RecordkeeperDirect. Plan Termination Request. Prior to submitting this request. Upon receipt of this request

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1 Forced distributions for non-responsive participants or beneficiaries You will need to submit both the form and the American Funds Automatic Rollover IRA Employer Agreement for Terminated Plans. If account balances remain on the final payout date specified in Section 2, accounts valued at $1,000 or more will be rolled into American Funds IRAs; balances under $1,000 will be distributed as a check payable to the participant. Please read the attached agreement for a more detailed explanation of automatic rollovers. For plans that are subject to Qualified Joint Survivor Annuity (QJSA) rules, accounts with balances greater than $5,000 may not be forced out without elections. Contact your TPA for more information about QJSA provisions. Prior to submitting this request These forms should not be submitted to American Funds until the plan is ready to begin distributing assets. Consult with your Third-Party Administrator to determine what actions are required. These may include, but are not limited to: Determining if you will file for an IRS determination letter. Finishing any required corrective processing and plan-year testing. Completing any required plan amendments and participant notices. Upon receipt of this request An American Funds termination coordinator will assist you through the following key milestones: 2 3 days after receipt of paperwork: Final American Funds invoice is delivered. If applicable, per-participant recordkeeping fees are debited from participant accounts days after receipt of paperwork: Plan-level accounts are distributed or reallocated to participant accounts. 15 days after invoice is delivered: Payment for outstanding fees is due. If no payment has been received, fees will be recovered from participant accounts. Once all fees have been paid and plan-level accounts have a zero balance: Participant distribution requests can be processed (vesting will be updated to 100% as of the plan termination date for all participants unless otherwise instructed). If vesting will be different for certain participants, the plan termination coordinator must be notified ahead of time in order to process those distributions first. Otherwise, expect delays in closing the plan, as variable vesting can impact the forfeiture account. Upon final payout date: Force-out distributions and automatic rollovers are processed on the final payout date indicated in Section 2. Following distribution of plan assets: Any uncashed distribution check valued at $1,000 or less will be escheated as unclaimed property according to the guidelines in the participant s or beneficiary s state of residence. Any uncashed distribution check over $1,000 will be rolled into an American Funds IRA.

2 Use this form when terminating your plan. If your plan is transferring to a different provider, complete the Deconversion Request form, which is available on the Plan Sponsor website. For plans with compensation recapture, compensation through the final payout date, such as 12b-1 and subtransfer agency payments otherwise payable to a registered broker-dealer and/or the plan s TPA, will be deposited into the Plan Expense Account in the quarter following the quarter of the final payout date. Unless instructed otherwise, American Funds will reallocate these funds to participants on a per capita basis (unless the amount is less than $25 per participant) and process trailing distributions by the end of the quarter following the quarter of the final payout date. Ask your TPA about possible effects to the Final Form 5500 filing. 1 Plan information Plan name Plan ID Name of plan contact coordinating the termination ( ) Ext. Daytime phone address 2 Termination Plan Termination Date (mm/dd/yyyy) required A. Final payout date if all participant distribution forms have not been received required (mm/dd/yyyy) This date must be a valid business day Monday Friday. You must submit this form at least 45 days prior to the final payout date. B. Application of remaining balances in Plan Forfeiture and Plan Expense Accounts (if applicable) Note: These accounts must have a zero balance prior to any participant disbursements. If these assets will be used for multiple purposes, check all applicable boxes and provide specific instructions below. Reallocate across the existing participant accounts. (Your termination coordinator will provide instructions for submitting the participant breakdown.) Pay outstanding fees invoiced by American Funds as noted in Section 3. Pay outstanding TPA fees $ balance will be remitted to the TPA.) (If amount provided exceeds the actual balance of these assets, the entire Pay order Mail to: TPA address of record OR Plan Sponsor address of record Specific instructions: 2 of 5

3 3 Payment of fees Any outstanding recordkeeping, trustee or other fees must be paid in full prior to any distributions being processed. Per-participant fees (if applicable) will be deducted directly from participant accounts (as described in the Recordkeeping Services Agreement). American Funds will prepare a final invoice showing all plan-level fees owed through the end of the recordkeeping quarter in which the final payout date occurs. Indicate the method of payment of these plan-level fees. Any amounts unpaid 15 calendar days after the invoice is sent will be deducted first from forfeiture assets and then pro rata from participant accounts. Method of payment (Select all that apply.) A. Employer will pay outstanding fees on the Online Billing Center B. Deduction directly from the participant accounts (amount to be deducted on a pro rata basis) C. Forfeiture assets (must be permitted by the terms of the plan document; amount deducted will be dependent on the current forfeiture account balance) D. Plan Expense Account (amount deducted will depend on the current account balance) Specific payment instructions: 4 Authorization I have the authority to sign this document in connection with this plan termination and have consulted legal advisors to the extent I believe necessary and appropriate. I am seeking guidance from a tax advisor or TPA regarding any additional steps necessary to terminate the plan (including but NOT limited to plan amendments and Form 5500). I authorize the distribution of all remaining account balances on the final payout date for full plan terminations. Name of authorized plan signer (print) Title X / / Signature of authorized plan signer Date (mm/dd/yyyy) This document may not be signed using Adobe Acrobat Reader s "fill and sign" feature. Next steps If your plan termination includes forced distributions for non-responsive participants or beneficiaries, you must also complete and return the attached Automatic Rollover IRA Employer Agreement for Terminated Plans along with the form. For fax and mailing instructions, see page 5. 3 of 5

