Common Contracts
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CUSTODIAL ROTH INDIVIDUAL RETIREMENT ACCOUNT ADOPTION AGREEMENTDecember 13th, 2010
SECT I O N ONE : CLI E N T IN F OR M ATION Name and Address SSN Date of Birth SECT I O N TWO : TYP E O F CONTR I BUT ION Select One: □ Roth IRARollover within 60 days from another Roth IRA (complete Rollover Certification)Transfer from another Roth IRA □□ Direct rollover of Roth deferrals from a Roth 401(k)/403(b) (complete Rollover Certification)Conversion from Traditional, SEP, or SIMPLE IRA or Employer-Sponsored Plan □ □ SECT I O N THR EE : BENEFICIARY DES IGNATION 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 remaining primary Beneficiaries, to the contingent Beneficiaries listed).Per Stirpes – Equally to such Beneficiary’s descendents, who survive you, by right of representation. Please n
