Church Benefits Board Roth Interest Form Name(Required) First Last Email(Required) Enter Email Confirm Email PhonePreferred method of contact: Email Phone Does your employer participate in the CBB Retirement Plan?(Required) Yes No Do you currently have Roth contributions with another 403(b) plan that you are interested in rolling over?(Required) Yes No Church/Employer:(Required)Address(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Financial Administrator Name: First Last Financial Administrator Email: Enter Email Confirm Email Financial Administrator Phone:Additional information or questions:EmailThis field is for validation purposes and should be left unchanged.