4 Automatic Rollover IRA Employer Agreement for Terminated Plans The Department of Labor (DOL) regulations permit the Plan Sponsor of a terminated Plan to roll over a participant s or beneficiary s account balance into an Automatic Rollover IRA if the balance is greater than $1,000 and the participant or beneficiary fails to make a distribution election within 30 days after the distribution notice is furnished. For terminating plans that are subject to Qualified Joint Survivor Annuity (QJSA) rules, accounts with balances greater than $5,000 may not be forced out as rollovers without elections. The plan must purchase annuities for any non-responsive participants. Instructions for transferring assets to an annuity provider must be provided to American Funds prior to the final payout date (as provided in the form), otherwise all payouts will be made in accordance with the automatic rollover provisions. Follow these steps to initiate automatic rollovers for participants in your Plan: 1. Sign and send us the attached Automatic Rollover IRA Employer Agreement for Terminated Plans, which will allow American Funds to open IRAs to receive the rollovers. Before signing the Agreement, be sure to read the Traditional or Roth IRA Custodial Agreement found in the American Funds Traditional/Roth IRA Application (available in the Online forms section of the Plan Sponsor website, As of the final payout date (as provided in the form), American Funds will open IRAs and roll over account balances into the Automatic Rollover IRA for any unresponsive participants and beneficiaries with a balance greater than $1, Mail a copy of the 402(f) Notice of Special Tax Rules on Distributions to the address you have on file for each of the participants. (You can obtain this notice from the Plan Sponsor website or from your TPA.) Depending on your Plan procedures, participants have between 30 and 90 days to notify you about what to do with their retirement plan money unless a statement is provided to explain that a participant or beneficiary must make an election within 30 days from receipt of the notice. Otherwise, the Plan will roll over the participant s or beneficiary s account balance into an IRA. Information you should know about these automatic rollover accounts: They will be invested in American Funds U.S. Government Money Market Fund SM (MMF). This type of fund seeks to preserve capital and is required in order to meet the DOL s safe harbor rules. MMF will be the only initial investment option available for Automatic Rollover IRAs. Although the fund seeks to preserve the investment value at $1.00 per share, it cannot guarantee it will do so. (Other important information about MMF is contained in the prospectus, which can be obtained from a financial professional or from and should be read carefully before investing.) Each participant s IRA account will be charged the normal $10 setup fee and an annual $10 custodian fee. If you have any questions, call American Funds at (800) of 5

5 Automatic Rollover IRA Employer Agreement for Terminated Plans Plan name Plan ID number On behalf of the terminated Plan identified above, the Plan Sponsor identified below hereby agrees to establish American Funds Traditional or Roth IRAs as Automatic Rollover IRAs on behalf of certain participants receiving distributions from the Plan and to appoint Capital Bank and Trust Company SM (CB&T) as the Custodian. Such Automatic Rollover IRAs are intended to satisfy the safe harbor requirements of the Department of Labor (DOL) regulations at 29 CFR Section a-3(d)(2). CB&T agrees and the Plan Sponsor acknowledges that participants for whom the Automatic Rollover IRAs are established will have the right to enforce the terms of the Traditional or Roth IRA Custodial Agreement and this Agreement. The Plan Sponsor certifies that the participant information provided to CB&T is accurate to the best of its knowledge. Such information includes the name, residence address, mailing address (if different), date of birth, Social Security number and daytime phone number (if available) of the participant. The Plan Sponsor acknowledges that the distributions transferred to the Automatic Rollover IRA will be invested in American Funds U.S. Government Money Market Fund, Class A shares, and that it has received and read the current prospectus for American Funds U.S. Government Money Market Fund. The Plan Sponsor acknowledges the $10 setup fee and the annual custodian fee (currently $10) for each American Funds Automatic Rollover IRA. Consistent with DOL requirements, CB&T certifies that these fees are the same as those charged by CB&T for comparable IRAs established for reasons other than the receipt of a distribution under CFR Section a-3. CB&T certifies that it is a financial institution as defined by DOL regulation Section a-3(d)(2)(ii)(B). Plan Sponsor signature. By signing below, the Plan Sponsor authorizes the establishment of Traditional and/or Roth Automatic Rollover IRAs on behalf of participants. Roth Rollover IRAs will accept the Roth portion of participants balances, if applicable. Authorized representative of Plan Sponsor (print) X Signature of authorized representative of Plan Sponsor This document may not be signed using Adobe Acrobat Reader s "fill and sign" feature. Send If you have any questions about this form, call American Funds at (800) You may fax this completed form to (855) or mail it to the address below. American Funds c/o Retirement Plan Services Regular mail Overnight mail P.O. Box N. Meridian St. Indianapolis, IN Carmel, IN Lit. No. RPDRFM O CGD/9839-S Capital Group. All rights reserved. 5 of 5