INDIVIDUAL RETIREMENT ACCOUNT ADOPTION AGREEMENT
FOR NEW IRAS
Use this form to open a new IRA, IRA R/O (Conduit), Xxxx XXX, Xxxx Conversion
IRA, SEP IRA, and/or SAR SEP. If you have an existing IRA of one of the types
listed above invested in the BARON FUNDS group of funds, you may open an
additional IRA of a different type by completion of a shorter form,
"AUTHORIZATION TO ADD AN IRA".(Do not use this application to open a SIMPLE IRA
or Education IRA.)Please use one application form for each IRA type.
For information or to request forms call 0-000-000-0000.
SEND ALL COMPLETED DOCUMENTATION TO: BARON FUNDS, P.O. BOX 419946, KANSAS CITY,
MO 64141-6946 ANNUAL MAINTENANCE FEE FOR ACCOUNTS LESS THAN $10,000 IS $12.
PARTICIPANT INFORMATION
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First Name Initial Last Name
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Social Security # Date of Birth
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Address
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City State Zip Code
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Daytime Phone Number Home Phone Number
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Name and Firm of Representative Representative's Phone Number
NEW ACCOUNT INFORMATION
Please select one IRA type, mark investment type, and complete requested
investment information.
DOLLARS CONTRIBUTION SPECIAL
IRA TYPE INVESTMENT TYPE INVESTED TAX YEAR FORM
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o Regular IRA
o IRA deductible or nondeductible Contribution $------ -------
o Direct Transfer from existing IRA $------ [ ]
o Rollover within 60 days of receipt from a regular IRA $------
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o Rollover IRA (Conduit)
o Direct Rollover payable to IFTC from 403(b)
or employer qualified plan $------
o Direct Transfer from existing Conduit IRA $------ [ ]
o Rollover within 60 days of receipt from 403(b) or
employer qualified plan $------
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o Xxxx XXX
o Xxxx XXX nondeductible Contribution $------ -------
o Direct Transfer from existing Xxxx XXX
with original start date --/--/-- $------ [ ]
o Rollover within 60 days from Xxxx XXX
with original start date --/--/-- $------
DOLLARS CONTRIBUTION SPECIAL
IRA TYPE INVESTMENT TYPE INVESTED TAX YEAR FORM
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x Xxxx Converted IRA
o Convert my existing NonBaron Funds to a
regular IRA to a Xxxx Converted IRA $------- [ ]
o Convert my existing Baron Funds IRA to a
Xxxx Converted IRA
o Direct Transfer from existing Xxxx Converted IRA
with original start date --/--/-- $------- [ ]
o Rollover within 60 days from Xxxx Converted IRA
with original start date --/--/-- $-------
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o SEP IRA
o SEP Employer (or self employed) Contribution $------- -------
o Direct Transfer from existing SEP IRA $------- [ ]
o Rollover within 60 days of receipt from a SEP IRA $-------
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o SAR SEP IRA plan established before 1997
o SEP Employee Salary Reduction $------- -------
o Direct Transfer from existing SAR SEP IRA $------- [ ]
o Rollover within 60 days of receipt from a SAR SEP IRA $-------
[ ] COMPLETE AND ENCLOSE "AUTHORIZATION FOR IRA TRANSFER, DIRECT ROLLOVER &
CONVERSION". Please call 0-000-000-0000 to request Authorization forms.
INVESTMENT INSTRUCTIONS
PLEASE ALLOCATE MY PURCHASE AS FOLLOWS:
If opening more than one type of IRA with this form, please give the reference
number of the account beside the investment instruction.
NAME OF FUND AMOUNT
BARON ASSET FUND ------------------------------------------------
BARON GROWTH & INCOME FUND ------------------------------------------------
XXXXX XXXXX CAP FUND ------------------------------------------------
DESIGNATION OF BENEFICIARIES
I designate the individual(s) named below the Beneficiary(ies) of this IRA. I
revoke all prior IRA Beneficiary designations, if any, made by me for these
assets. I understand that I may change or add Beneficiaries at any time by
written notice to the Custodian. If I am not survived by any Beneficiary, my
Beneficiary shall be my estate. (If no percentage is specified, primary
beneficiaries will share the account balance equally.)
