax contributions from an IRA or a prior employer's
qualified retirement plan or any distributions from a Roth IRA.
PLEASE NOTE: AN INCOMPLETE APPLICATION, INSUFFICIENT DOCUMENTATION, A MISSING CHECK OR A CHECK WITH INCORRECT PAYEE
INFORMATION MAY RESULT IN A DELAY IN POSTING FUNDS TO YOUR ACCOUNT OR THE RETURN OF YOUR APPLICATION AND/OR CHECK.
PROOF OF PLAN QUALIFICATION AND TAXABILITY
Plan qualification: Your rollover contribution to The Bank of New York Mellon Corporation 401(k) Savings Plan must be from another qualified
plan or IRA. The Bank of New York Mellon Corporation 401(k) Savings Plan accepts rollover contributions from a 401(k) plan, 403(b) plan, 457(b)
governmental plan, profit sharing plan, defined benefit plan or Rollover IRA. If you choose to rollover an eligible plan payment that was paid to you,
it will be treated as an indirect rollover which must be completed within 60 days after you received the payment.
Note: If you are directly rolling over Roth money, we must receive cost basis and the Roth account's start date directly from your prior record keeper.
Please include a copy of your rollover distribution statement from your former plan PLUS documentation providing the start date and total amount of
your Roth contributions.
Taxability: You must provide documentation that details the taxability of the funds to be rolled over indicating: pre-tax, Roth.
You may need to contact your former employer, plan administrator, or financial institution to provide you with this information which must accompany
this application and rollover check.
BM350011ROLLVRY
PAGE 1 of 2
V6
The Bank of New York Mellon Corporation 401(k) Savings Plan
ROLLOVER CONTRIBUTION FORM
INVESTMENT FUND ELECTIONS (MUST TOTAL 100%)
I elect to make a rollover contribution to The Bank of New York Mellon Corporation 401(k) Savings Plan in the amount of: $__________
If you do not designate fund elections or elections do not total 100%, your rollover contribution allocation will default to the Life Path Index Fund closest to
your attainment age 65.
LifePath Retirement ________ .00% High Yield Bond Fund ________ .00%
LifePath Index 2020 ________ .00% Large Cap Growth Equity Fund ________ .00%
LifePath Index 2025 ________ .00% Large Cap Value Equity Fund ________ .00%
LifePath Index 2030 ________ .00% Mid Cap Growth Equity Fund ________ .00%
LifePath Index 2035 ________ .00% Mid Cap Value Equity Fund ________ .00%
LifePath Index 2040 ________ .00% Small Cap Growth Equity Fund ________ .00%
LifePath Index 2045 ________ .00% Small Cap Value Equity Fund ________ .00%
LifePath Index 2050 ________ .00% International Growth Equity Fund ________ .00%
LifePath Index 2055 ________ .00% International Value Equity Fund ________ .00%
LifePath Index 2060 ________ .00% Emerging Markets Equity Fund ________ .00%
Aggregate Bond Index Fund ________ .00% Global Real Estate (REIT) Fund ________ .00%
Large Cap Stock Index Fund ________ .00% Stable Value Fund ________ .00%
Small-Mid Cap Stock Index Fund ________ .00% Money Market Fund ________ .00%
International ACWI Ex-US Stock Index Fund ________ .00% Bank of New York Mellon Common Stock ________ .00%
Core Plus Bond Fund ________ .00%
TOTAL 100%
AUTHORIZATION
I certify that the amount of my rollover contribution represents only money that is eligible to be rolled over into The Bank of New York Mellon Corporation 401(k)
Savings Plan. If any of the money is subsequently determined to be ineligible for rollover, I understand that the Plan will distribute the ineligible amount and any
attributable earnings, if applicable.
PARTICIPANT SIGNATURE ___________________________________________________________ DATE __________________________
If you have any questions, please go online at www.bnymellon401k.com or call the 401(k) Savings Line at 1-800-947-HR4U (4748), Option 1.
Customer Service Associates are available Monday through Friday, 8:00 A.M. to 8:00 P.M. Eastern Time (excluding stock market holidays).
CHECKLIST
PLEASE REVIEW YOUR APPLICATION CAREFULLY. If your application is complete,
r Completed the Personal Information section, and
please mail the application and
any required documentation to:
r Contacted your former employer or financial institution, and VIA MAIL
r Completed the Investment Fund Elections section, and Voya Financial
r Included your rollover check (made payable to The Bank of New York Mellon Corporation 401(k) Savings Attn: BNYM Plan Administration
Plan (FBO Your name)), and P.O. Box 55772
r Included proof of plan qualification documenting the source of your rollover contribution such as: 401(k),
Boston, MA 02205-5772
403(b), 457 or IRA (IRS Letter of Determination, letter from plan's prior record keeper, or distribution VIA OVERNIGHT DELIVERY
statement), and Voya Financial
r Included proof of taxability detailing the taxability of funds to be rolled over such as: pre-tax, Roth. (Letter Attn: BNYM Plan Administration
from plan's prior record keeper, and/or rollover distribution statement), and 30 Braintree Hill Office Park
r Signed and dated the Rollover Contribution form
Braintree, MA 02184-8747
If your rollover check or any of the above required information or documentation is missing
from your application, there will be a delay in processing your rollover contribution and your
application and/or check may be returned to you.
ROLLOVER CONTRIBUTION FORM / PAGE 2 of 2 BM350011ROLLVRY
11/15/2016


• Voya Roth IRA Conversion Request Form
• LifePath Index Retirement - Voya Financial Login
• Voya Mutual Fund Non-Retirement Account Application
• ROLLOVER CONTRIBUTION FORM - Voya Financial …
• The Bank of New York Mellon Corporation 401(k) …