Acknowledgement and Signature. I understand that conversions from a Traditional IRA to a Roth IRA will be treated as a distribution and may be considered ordinary income for tax purposes. I have been advised to consult a tax professional and assume full responsibility for this conversion transaction and will not hold Computershare Trust Company, N.A. and its agents are not liable for any adverse consequences that may result. I understand that the resigning custodian will remit any income tax which has been withheld to the Internal Revenue Service on my behalf and I have made my election directly with them. I also understand that if I recharacterize, amounts previously withheld may only be refunded by the Internal Revenue Service. Amounts withheld may be subject to a 10% early withdrawal penalty in addition to income tax. By signing this IRA Transfer/Conversion Request Form, I certify that the information I have provided is true and correct. I authorize the current IRA Trustee/Custodian to transfer/convert the IRA assets as instructed above. I understand that I am responsible for ensuring I am eligible to authorize this transfer/conversion and I assume all responsibilities for any consequences that arise as a result of my actions. I agree to indemnify and hold the IRA Trustee/Custodian harmless from any consequences related to executing my directions. I have been advised to seek competent legal and tax advice, and have not been provided any such advice from the IRA Trustee/Custodian. Signature Date
Acknowledgement and Signature. I certify that the information set forth within this application is complete, true, and correct, to the best of my knowledge and belief, and that I will comply with the information set forth within this application. Acceptance of the application should in no way be construed as final approval or confirmation of the request. The Town of Xxxxxxxxx reserves the right to deny the application and it is revocable if deemed in the best interest of the Town of Xxxxxxxxx. Responsible Party (please print): Signature: Date:
Acknowledgement and Signature. I certify that the information set forth within this application is complete, true, and correct, to the best of my knowledge and belief, and that I will comply with the information set forth within this application. Acceptance of the application should in no way be construed as final approval or confirmation of the request. The Town of Xxxxxxxxx reserves the right to deny the application and it is revocable if deemed in the best interest of the Town of Guadalupe. Responsible Party (please print): Signature: Date:
Acknowledgement and Signature. By applying for and/or using the electronic banking services indicated above, I agree to the Terms and Conditions described above and certify that all information I furnish now and hereafter is true and complete; I authorize and consent to: (a.) investigation and verification of my application and account information, (b.) the Credit Union sharing such information with others including credit and check reporting agencies as well as Credit Union affiliates. I agree to be responsible for all charges, advances and other fees and to abide by all of the terms governing the services and my accounts. I understand that this application will remain the property of the Credit Union. By selecting the Online Banking service I understand and acknowledge that I have authorized The Bank Employees’ Credit Union (BECU) to provide electronic services as previously indicated. Use of the Online Banking service or other banking products shall be deemed to be my written authorization to charge, debit, or credit my account(s) for the amount and type of transaction(s) indicate at the time of use.
Acknowledgement and Signature. By my signature below, I verify that I have read, understand, and will abide by the requirements outlined here and I agree to provide the additional information required to complete my Housing Accommodation Request under the University’s Emotional Support Animal Policy.
Acknowledgement and Signature. By signing this Xxxxxxxxx ESA Transfer Request Form, I certify that I am the Responsible Individual, the information provided is true, correct and complete, and the Trustee/Custodian may rely on what I have provided. I understand that I am responsible for ensuring I am eligible to authorize this transfer and I assume all responsibilities for any consequences as a result of my actions. I have been advised to seek competent legal and tax advice and have not been provided any such advice from the Trustee/Custodian. I will indemnify and hold the Trustee/Custodian harmless from any consequences related to executing my directions. The Trustee/Xxxxxxxxx agrees to accept this transfer as instructed above. Complete for Transfers (for internal use only): – Computershare Trust Company, N.A., agrees to serve as the new Custodian for the Xxxxxxxxx Education Savings Account of the above-named individual, and as Custodian we agree to accept the assets being transferred.
