Common Contracts
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CUSTODIAL INDIVIDUAL RETIREMENT ACCOUNT ADOPTION AGREEMENTDecember 13th, 2010
SECT I O N ONE : CLI E N T IN F OR M ATION Name and Address Date of Birth SSN SECT I O N TWO : TYP E O F CONTR I BUT ION Select One: IR □IR □ RR □ IRAIRA Rollover from Qualified Plan, TSA/403(b), or Governmental 457(b) - Commingled (Complete Rollover Certification)IRA Rollover from Qualified Plan, TSA/403(b), or Governmental 457(b) - Segregated (Complete Rollover Certification) DI □IP □ IS □ Decedent IRASEP/IRA Business Name: (Attach copy of employer’s SEP document.)Employer’s SEP or SAR/SEP Account Number: SAR/SEP Business Name: (Attach copy of SEP form.)Employer’s SEP or SAR/SEP Account Number: SECT I O N THR EE : BENEF IC I ARY DESI G N AT I O N Relationship Definitions: S=Spouse N=Nonspouse E=Entity T=Trust (Mark one in the box provided.) At each Beneficiary designation, indicate if such Beneficiary dies before you, how their portion should be paid: Pro Rata – To the remaining primary Beneficiaries named on this form proportionate to their relative percentages (or if there are no r
