Type of IRA. (Check only one; use a separate form for each type of account) Traditional IRA Rollover IRA SEP-IRA* (must attach Employer’s IRS Form 5305-SEP) Xxxx XXX Inherited IRA Inherited Xxxx XXX For SEP-IRA* only: Employer Information |( ) Employer’s Name Telephone | | | Employer’s Address City State Zip Code
Type of IRA. (Check ONE) ❑ Traditional IRA ❑ Traditional IRA Rollover (Must also complete a Rollover Certification Form) ❑ Beneficiary IRA
Type of IRA. Select one – Some types of accounts require additional information which has been noted Traditional IRA Rollover IRA Xxxx XXX Original Open Date SEP-IRA1 SARSEP-IRA Rollovers2 1Attach copy of IRS Form 5305-SEP 2Attach copy of IRS form 5305A-SEP Employer Information (required for SEP-IRA and SARSEP-IRA only) Employer Name Daytime Telephone Number Employer Address City State Zip
Type of IRA. (Check ONE.)
Type of IRA. If no tax year is indicated, we will assume it is for the current tax year. Refer to disclosure statement for eligibility requirements and contribution limits. Choose ONE of the following account types: ❍ Traditional IRA Account ❍ For tax year ❍ IRA to IRA Transfer (please complete IRA Transfer Form) ❍ Rollover (shareholder had receipt of funds) ❍ Inherited IRA – Name of Decedent Date of Death Date of Birth ❍ IRA Rollover Account ❍ Rollover IRA to Rollover IRA ❍ Direct Rollover from qualified plan – complete any additional form(s) required by your Plan Administrator. Please check the type of qualified plan: ❍ Corporate ❍ Pension ❍ Profit Sharing Plan ❍ 401(k) ❍ 403(b) ❍ Other:
