[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-303660-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-303660-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","roth-ira-conversion-form-bny-mellon","Roth IRA Conversion Form - BNY Mellon","","Form for converting a Traditional IRA, SEP IRA, SIMPLE IRA, SAR-SEP IRA, or other non-Roth retirement plan account to a Roth IRA. Requires attaching a completed BNY Mellon Family of Funds Individual Retirement Account Application if no Roth IRA exists. Provides conversion distribution choices for BNY Mellon custodial accounts and for accounts transferred from other trustees or custodians, including liquidation instructions. Includes income tax withholding election guidance and references Form W-4R.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/roth-ira-conversion-form-bny-mellon/303660/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/roth-ira-conversion-form-bny-mellon/303660.png","ImageObject",442,249,{"name":42,"@type":43},"Riley West","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-04","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Which types of retirement accounts can be converted to a Roth IRA using this form?","Question",{"text":63,"@type":64},"The form covers conversions from a Traditional IRA, SEP IRA, SIMPLE IRA, SAR-SEP IRA, or other non-Roth retirement plan accounts to a Roth IRA.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What happens to any existing systematic investment or withdrawal if you convert 100% of assets to a Roth IRA?",{"text":68,"@type":64},"The systematic investment or withdrawal will automatically be discontinued. You can indicate whether to move it to the new Roth IRA.",{"name":70,"@type":61,"acceptedAnswer":71},"Is a Roth conversion considered taxable?",{"text":72,"@type":64},"Yes. A conversion from a non-Roth IRA or non-Roth retirement plan account is a taxable event reported to the IRS by your current custodian, and you should consult a tax advisor regarding financial effects.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},303660,1790222490,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":55,"slug":121},21,"Paper Templates","papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":135,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":30},1099523885074,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","• This form can be used to convert a Traditional IRA, SEP IRA, SIMPLE IRA or SAR-SEP IRA or other non-Roth retirement plan account to a Roth IRA.  \n• If you do not have an existing Roth IRA, you must attach a completed BNY Mellon Family of Funds Individual Retirement Account Application.  \n• If you are converting a non-Roth IRA or non-Roth retirement plan account held at another financial institution, please contact your current custodian to determine whether any other form is necessary to complete this transaction.  \n• A conversion from a non-Roth IRA or non-Roth retirement plan account is a taxable event that will be reported to the Internal Revenue Service (IRS) by your current custodian for such IRA or plan account. Please consult with your tax advisor regarding the financial effects of this conversion. Please refer to the attached Form W-4R for additional withholding information.  \n1. ACCOUNT INFORMATION  \nName of registered owner (first, middle,last)  \n\n| Social Security Number | Phone number (include area code) |\n| --- | --- |\n| Email Address\u003Cbr>Type of account you are converting:\u003Cbr>❏ Traditional IRA ❏ SEP IRA ❏ SAR-SEP IRA\u003Cbr>❏ Other Retirement Plan (please specify):   |  |\n\n2. DISTRIBUTION (CONVERSION INSTRUCTIONS)  \n❏ A. Convert my BNY Mellon Custodial non-Roth IRA or non-Roth retirement plan account to a BNY Mellon Custodial Roth IRA and maintain my current fund selection. (Section 3 should be completed below for a conversion of a BNY Mellon Custodial non-Roth IRA only.)  \n  ❏ Full ❏ Partial     % 14-Digit non-Roth Account Number Amount OR Percentage  \n  ❏ Full ❏ Partial     % 14-Digit non-Roth Account Number Amount OR Percentage  \n  ❏ Full ❏ Partial     % 14-Digit non-Roth Account Number Amount OR Percentage  \nIf you have an existing systematic investment or withdrawal on your non-Roth IRA or non-Roth retirement plan account, and you convert 100% of your assets to a Roth IRA, the systematic investment or withdrawal will automatically be discontinued. If you wish to move the systematic investment or withdrawal to your new RothIRA, please check the box below.  \n❏ Please move the existing systematic investment/withdrawal for my non-Roth IRA or plan account to my Roth IRA.  \n2. DISTRIBUTION (CONVERSION INSTRUCTIONS) Cont.  \n❏ B. Convert my non-Roth IRA or non-Roth retirement plan account from another trustee/ custodian to a BNY Mellon Custodial Roth IRA. (Section 3 should not be completed below.)  \nBy checking box B above, I acknowledge that this Roth conversion will be reported by the current trustee/custodian for my non-Roth IRA or plan account as a taxable conversion or taxable rollover.  \nPlease provide the following information about your current trustee or custodian.  \n\n| Account Number(s) |  |  |\n| --- | --- | --- |\n| Trustee/custodian for non-Roth IRA or plan account |  | Phone Number |\n| Address of trustee/custodian for non-Roth IRA or plan | account |  |\n| City State Zip Code\u003Cbr>Please liquidate ❏ all or ❏ part $  of the retirement accounts listed above, and transfer the proceeds to BNY Mellon Custodial Roth IRA. All amounts transferred must be in cash.\u003Cbr>❏ immediately (I am aware of any penalties which may be applied); or\u003Cbr>❏ at maturity date of my Certificate of Deposit. Date of maturity:   Please send us this form at least three weeks prior to the maturity date of your CD.\u003Cbr>Note: If neither box is checked above, we will immediately begin the process of transferring your account. |  |  |\n\n3. INCOME TAX WITHHOLDING (Complete this section for Roth conversion of BNY Mellon Custodial non-Roth IRAs only.)  \nThis section applies to the Roth conversion of a Traditional IRA, SEP IRA, SIMPLE IRA or SARSEP IRA held at BNY (each, a “Non-Roth IRA”) . WIth respect to the Roth conversion of a nonRoth reitrement plan account held at BNY, this section will not apply and your plan will provide arollover notice that generally includes information about taxable rollovers to a Roth IRA.  \nFEDERAL INCOME TAX WITHHOLDING EL","cbCaipEGXWO9YPeH","https://ap.wps.com/l/cbCaipEGXWO9YPeH","pdf",89079,8,"English","# Account information\n## Distribution (conversion instructions)\n## Income tax withholding","[{\"question\":\"Which types of retirement accounts can be converted to a Roth IRA using this form?\",\"answer\":\"The form covers conversions from a Traditional IRA, SEP IRA, SIMPLE IRA, SAR-SEP IRA, or other non-Roth retirement plan accounts to a Roth IRA.\"},{\"question\":\"What happens to any existing systematic investment or withdrawal if you convert 100% of assets to a Roth IRA?\",\"answer\":\"The systematic investment or withdrawal will automatically be discontinued. You can indicate whether to move it to the new Roth IRA.\"},{\"question\":\"Is a Roth conversion considered taxable?\",\"answer\":\"Yes. A conversion from a non-Roth IRA or non-Roth retirement plan account is a taxable event reported to the IRS by your current custodian, and you should consult a tax advisor regarding financial effects.\"}]","Roth IRA Conversion Form - BNY Mellon | PDF",1789805959]