CUSTODIAL SIMPLE IRA PARTICIPANT ADOPTION AGREEMENTCustodial Simple Ira Participant Adoption Agreement • December 14th, 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 : ACCOUNT INFORM ATION Employer Name and Address Employer Account Number SSN/EIN Date of Initial Deposit (Note: If this account is established due to a rollover or transfer from another SIMPLE IRA, the initial deposit date refers to the date a deposit was made to this plan with the previous trustee/custodian.) 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 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, if no select
