Follow the steps to successfully complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This will allow you to begin filling out the form directly online.
2. In Section 1, enter your Nationwide plan information by providing your plan number and plan name.
3. In Section 2, fill out your participant information. You will need to provide your name, Social Security number, phone number, date of birth, date of hire, street address, city, state, zip code, and email address.
4. Section 3 requires you to input rollover/transfer information. Indicate whether you have already completed all requirements and if the funds are on their way to Nationwide. If yes, you can skip to the Next Steps. If no, answer the questions regarding your current provider/custodian's requirements.
5. In Section 4, provide the submission information. Make your check payable to Nationwide Financial and include your plan number and last four digits of your Social Security number in the memo section. Fill out the appropriate mailing or express mailing addresses and provide wire transfer details if applicable.
6. In Section 5, enter both your participant information and your prior provider/custodian information. Include their name, phone number, address, account number, and account type.
7. Section 6 is where you will direct your investment. Specify how assets will be applied unless otherwise noted.
8. In Section 7, the plan sponsor or an authorized representative must sign to verify the request and authorize its acceptance into the retirement plan.
9. Section 8 includes participant authorization. You will need to certify the accuracy of your information and provide your signature and date. A Medallion Signature Guarantee stamp may be required.
10. Once you have filled out all required sections and reviewed your information for accuracy, you can save changes, download, print, or securely share the form as necessary.

Complete your Fillable Online Inbound Rollover Deposit Form online today!