PRIMARY BENIFICIARY(IES)
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First Name Initial Last Name Relationship
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Social Security Number Date of Birth % of Account
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Address
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First Name Initial Last Name Relationship
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Social Security Number Date of Birth % of Account
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Address
CONTINGENT BENIFICIARY(IES)
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First Name Initial Last Name Relationship
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Social Security Number Date of Birth % of Account
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Address
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First Name Initial Last Name Relationship
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Social Security Number Date of Birth % of Account
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Address
SPOUSAL CONSENT
(This section should be reviewed if the accountholder is married, is a resident
of a community property or marital property state, 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 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 IRA, 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
CERTIFICATION AND SIGNATURES
If the Depositor has indicated a Regular IRA 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; if the distribution is from another
Regular IRA, that Depositor has not made another rollover within the oneyear
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 or a Rollover of an existing Regular IRA
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, Depositor certifies that the information given above 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 "Universal
Individual Retirement Account Disclosure Statement" relating to this Account.
The Custodial Account document, and the "Instructions" pertaining to this
Adoption Agreement.
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.
If the Depositor is a minor under the laws of the Depositor's state of
residence, a parent or guardian must sign the Adoption Agreement. 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 Depositor Date
CUSTODIAN ACCEPTANCE: Investors Fiduciary 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 Investors Fiduciary
Trust Company's acceptance of appointment as Custodian of the Depositor's
Account.
INVESTORS FIDUCIARY TRUST COMPANY, CUSTODIAN
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Signature of Custodian
RETAIN A PHOTOCOPY OF THIS FORM FOR YOUR RECORDS
AUTHORIZATION TO ADD AN IRA
USE THIS FORM TO OPEN AN ADDITIONAL IRA IF YOU HAVE AN EXISTING IFTC IRA
INVESTED IN THE BARON FUNDS.(THIS FORM IS NOT REQUIRED TO OPEN AN INVESTMENT
ACCOUNT IN AN ADDITIONAL FUND OF THE SAME FUND GROUP IN THE SAME TYPE IRA.) DO
NOT USE FORM TO OPEN A SIMPLE IRA. FOR SIMPLE IRA INFORMATION CALL
00000000000.SEND ALL COMPLETED DOCUMENTATION TO: BARON FUNDS, P.O. BOX 419946,
KANSAS CITY, MO 641416946
REQUEST FOR ADDITIONAL IRA
Please open an additional Individual Retirement Account (IRA) for which I
authorize the identical mutual fund for investment, address, accountholder
birthdate, social security number, and beneficiary information as that shown on
the existing account referenced below. For information on how to make future
changes to your IRA, call 18004423814. Annual Maintenance Fee for accounts less
than $10,000 is $12.
EXISTING ACCOUNT INFORMATION
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Existing IRA account number Fund
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Social Security #
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First Name Initial Last Name (on existing XXX)
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Daytime Phone Number Home Phone Number
NEW ACCOUNT INVESTMENT INFORMATION
Please select one IRA type, mark investment type, and complete requested
investment information.
DOLLARS CONTRIBUTION SPECIAL
IRA TYPE INVESTMENT TYPE INVESTED TAX YEAR FORM
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o Regular IRA
o IRA deductible or nondeductible Contribution $------ ------
o Direct Transfer from existing IRA $------ [ ]
o Rollover within 60 days of receipt from a regular IRA $------
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o Rollover IRA (Conduit)
o Direct Rollover payable to IFTC from
403(b) or employer qualified plan $------
o Direct Transfer from existing Conduit IRA $------ [ ]
o Rollover within 60 days of receipt from 403(b)
or employer qualified plan $------
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o Xxxx XXX
o Xxxx XXX nondeductible Contribution $------ -------
o Direct Transfer from existing Xxxx XXX
with original start date --/--/-- $------ [ ]
o Rollover within 60 days from Xxxx XXX
with original start date --/--/-- $------
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x Xxxx Converted IRA
o Convert my existing regular IRA to Xxxx Converted IRA $------ [ ]
o Direct Transfer from existing Xxxx Converted IRA
with original start date --/--/-- $------ [ ]
o Rollover within 60 days from Xxxx Converted IRA
with original start date --/--/-- $------
DOLLARS CONTRIBUTION SPECIAL
IRA TYPE INVESTMENT TYPE INVESTED TAX YEAR FORM
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o SEP IRA
o SEP Employer (or self employed) Contribution $------ ---------
o Direct Transfer from existing SEP IRA $------ [ ]
o Rollover within 60 days of receipt from a SEP IRA $------
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o SAR SEP IRA plan established before 1997
o SEP Employee Salary Reduction $------ ---------
o Direct Transfer from existing SAR SEP IRA $------ [ ]
o Rollover within 60 days of receipt from a SAR SEP IRA $------
[ ]Complete and enclose "Authorization to Transfer/Direct Rollover/Convert IRA
to Xxxx XXX". Please call 00000000000 to request Authorization forms.
