Common use of Financial Institution Where IRA is established to Provide Information Clause in Contracts

Financial Institution Where IRA is established to Provide Information. The financial institution must provide you with a disclosure statement that contains information described in section 1.408-6 of the regulations. The Disclosure Statement that is a part of this Custodian's SIMPLE IRA account documentation must be read in conjunction with this Summary Description for Non-Designated Financial Institutions. The Disclosure Statement contains important information about the SIMPLE plan rules and the contents of such Disclosure Statement are incorporated herein by reference. See Publications 590-A and 590-B, "Individual Retirement Arrangements", which is available at most IRS offices, for a more complete explanation of the disclosure requirements. In addition to the disclosure statement, the financial institution is required to provide you with a financial statement each year. It may be necessary to retain and refer to statements for more than one year in order to evaluate the investment performance of your IRA and in order that you will know how to report IRA distributions for tax purposes. PARTICIPANT INFORMATION SIMPLE IRA ADOPTION AGREEMENT Name: Account No.: Address: SSN: Home Phone #: Bus. Phone #: Birthdate: Date Age 59½: Year Age 70½: Check one EMPLOYER INFORMATION Name: Contact Person: Married Unmarried Address: Phone #: ACCOUNT INFORMATION CUSTODIAN INFORMATION Date of Initial Deposit Name: Elective Deferral Amount $ Notice of revocation must be delivered or mailed to: Employer Contribution Amount $ Contact Person's Name: Rollover from another Plan $ Address: Indicate Plan: Transfer from SIMPLE IRA $ Transfer received from Phone #: The Custodian is the: BENEFICIARY DESIGNATION Description) Non-DFI (Employer must complete the enclosed Summary Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % In the event of my death, the balance in the account shall be paid to the Primary Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). If the Primary or Contingent Beneficiary box is not checked for a beneficiary, the beneficiary will be deemed to be a Primary Beneficiary. If none of the Primary Beneficiaries survive me, the balance in the account shall be paid to the Contingent Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). CONSENT OF SPOUSE (if required) I consent to the above Beneficiary Designation. Signature of Spouse Date (Note: Consent of the Participant's Spouse may be required in a community property or marital property state to effectively designate a beneficiary other than or in addition to the Participant's Spouse.)

Financial Institution Where IRA is established to Provide Information. The financial institution must provide you with a disclosure statement that contains information described in section 1.408-6 of the regulations. The Disclosure Statement that is a part of this Custodian's SIMPLE IRA account documentation must be read in conjunction with this Summary Description for Non-Designated Financial Institutions. The Disclosure Statement contains important information about the SIMPLE plan rules and the contents of such Disclosure Statement are incorporated herein by reference. See Publications 590-A and 590-B, "Individual Retirement Arrangements", which is available at most IRS offices, for a more complete explanation of the disclosure requirements. In addition to the disclosure statement, the financial institution is required to provide you with a financial statement each year. It may be necessary to retain and refer to statements for more than one year in order to evaluate the investment performance of your IRA and in order that you will know how to report IRA distributions for tax purposes. PARTICIPANT INFORMATION SIMPLE IRA ADOPTION AGREEMENT Name: Account No.: Address: SSN: Home Phone #: Bus. Phone #: Birthdate: Date Age 59½: Year Age 70½: Check one EMPLOYER INFORMATION Name: Contact Person: Married Unmarried Address: Phone #: ACCOUNT INFORMATION CUSTODIAN INFORMATION Date of Initial Deposit Name: Elective Deferral Amount $ Notice of revocation must be delivered or mailed to: Employer Contribution Amount $ Contact Person's Name: Rollover from another Plan $ Address: Indicate Plan: Transfer from SIMPLE IRA $ Transfer received from Phone #: The Custodian is the: BENEFICIARY DESIGNATION Description) Non-DFI (Employer must complete the enclosed Summary BENEFICIARY DESIGNATION Description) Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % In the event of my death, the balance in the account shall be paid to the Primary Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). If the Primary or Contingent Beneficiary box is not checked for a beneficiary, the beneficiary will be deemed to be a Primary Beneficiary. If none of the Primary Beneficiaries survive me, the balance in the account shall be paid to the Contingent Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). CONSENT OF SPOUSE (if required) I consent to the above Beneficiary Designation. Signature of Spouse Date (Note: Consent of the Participant's Spouse may be required in a community property or marital property state to effectively designate a beneficiary other than or in addition to the Participant's Spouse.)

Financial Institution Where IRA is established to Provide Information. The financial institution must provide you with a disclosure statement that contains the following items of information described in section 1.408-6 plain nontechnical language: 1. The statutory requirements that relate to the IRA; 2. The tax consexxxnces that follow the exercise of various options and what those options are; 3. Participation eligibility rules, and rules on the deductibility and nondeductibility of retirement savings; 4. The circumstances and procedures under which you may revoke the IRA, including the name, address, xxd telephone number of the regulations. The Disclosure Statement that is a part person designated to receive notice of revocation (this Custodian's SIMPLE IRA account documentation explanation must be read prominently displayed at the beginning of the disclosure statement); 5. Explanations of when penalties may be assessed against you because of specified prohibited or penalized activities concerning the IRA; and 6. Financial xxsclosure information which: (a) Either projects value growth rates of the IRA under various contribution and retirement schedules, or describes the method of computing and allocating annual earnings and charges which may be assessed; (b) Describes whether, and for what period, the growth projections for the plan are guaranteed, or a statement of earnings rate and terms on which these projections are based; and (c) States the sales commission to be charged in conjunction with this Summary Description for Non-Designated Financial Institutions. The Disclosure Statement contains important information about the SIMPLE plan rules and the contents each year expressed as a percentage of such Disclosure Statement are incorporated herein by reference$1,000. See Publications Publication 590-A and 590-B, "Individual Retirement Arrangements", ," which is available at most IRS offices, for a more complete explanation of the disclosure requirements. In addition to the disclosure statement, the financial institution is required to provide you with a financial statement each year. It may be necessary to retain and refer to statements for more than one year in order to evaluate the investment performance of your IRA and in order that you will know knxx how to report IRA distributions for tax purposesxurposes. PARTICIPANT INFORMATION SIMPLE IRA ADOPTION AGREEMENT Name: Individual Retirement Custodial Account No.: Address: SSN: Home Phone #: BusAgreement IRS Approval Serial Number D110849b By signing the Application, you establish an Individual Retirement Custodial Account sponsored by The Dreyfus Corporation ("we" or "us") and The Dreyfus Trust Company (the "Custodian"), by countersigning the Application, accepts the Custodianship upon the following conditions. Phone #: Birthdate: Date Age 59½: Year Age 70½: Check one EMPLOYER INFORMATION Name: Contact Person: Married Unmarried Address: Phone #: ACCOUNT INFORMATION CUSTODIAN INFORMATION Date You intend this account ("Account") be administered and this Agreement be interpreted to qualify at all times as an Individual Retirement Account ("IRA") under section 408 of Initial Deposit Name: Elective Deferral Amount $ Notice the Inxxxnal Revenue Code of revocation must be delivered or mailed to: Employer Contribution Amount $ Contact Person's Name: Rollover from another Plan $ Address: Indicate Plan: Transfer from SIMPLE IRA $ Transfer received from Phone #: 1986, as amended (the "Code"). The Custodian Account is the: BENEFICIARY DESIGNATION Description) Non-DFI established for the exclusive benefit of you and your designated beneficiary (Employer must complete "Beneficiary"), and solely for the enclosed Summary Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % In the event of my death, the balance purpose stated in this Agreement. Your interest in the account Account shall at all times be paid to the Primary Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). If the Primary or Contingent Beneficiary box is not checked for a beneficiary, the beneficiary will be deemed to be a Primary Beneficiary. If none of the Primary Beneficiaries survive me, the balance in the account shall be paid to the Contingent Beneficiaries who survive me in equal shares (or in the specified shares, if indicated). CONSENT OF SPOUSE (if required) I consent to the above Beneficiary Designation. Signature of Spouse Date (Note: Consent of the Participant's Spouse may be required in a community property or marital property state to effectively designate a beneficiary other than or in addition to the Participant's Spousenonforfeitable.)

Financial Institution Where IRA is established to Provide Information. The financial institution must provide you with a disclosure statement that contains information described in section 1.408-6 of the regulations. The Disclosure Statement that is a part of this Custodian's SIMPLE IRA account documentation must be read in conjunction with this Summary Description for Non-Designated Financial Institutions. The Disclosure Statement contains important information about the SIMPLE plan rules and the contents of such Disclosure Statement are incorporated herein by reference. See Publications 590-A and 590-B, "Individual Retirement Arrangements", which is available at most IRS offices, for a more complete explanation of the disclosure requirements. In addition to the disclosure statement, the financial institution is required to provide you with a financial statement each year. It may be necessary to retain and refer to statements for more than one year in order to evaluate the investment performance of your IRA and in order that you will know how to report IRA distributions for tax purposes. PARTICIPANT INFORMATION SIMPLE IRA ADOPTION AGREEMENT Name“Reproduction” Internal Revenue Service Department of the Treasury Washington, DC 20224 Person to Contact: Account No.Xx. X. Garcia Xxxxxx Xxxxxxxxxx Xxxxx, Inc. Telephone Number: Address: SSN: Home Phone #: Bus. Phone #: Birthdate: Date Age 59½: Year Age 70½: Check one EMPLOYER INFORMATION Name: Contact Person: Married Unmarried Address: Phone #: ACCOUNT INFORMATION CUSTODIAN INFORMATION Date of Initial Deposit Name: Elective Deferral Amount $ Notice of revocation must be delivered or mailed 5 Penn Center (000) 000-0000 Philadelphia, PA 19103 Refer Reply to: Employer Contribution Amount $ Contact Person's NameE:EP:T:3 EIN: Rollover from another Plan $ Address00-0000000 Date: Indicate PlanMarch 23, 1982 Gentlemen: Transfer from SIMPLE IRA $ Transfer received from Phone #: The Custodian is the: BENEFICIARY DESIGNATION DescriptionYou have requested a determination that Xxxxxx Xxxxxxxxxx Xxxxx, Inc. may act as a passive trustee or custodian of plans benefiting owner-employees (Xxxxx plans) Nonand Individual Retirement Accounts (IRAs) as provided in section 1.401-DFI 12(n) of the Income Tax Regulations. Sections 401(d)(1) and 408(a)(2) of the Internal Revenue Code, as amended by the Employee Retirement Income Security Act of 1974 (Employer must complete ERISA), requires a trustee or custodian of Xxxxx plans and IRAs to be a bank or such other person who demonstrates to the enclosed Summary Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % Primary Contingent Name: SSN: Birthdate: Address: Relationship: Share: % In satisfaction of the event Commissioner that he will administer such trusts in accordance with the requirements of my deathsections 401 and 408, respectively. Additionally, section 401(f) of the balance in the Code provides that a custodial account shall be paid treated as a qualified trust under this section if such custodial account would, except for the fact it is not a trust, constitute a qualified trust under this section and the custodian is a bank (as defined in section 401(d)(1)) or other person who demonstrates to the Primary Beneficiaries who survive me satisfaction of the Commissioner that the manner in equal shares (or in which such other plan will hold the specified shares, if indicated). If the Primary or Contingent Beneficiary box is not checked for a beneficiary, the beneficiary assets will be deemed to be a Primary Beneficiary. If none consistent with the requirements of section 401 of the Primary Beneficiaries survive me, the balance in the account shall be paid to the Contingent Beneficiaries who survive me in equal shares (or in the specified shares, if indicated)Code. CONSENT OF SPOUSE (if requiredSection 408(h) I consent to the above Beneficiary Designation. Signature provides similar rules for custodians of Spouse Date (Note: Consent of the Participant's Spouse may be required in a community property or marital property state to effectively designate a beneficiary other than or in addition to the Participant's Spouseindividual retirement accounts.)