Exhibit 14.2
Application
THE OAKMARK FAMILY OF FUNDS
STATE STREET BANK AND TRUST COMPANY
INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT
APPLICATION AND ADOPTION AGREEMENT ("ADOPTION AGREEMENT")
I, the person signing this Adoption Agreement (hereinafter called the
"Depositor"), establish an Individual Retirement Account (XXX), which is either
a Regular XXX or a Xxxx XXX, as indicated below, (the "Account") with State
Street Bank and Trust Company as Custodian ("Bank"). A Regular XXX operates
under Internal Revenue Code Section 408(a). A Xxxx XXX operates under Internal
Revenue Code Section 408A. I agree to the terms of my Account, which are
contained in the applicable provisions of the document entitled "State Street
Bank and Trust Company Individual Retirement Custodial Account" and this
Adoption Agreement. I certify the accuracy of the information in this Adoption
Agreement. My Account will be effective upon acceptance by Bank.
PART 1. DEPOSITOR INFORMATION
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Print Full Name Social Security
Number
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Address Date of Birth
( )
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City State Zip Daytime Telephone
No.
PART 2. XXX ELECTION
INSTRUCTIONS: To establish a Regular XXX, check Box A and complete Part A. To
establish a Xxxx XXX, check Box B and complete Part B. (In either case, complete
Part 3 to select your investment choices, and sign at the end of Part 5.)
[ ] A. REGULAR XXX By checking this box, I designate my Account as a Regular
XXX under Code Section 408(a). (Complete 1, 2, 3 or 4 below to indicate the type
of Regular XXX you are opening. Check box 5, if applicable.)
1. [ ] ANNUAL CONTRIBUTIONS
Current Contribution for the tax year.
Check enclosed for $.
This contribution does not exceed the maximum permitted amount as described
in the Regular XXX Disclosure Statement.
2. [ ] TRANSFER
[ ] Transfer of existing Regular XXX directly from current Custodian or
Trustee. Complete the XXX Transfer of Assets Form.
[ ] The transferring XXX held annual contributions by me (or amounts
transferred or rolled over from another XXX holding annual contributions).
[ ] The transferring XXX held only amounts that were originally contributions
to an employer qualified plan or 403(b) plan.
3. [ ] ROLLOVER
The requirements for a valid rollover are complex. See the Regular XXX
Disclosure Statement for additional information and consult your tax advisor for
help if needed. Check enclosed for $.
[ ] Rollover of a qualifying rollover distribution to Depositor from an
employer plan or 403(b) arrangement, or rollover from another Regular XXX
which held only assets distributed to Depositor from an employer plan or
403(b) arrangement and to which Depositor made no direct contributions.
[ ] Rollover of distribution to Depositor from another Regular XXX that held
amounts that originated from annual contributions by the Depositor.
4. [ ] DIRECT ROLLOVER
[ ] Direct rollover of an eligible distribution from a qualified plan.
[ ] Direct rollover of an eligible distribution from a 403(b) account or
annuity.
Direct rollovers are described in the Regular XXX Disclosure Statement.
5. [ ] SEP PROVISION_ check here if the Depositor intends to use this
Account in connection with a SEP Plan or grandfathered SARSEP Plan
established by the Depositor's employer.
[ ] X. XXXX IRA_ By checking this box, I designate my Account as a Xxxx XXX
under Code Section 408A. (Complete 1, 2, 3 or 4 below to indicate the type of
Xxxx XXX you are opening.)
1. [ ] ANNUAL CONTRIBUTIONS
Current Contribution for the tax year .
Check enclosed for $.
This contribution does not exceed the maximum permitted amount as described
in the Xxxx XXX Disclosure Statement.
2. [ ] CONVERSION OF AN EXISTING OAKMARK FUNDS REGULAR XXX TO A XXXX XXX.
Current Regular XXX Account No.:
Amount Converted
[ ] All
[ ] Part (specify how much): $
3. [ ] ROLLOVER OR TRANSFER FROM EXISTING REGULAR XXX TO A XXXX XXX*
4. [ ] ROLLOVER OR TRANSFER FROM EXISTING XXXX XXX TO A XXXX XXX*
Date existing Xxxx XXX was originally opened:
Indicate whether any amount in the existing Xxxx XXX represents amounts
converted or transferred from a Regular XXX into such other Xxxx XXX:
[ ] Yes [ ] No
If yes, date of the most recent conversion or transfer into such other
Xxxx:
* Complete the XXX Transfer of Assets Form if either 3 or 4 is checked
and the transaction is a transfer (as opposed to a rollover).
Note: If a conversion, rollover or transfer from a Regular XXX to a Xxxx
XXX is being made, only amounts converted, rolled over or transferred
during the same tax year will be accepted in a single Xxxx XXX. A separate
Xxxx XXX must be established to hold such amounts from a different tax
year. Annual contributions may not be deposited in a Xxxx XXX holding such
converted, rolled over or transferred amounts.
PART 3. INVESTMENTS
Invest contributions to my Account as follows:
Minimum investment per fund $1,000.
Oakmark % or $
Oakmark Select %
Oakmark Equity & Income %
Oakmark International %
Oakmark International %
Small Cap
Must Total 100%
$5 Setup fee [ ] enclosed or
[ ] deduct
$10 Annual fee [ ] enclosed or
[ ] deduct
I acknowledge that I have sole responsibility for my investment choices and
that I have received a current prospectus. Please read the prospectus before
investing.
