Spousal Consent for Retirement Account Rollover Form
Please complete this form to provide spousal consent for a retirement account rollover. All information is required to process your request. Sensitive personal or financial data is not collected.
Participant's Full Name
*
First Name
Last Name
Spouse's Full Name
*
First Name
Last Name
Participant's Email Address
*
example@example.com
Spouse's Email Address
*
example@example.com
Retirement Plan Name
*
Rollover Institution Name
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I, the spouse, consent to the rollover of the participant's retirement account as described above.
*
I consent and understand this action is irrevocable.
Spouse's Signature
*
Participant's Signature
*
Submit Consent
Submit Consent
Should be Empty: