Signature of Participant. If you are only coaching and do not have a child playing, please sign this page only:
Signature of Participant. Check one: 18 years of age or older Under 18 years of age (Parent/Guardian consent required)
Signature of Participant. Print name of Participant
Signature of Participant. (if the participant is under the age of 18, his/her parent or legal guardian must sign instead)
Signature of Participant. I, the undersigned participant, certify to the current SIMPLE IRA custodian or trustee that I have established a successor SIMPLE Individual Retirement Custodial Account meeting the requirements of Internal Revenue code section 408(p) to which assets will be transferred, and I certify to UMB Bank, n.a., that the SIMPLE IRA from which assets are being transferred meets the requirements of Internal Revenue code section 408(p) (and that the transfer satis- fies the requirement for a nontaxable transaction). Signature of Participant Date Medallion Signature Guarantee (only if required by current SIMPLE IRA Sponsor) Affix Medallion Signature Guarantee here: Signature guaranteed by: Signature of officer and title UMB Bank, n.a., agrees to accept transfer of the above amount for deposit to the participant’s UMB Bank, n.a., SIMPLE Individual Retirement Custodial Account, and requests the liquidation and transfer of assets as indicated above. See attached Letter of Acceptance for the signature of an authorized officer of the custodial agent. Form 5305-SA under section 408(p) of the Internal Revenue Code. FORM (Rev. April 2017) The participant named on the application is establishing a savings incentive match plan for employees of small employers individual retirement account (SIMPLE IRA) under sections 408(a) and 408(p) to provide for his or her retirement and for the support of his or her beneficiaries after death. The custodian named on the application has given the participant the dis- closure statement required by Regulations section 1.408-6. The participant and the custodian make the following agreement:
ARTICLE I The custodian will accept cash contributions made on behalf of the partic- ipant by the participant’s employer under the terms of a SIMPLE IRA plan described in section 408(p). In addition, the custodian will accept transfers or rollovers from other SIMPLE IRAs of the participant and, after the two- year period of participation defined in section 72(t)(6), transfers or rollovers from any eligible retirement plan (as defined in section 402(c)(8)(B)) other than a Xxxx XXX or a designated Xxxx account. No other contributions will be accepted by the custodian.
ARTICLE II The participant’s interest in the balance in the custodial account is nonfor- feitable.
1. No part of the custodial account funds may be invested in life insurance contracts, nor may the assets of the custodial account be commingled with other property except in a common trust fund or co...
Signature of Participant. IF 18 YEARS OF AGE OR OVER Date:
Signature of Participant. If participant is a minor under the age of 16 (“Child”), signature of parent or responsible adult is required below:
Signature of Participant. If under the age of eighteen years, please have a parent or guardian also sign below: Signature of Parent or Guardian
Signature of Participant. Signed: ........................................ Date: ...........................................
Signature of Participant. The Participant named above executed this document in my presence.
