Custodial Roth Individual retirement Account Adoption AgreementCustodial Roth Individual Retirement Account Adoption Agreement • November 29th, 2007
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: □□ Rollover 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: Per Capita – To the remaining primary Beneficiaries named on this form proportionately (or if there are no primary Beneficiaries, to the contingent Beneficiaries listed).Per Stirpes – Equally to such Beneficiary’s descendents, who survive you, by right of representation. Please note, if no selection is made the Per Capita de
CUSTODIAL ROTH INDIVIDUAL RETIREMENT ACCOUNT ADOPTION AGREEMENTCustodial Roth Individual Retirement Account Adoption Agreement • May 19th, 2008
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: □□ Rollover 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: Per Capita – To the remaining primary Beneficiaries named on this form proportionately (or if there are no primary Beneficiaries, to the contingent Beneficiaries listed).Per Stirpes – Equally to such Beneficiary’s descendents, who survive you, by right of representation. Please note, if no selection is made the Per Capita de
Custodial Roth Individual retirement Account Adoption AgreementCustodial Roth Individual Retirement Account Adoption Agreement • November 6th, 2008
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 note,
CUSTODIAL ROTH INDIVIDUAL RETIREMENT ACCOUNT ADOPTION AGREEMENTCustodial Roth Individual Retirement Account Adoption Agreement • December 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
