TRANSFER REQUEST FORM - Alerus Retirement and Benefits 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Employer Information section if applicable, including Previous and New Employer Names.
3. Next, complete the Accountholder Information section. Provide your Last Name, First Name, Middle Initial, Address, City, State, Social Security Number, Date of Birth, Employer, Telephone Number, Email Address, and ZIP code.
4. In the Rollover/Transfer section, indicate whether you are requesting account closure and specify if you want to liquidate your entire account balance or a specific amount.
5. Select whether this transfer will close your HSA Account or not. Ensure you understand the IRS regulations regarding rollovers.
6. Fill in the details for the receiving Trustee/Custodian including their name and address where the check should be sent.
7. Finally, sign and date the form to certify that all information is accurate and that you understand the transaction terms.

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