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[PLAN NAME] DIRECT ROLLOVER STATEMENT - …

F6826rpbroth COMPLETE ALL PAGES MassMutual, PO Box 219062, Kansas City MO 64121-9062 For Overnight Mail: MassMutual, 430 W 7th St, Kansas City MO 64105 RS-42603-01 EXP 12/01/2019 [PLAN NAME] DIRECT ROLLOVER STATEMENT Account Number _____ DIRECT ROLLOVER This form provides for the transfer of assets from one qualified retirement plan or IRA directly to another qualified retirement plan or IRA. Your distribution will be made payable directly to your new account for your benefit. No taxes will be withheld from your ROLLOVER amount.

Note: Roth Contributions can only be rolled over as part of a direct rollover from a Roth plan and rolled into a plan that accepts Roth money.

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