CERTIFICATION AND SIGNATURES
If the Depositor has indicated a Regular IRA 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; if the distribution is from another Regular
IRA, that Depositor has not made another rollover within the oneyear 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 or a Rollover of an existing Regular IRA
to a RothIRA, 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, Depositor certifies that the information given above 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 "Universal
Individual Retirement Account Disclosure Statement" relating to this Account.
The Custodial Account document, and the "Instructions" pertaining to this
Adoption Agreement.
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.
If the Depositor is a minor under the laws of the Depositor's state of
residence, a parent or guardian must sign the Adoption Agreement. 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 (AND TITLE IF APPLICABLE) DATE
CUSTODIAN ACCEPTANCE: Investors Fiduciary 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 Investors Fiduciary
Trust Company's acceptance of appointment as Custodian of the Depositor's
Account.
INVESTORS FIDUCIARY TRUST COMPANY, CUSTODIAN
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SIGNATURE OF CUSTODIAN
RETAIN A PHOTOCOPY OF THIS FORM FOR YOUR RECORDS
ACCOUNT APPLICATION
AUTHORIZATION FOR IRA TRANSFER,
DIRECT ROLLOVER & CONVERSION
You may use this form to effect a direct transfer from an IRA to an IRA with
another Custodian; a direct rollover from a Qualified Plan or 403(b) to an IRA;
or a conversion from a regular IRA to a Xxxx XXX. The assets may be from another
fund family or within the BARON Funds. Make sure you attach a copy of your
existing account statement, any other forms required by your current
custodian/trustee, and an IRA Application or "Authorization to Add an IRA" form
if you do not have an existing IRA of the type necessary to receive the assets.
Send all completed documentation to: BARON FUNDS,P.O. Box 419946, Kansas City,
MO 64141-6946 ANNUAL MAINTENANCE FEE IS $12.
PARTICIPANT INFORMATION
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First Name Initial Last Name
--------------------------------- -----------------------
Social Security # Date of Birth
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Address
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City State Zip Code
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Daytime Phone Number Home Phone Number
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Name and Firm of Representative Representative's Phone Number
CURRENT CUSTODIAN ACCOUNT INFORMATION
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Custodian Name Current Fund Name/Class
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Custodian Address Current Account Number
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Additional Fund Name/Class
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Custodian Telephone Number Additional Account Number
INSTRUCTIONS TO MY CURRENT CUSTODIAN
I have established a Baron Funds Individual Retirement Account with Investors
Fiduciary Trust Company as Custodian. Please transferinkind or withdraw assets
from my account in your custody in the following manner and send a check payable
to Investors Fiduciary Trust Company (IFTC) Individual Retirement Account FBO my
name and social security number. Mail to Baron Funds, P.O. Box 419946, Kansas
City, MO 64141-6946
TYPE OF ACCOUNT TO BE TRANSFERRED (CHECK ONE)*
o IRA
o Conduit IRA (direct rollover from my current qualified plan or 403(b))
x Xxxx Contributory Account (Account start date --/--/--)
x Xxxx Conversion Account (Account start date --/--/--)
o SEP IRA
o SARSEP IRA (For plans established prior to 1/1/97)
o SIMPLE IRA transfer to a SIMPLE IRA
o Employers Qualified Plan, 403(b), 401(k), etc..