PART 4. DESIGNATION OF BENEFICIARY
As Depositor, I hereby make the following designation of beneficiary in
accordance with the State Street Bank and Trust Company Regular Individual
Retirement Custodial Account, or Xxxx Individual Retirement Custodial Account:
In the event of my death, pay any interest I may have under my Account to
the following Primary Beneficiary or Beneficiaries who survive me. Make payment
in the proportions specified below (or in equal proportions if no different
proportions are specified). If any Primary Beneficiary predeceases me, his share
is to be divided among the Primary Beneficiaries who survive me in the relative
proportions assigned to each such surviving Primary Beneficiary.
PRIMARY BENEFICIARY OR BENEFICIARIES:
Name Relationship Date of Social Security Proportion
Birth Number
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If none of the Primary Beneficiaries survives me, pay any interest I may
have under my Account to the following Alternate Beneficiary or Beneficiaries
who survive me. Make payment in the proportions specified below (or in equal
proportions if no different proportions are specified). If any Alternate
Beneficiary predeceases me, his share is to be divided among the Alternate
Beneficiaries who survive me in the relative proportions assigned to each such
surviving Alternate Beneficiary.
ALTERNATE BENEFICIARY OR BENEFICIARIES:
Name Relationship Date of Social Security Proportion
Birth Number
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IMPORTANT: This Designation of Beneficiary may have important tax or estate
planning effects. Also, if you are married and reside in a community property or
marital property state (Arizona, California, Idaho, Louisiana, Nevada, New
Mexico, Texas, Washington or Wisconsin), you may need to obtain your spouse's
consent if you have not designated your spouse as primary beneficiary for at
least half of your Account. See your lawyer or other tax professional for
additional information and advice.
SPOUSAL This section should be reviewed if the accountholder is married
CONSENT and designates a beneficiary other than the
spouse. It is the accountholder's responsibility to determine if this
section applies. The accountholder may need to consult with legal
counsel. Neither the Custodian nor the Sponsor are liable for any
consequences resulting from a failure of the accountholder to provide
proper spousal consent.
I am the spouse of the above-named accountholder. I
acknowledge that I have received a full and reasonable disclosure of
my spouse's property and financial obligations. Due to any possible
consequences of giving up my community property interest in this XXX,
I have been advised to see a tax professional or legal advisor.
I hereby consent to the beneficiary designation(s)
indicated above. I assume full responsibility for any adverse
consequence that may result. No tax or legal advice was given to me
by the Custodian or Sponsor.
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Signature of Spouse Date
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Signature of Witness for Spouse Date
PART 5. CERTIFICATIONS AND SIGNATURES
If the Depositor has indicated a Regular XXX Rollover or Direct Rollover
above, Depositor certifies that the contribution does not include any employee
contributions to any qualified plan (other than accumulated deductible employee
contributions) or 403(b) arrangement; that any assets transferred in kind by
Depositor are the same assets received by the Depositor in the distribution
being rolled over; if the distribution is from another Regular XXX, that
Depositor has not made another rollover within the one-year period immediately
preceding this rollover; that such distribution was received within 60 days of
making the rollover to this Account; and that no portion of the amount rolled
over is a required minimum distribution under the required distribution rules.
If Depositor has indicated a Conversion, Transfer or a Rollover of an
existing Regular XXX to a Xxxx XXX, Depositor acknowledges that the amount
converted will be treated as taxable income (except for prior nondeductible
contributions) for federal income tax purposes. If Depositor has indicated a
Rollover from another Xxxx XXX (Item 4 of Part B above), Depositor certifies
that the information given in Item 4 is correct and acknowledges that adverse
tax consequences or penalties could result from giving incorrect information.
Depositor has received and read the applicable sections of the "State
Street Bank and Trust Company Universal Individual Retirement Account Disclosure
Statement" relating to this Account (including the Custodian's fee schedule),
the Custodial Account document, and the "Instructions" pertaining to this
Agreement. Depositor acknowledges receipt of the Universal Individual Retirement
Custodial Account document and Universal XXX Disclosure Statement at least 7
days before the date inscribed below and acknowledges that Depositor has no
further right of revocation.
Depositor acknowledges and understands that the beneficiaries named herein
may be changed or revoked at any time by filing a new designation in writing
with the Custodian. All forms must be acceptable to the Custodian and dated and
signed by the Depositor.
Under penalty of perjury, I hereby certify that I am NOT currently subject
to IRS backup withholding. (Cross out "NOT" if you are currently subject to
withholding.)
Under penalty of perjury, I hereby certify that the Taxpayer Identification
Number given is correct.
The Internal Revenue Service does not require your consent to any provision
of this document other than the certifications required to avoid backup
withholding.
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Signature of Depositor
Date
Custodian Acceptance. State Street Bank and Trust Company will accept
appointment as Custodian of the Depositor's Account. However, this Agreement is
not binding upon the Custodian until the Depositor has received a statement of
the transaction. Receipt by the Depositor of a confirmation of the purchase of
the Fund shares indicated above will serve as notification of State Street Bank
and Trust Company's acceptance of appointment as Custodian of the Depositor's
Account.
STATE STREET BANK AND TRUST COMPANY, CUSTODIAN
By
Date
If the Depositor is a minor under the laws of the Depositor's state of
residence, a parent or guardian must also sign the Agreement here. Until the
Depositor reaches the age of majority, the parent or guardian will exercise the
powers and duties of the Depositor.
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Signature of Parent or Guardian
RETAIN A PHOTOCOPY OF THE COMPLETED AGREEMENT FOR YOUR RECORDS