Acknowledgement and Signature. (All account owners/trustees must sign on the following page) By signing below: AN INVESTMENT IN THE FUND IS SPECULATIVE WITH A SUBSTANTIAL RISK OF LOSS. THE FUND DOES NOT GUARANTEE ANY LEVEL OF RETURN OR RISK ON INVESTMENTS AND THERE CAN BE NO ASSURANCE THAT THE FUND’S INVESTMENT OBJECTIVE WILL BE ACHIEVED. AN INVESTMENT IN THE FUND ENTAILS SUBSTANTIAL RISKS, INCLUDING BUT NOT LIMITED TO: • LOSS OF CAPITAL, UP TO THE ENTIRE AMOUNT OF A SHAREHOLDER’S INVESTMENT. • THE FUND’S SHARES ARE ILLIQUID SECURITIES AND AN INVESTMENT IN THE FUND IS APPROPRIATE ONLY FOR THOSE INVESTORS WHO DO NOT REQUIRE A LIQUID INVESTMENT. • SHARES WILL NOT BE LISTED ON ANY NATIONAL OR OTHER SECURITIES EXCHANGE AND NO SECONDARY MARKET IS EXPECTED TO DEVELOP FOR SHARES OF THE FUND. • SHARES ARE SUBJECT TO SUBSTANTIAL RESTRICTIONS ON TRANSFERABILITY, AND LIQUIDITY, IF ANY, MAY BE PROVIDED BY THE FUND ONLY THROUGH REPURCHASE OFFERS, WHICH MAY, BUT ARE NOT REQUIRED TO, BE MADE FROM TIME TO TIME BY THE FUND AS DETERMINED BY THE FUND’S BOARD OF TRUSTEES IN ITS SOLE DISCRETION. • AN INVESTMENT IN THE FUND IS APPROPRIATE ONLY FOR THOSE INVESTORS WHO CAN TOLERATE A HIGH DEGREE OF RISK AND DO NOT REQUIRE A LIQUID INVESTMENT AND FOR WHOM AN INVESTMENT IN THE FUND DOES NOT CONSTITUTE A COMPLETE INVESTMENT PROGRAM. YOU SHOULD CAREFULLY CONSIDER THESE RISKS TOGETHER WITH ALL OF THE OTHER INFORMATION CONTAINED IN THE PROSPECTUS BEFORE MAKING A DECISION TO INVEST IN THE FUND. Under penalty of perjury, I certify that:
1. The Social Security Number or Taxpayer Identification Number shown on this application is correct.
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding; or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me that I am no longer subject to backup withholding.
3. I am a U.S. citizen or other U.S. Person (including resident alien).
4. I am exempt from FATCA reporting. Note: Cross out number 2 if you have been notified by the IRS that you are currently subject to backup withholding The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid back-up withholding. If this is an individual retirement account the custodian or trustee of the account is also required to execute this Application below: Signature of Owner, Trustee or...
Acknowledgement and Signature. The undersigned hereby attest(s) and agree(s) that the above application is for the purpose of opening an account with TRADEVIEW LTD (hereinafter referred to as ‘TRADEVIEW LTD’) and that such an account will be governed by the terms and conditions set forth within TRADEVIEW LTD’s Client Agreement. The undersigned further certifies that he/she has received a copy of TRADEVIEW LTD’s Client Agreement, Online Services and Electronic Trading Agreement and Risk Disclosure Statement and has read, understands and agrees that all terms and conditions contained therein shall govern his/her business relationship with TRADEVIEW LTD. The undersigned agrees and understands that TRADEVIEW LTD retains the right to amend any and all Agreements at any time by means of proper notification. The undersigned hereby attest(s) and agree(s) that the above information is complete and accurate and certifies that the signature is genuine and that any photocopies, including copies of the verification of identity documents supplied are unaltered, exact copies of the corresponding originals. The undersigned hereby authorizes TRADEVIEW LTD to verify any or all of the foregoing information through any means deemed proper by TRADEVIEW LTD. Client’s Name Client’s Signature Tradeview’s Signature Date Date The undersigned hereby acknowledges and certifies that he/she is neither a citizen, (whether natural or naturalized, if applicable) nor a permanent resident of the United States and has not been granted any visa authorizing him/her to reside, work or otherwise be legally present in the United States. The undersigned further certifies that he/she will not attempt to fund any account maintained at TRADEVIEW LTD (‘TRADEVIEW LTD’) with a banking or credit card account maintained under a United States address. The undersigned attests and agrees that should he/she become a citizen of, a permanent resident of, or obtain any form of visa authorizing him/her to reside and/or work within, the United States the undersigned is obligated to inform TRADEVIEW LTD immediately. The undersigned hereby acknowledges and agrees that should any certification contained herein be false or inaccurate TRADEVIEW LTD is authorized to immediately close any and all accounts maintained by the undersigned at TRADEVIEW LTD, including the closure of any open positions with no liability placed upon TRADEVIEW LTD for market loss as a result of such. The undersigned hereby authorizes TRADEVIEW LTD to verify any or all of the f...
Acknowledgement and Signature. By my signature below, I acknowledge that I have received, read, understand, and will abide by the terms and conditions set forth in this General Hold Harmless Agreement:
Acknowledgement and Signature. I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT that is binding upon myself and my heirs, executors, administrators, successors and assigns. I HAVE READ AND UNDERSTAND THE TERMS OF THIS AGREEMENT and I ACKNOWLEDGE THAT by signing this agreement voluntarily, I am agreeing to abide by its terms and I am waiving certain legal rights that my child or I may have.