* Note: You may not transfer from a Xxxx XXX or a simplified employee pension
(SEP)XXX. Transfers to a Regular IRA or SEP IRA may be made from another
Regular IRA or SEP IRA, qualified employer plan, 403(b) arrangement, or a
SIMPLE IRA account (but not until at least 2 years after the first
contribution to your SIMPLE IRA account).
Transfers to a Xxxx XXX are possible only from another Xxxx XXX or from a
Regular IRA, not from other types of taxdeferred accounts. A transfer from a
Regular IRA will trigger federal income tax on the taxable amount transferred
from the Regular IRA. Transfers to a SIMPLE IRA may be made only from another
SIMPLE IRA. During the first two years after a SIMPLE IRA may be made only from
another SIMPLE IRA; after two years, transfers may be made from a SIMPLE IRA to
a Regular IRA..
PORTION OF ACCOUNT TO BE TRANSFERRED (CHECK ONE):
o All of the assets in my account OR $--- or --- % of my account.
o Transfer of Baron Fund shares in kind. Check here to authorize a
transferinkind of Baron Fund shares only from your existing
trustee/custodian to Investors Fiduciary Trust Company.
IF YOU ARE TRANSFERRING A CERTIFICATE OF DEPOSIT IRA CHOOSE ONE OPTION:
o Liquidate prior to maturity date. I am aware that I may incur a penalty for
early withdrawal.
o Liquidate at maturity. (Maturity date must be within 60 days. If the
maturity date is less than 15 days from the date of this request, you may
want to contact your custodian bank to prevent automatic reinvestment of
the account.)
INSTRUCTIONS TO INVESTORS FIDUCIARY TRUST COMPANY
Invest my assets into the IRA and investment type indicated below.
IRA TYPES: (CHOOSE ONE) INVESTMENT TYPES: (CHOOSE ONE)
o Regular IRA o Direct Transfer from existing IRA
o Rollover IRA (Conduit) o Direct Rollover payable to IFTC from 403(b) or employer qualified plan
o Direct Transfer from existing Conduit XXX
x Xxxx IRA o Direct Transfer from existing Xxxx XXX-original start date --/--/--
x Xxxx Conversion IRA o Convert my existing regular IRA to a Xxxx Conversion IRA
o Direct Transfer from existing Xxxx Conversion IRA-
original start date of --/--/--
o SEP IRA o Direct Transfer from existing SEP IRA
o SAR SEP IRA plan o Direct Transfer from existing SAR SEP IRA established before 1997 ------
o SIMPLE IRA o Direct Transfer from existing SIMPLE IRA
PLEASE ALLOCATE MY PURCHASE AS FOLLOWS:
NAME OF FUND ACCOUNT NUMBER AMOUNT
BARON ASSET FUND ------------------- ------------------------
BARON GROWTH & INCOME FUND ------------------- ------------------------
XXXXX XXXXX CAP FUND ------------------- ------------------------
SIGNATURE OF DEPOSITOR
The undersigned certifies to the present IRA custodian or trustee that the
undersigned has established a successor Individual Retirement Custodial Account
meeting the requirements of Internal Revenue Code Section 408(a), 408(p) or 408A
(as the case may be) to which assets will be transferred, and certifies to
Investors Fiduciary Trust Company that the IRA from which assets are being
transferred meets the requirements of Internal Revenue Code Section 408(a),
408(p) or 408A (as the case may be).
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Signature Date
SIGNATURE GUARANTEE (only if required by current Custodian or Trustee).
Signature guaranteed by:
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Name of Bank or Dealer Firm
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Signature of Officer and Title
ACCEPTANCE BY NEW CUSTODIAN
Investors Fiduciary Trust Company agrees to accept transfer of the above amount
for deposit to the Depositor's Investors Fiduciary Trust Company Individual
Retirement Custodial Account, and requests the liquidation and transfer of
assets as indicated above.
INVESTORS FIDUCIARY TRUST COMPANY
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Signature of Custodian Date
