Rollover Application - Korn/Ferry International

Part 2 - Indicate the source of your rollover (select one) Qualified retirement plan 403(b) plan 457 governmental plan Conduit IRA (Traditional IRAs consisting solely ofamounts from a qualified retirement plan)Part 3 - Type of rollover (select one) Direct rollover (check is made out to the Plan or itstrustee for your benefit), but no after-tax contributions Other rollover (check is made out to you)Documents required (see list below)ABCA, DDocuments required (see list below)EFA. A letter from the prior plan administrator stating the distributing plan has an IRS determination letter (or a copy of thedetermination letter itself); or a letter from the prior plan administrator attesting to that plan's qualified status.B. A copy of your most recent statement from your 403(b) plan provider.C. A copy of your most recent statement from your 457(b) governmental plan provider.D. A copy of your most recent IRA statement. The date on the check from your IRA must be within 60 days of your rollovercontribution. Additionally, by signing this form, you certify under penalties of perjury that your contribution from the originalplan to the IRA was made within 60 days of its distribution, you have contributed no other amounts to the IRA, and you aremaking this rollover contribution within 60 days of the distribution from your IRA.E. No additional documents needed.F. A copy of the distribution statement that accompanied your check showing the date, tax withholding, and amount of thedistribution. By signing this form you certify under penalties of perjury that your distribution is not one of a series of periodicpayments, that the entire amount of the rollover contribution would be includible in gross income if not rolled over, and that youdid not receive the distribution more than 60 days before this attempted rollover.SECTION IV: InstructionsThe following information may assist you in filling out the distribution form you will receive from your former employer:Name of Plan:Korn/Ferry International Employee Tax Deferred Savings PlanPlan ID#: 152147Name of Trustee: Wells Fargo Bank, N.A.Have rollover check made payable to Wells Fargo Bank, N.A. as Trustee for the Korn/Ferry International 401(k) Plan, FBO“Participant Name” and mailed to your home address. Mail the check, this completed form (no personal check will be accepted), andthe supporting documentation described in section III above to:Wells Fargo Retirement Plan ServicesAttn: Client Services, Korn/Ferry InternationalMAC N9113-0302700 Snelling Ave. N., Suite 300Roseville, MN 55113Your rollover will be delayed and/or returned to you if any of the requested information is incomplete! It is your responsibility tomake sure the funds and supporting documentation are sent to the above address with this form!SECTION V: SignatureSign and date this form.I certify that the requirements stated above have been fulfilled and the information provided is true and correct to the best of myknowledge. I understand that decisions regarding rollovers have important tax consequences and I have been advised to seek theguidance of a tax professional with regard to this decision. I choose to make this rollover contribution to the plan in the amountshown on the rollover check. I assume full and sole responsibility for the consequences of this decision.____________________________________________________Employee Signature____________________________________DatePage 2 of 2