1 99993 (04/10) SEP-IRA E*TRADE Securities LLC P.O. Box 1542 Merrifield, VA 22116-1542 etrade.com SEP-IRA APPLICATION How to Apply for an Individual SEP-IRA " Complete all sections. " Be sure to sign and date the completed application.
" Mail the completed application to the address to the left. " Questions? Call 1-888-402-0654 (+1-678-624-6210 from outside the U.S.) from 9 a.m.
to 9 p.m. ET, Monday - Friday. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT To help the government fight the funding of terrorism and money laundering activities, the USA PATRIOT Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver 9s license or other identifying documents. Continued on next page Enter Your Account Holder Information (please print) 1 Securities industry regulations require that we collect all of the following information.
Name (first, middle initial, last) Mr. Ms. Dr.
Home Street Address (cannot be a P.O. box) Mailing Address (if different from above; P.O. box may be used) Home Phone E-mail Address (required for account updates) Employment Status Employed Self-employed * Retired Student Not Employed Line of Business * (this box must be filled in for self-employed persons) Business Street Address Marital Status Single Married Divorced Widowed Number of Dependents (Including self) 1 2 3 4 Other: ... more.
Do you have accounts at other brokerage firms or mutual fund companies?
No Yes Full Commission Discount (traditional) If you are not a U.S. resident, please provide the following information. If you are not a U.S.
citizen, please provide the following information. If you have been at your current address for less than six months, please provide your previous address. Passport NumberPassport Country of Issuance NOTE: If you are a non-U.S.
resident, please attach a photocopy of your passport or government-issued identification. We cannot open your account without this documentation. Country of Citizenship Street Address City, State, ZIP City, State, ZIP Date of Birth (mm/dd/yyyy) Social Security Number/Tax ID Number City, State, ZIP Specific Occupation Employer Business Phone Are employed by a registered broker-dealer, a securities exchange, or FINRA?
No Yes (you must submit a compliance letter with this application) Are you a director, 10% shareholder, or policymaker of a publicly held company? No Yes (specify companies) Country of Legal Residence (please attach Form W-8BEN) City, State, ZIP 2 99993 (04/10) SEP-IRA Overall Investment Objective for This Account (choose only one) Capital preservation Minimize the potential for any loss of principal. Income Provide current income rather than growth of principal.
Growth Increase investment value over time while accepting price fluctuations. Speculation Assume the highest degree of risk for potentially higher returns. Investment Experience None Limited Good Excellent Annual Income $0 3$14,999 $15,000 3$24,999 $25,000 3$49,999 $50,000 3$99,999 $100,000 3$199,999 $200,000+ Approximate Net Worth (excluding residence) $0 3$24,999 $25,000 3$49,999 $50,000 3$99,999 $100,000 3$499,999 $500,000 3$999,999 $1,000,000+ Approximate Liquid Net Worth (cash, stocks, etc.) $0 3$14,999 $15,000 3$24,999 $25,000 3$49,999 $50,000 3$99,999 $100,000 3$199,999 $200,000 3$499,999 $500,000 3$999,999 $1,000,000+ Securities industry regulations require that we collect all of the following information.
Continued on next page Designate Your IRA Beneficiaries Designate beneficiaries to receive payment of the value of your IRA upon your death. If no primary beneficiary survives you, th e balance of your IRA will be distributed to any contingent beneficiaries named below. Spousal Consent (needed only if you live in a community property state and are not naming your spouse as the primary beneficiary) I am the spouse of the above-named IRA account holder.
I acknowledge that I have received a fair and reasonable disclosure of m y spouse 9s property and financial obligations. Due to the important tax consequences of giving up my interest in this IRA, I have been adv ised to see a tax professional. I hereby give the IRA account holder any interest I have in the funds or properties deposited in this IRA a nd consent to the beneficiary designation indicated above.
I assume full responsibility for any adverse consequences that may result. No tax or legal advice was given to me by E*TRADE Securities. 7 Signature of Spouse Date Name and AddressBirth DateSocial Security NumberRelationshipType of BeneficiaryShare % * Primary Contingent Primary Contingent Primary Contingent Primary Contingent 2 Create Your Investment Profile 3 How often do you trade?
0-3 trades per month 4-9 trades per month 10+ trades per month Does anyone other than the account holder have trading authorization over the account? Yes No If yes, please complete and mail the Power of Attorney form to add an individual as having trading authority. This form can be found on our website under 8Form and Applications.
9 * Enter whole % amounts only. Total must add up to 100% per beneficiary type (e.g. allocation for three primary beneficiaries wou ld be 34%, 33%, and 33%).
If you wish to designate more than four primary or contingent beneficiaries, attach a separate sheet and include all the information as indicated above. 3 99993 (04/10) SEP-IRA Continued on next page Select Your Account Options 5 i Earn Income on Your Uninvested Cash Select only one of the following choices for the cash balance in your account. For current rates and other information, go to www .
etrade.com/rates . Taxable Income E*TRADE FINANCIAL Extended Insurance Retirement Sweep Deposit Account (Offers daily interest and FDIC insurance up to $500,000.) E*TRADE FINANCIAL SweepMax TM Retirement Sweep Deposit Account (Offers daily interest and FDIC insurance up to $250,000. Requires electronic delivery of account records.) JP Morgan Liquid Asset Money Market Fund- ETRADE Class (Requires electronic delivery of account records.) JPMorgan Liquid Assets Money Market Fund 3 Morgan Class (Limited Availability) If you choose the E*TRADE FINANCIAL SweepMax TM Retirement Sweep Deposit Account ( cSweepMax Retirement SDA d) or the E*TRADE FINANCIAL Extended Insurance Retirement Sweep Deposit Account ( cERDA d), we will mail you a copy of the BSA Account agreement an d the BSA Rate & Fee Schedule, which can also be found at www.etrade.com/bsaaccountagreement and www.etrade.com/bsarateandfee.com , respectively.
If you do not check a box, you will automatically be enrolled in the ERDA. You may change your selection at any t ime. With the ERDA, your uninvested cash is held at E*TRADE Bank and up to four other ERDA Program Banks.
For more information, please visit www.etrade.com/sweepoptions. This sweep option is only available to the following persons: (i) customers with $10 million or more in E*TRADE Securities brok erage accounts; (ii) clients of investment advisers that have aggregate discretionary assets of $10 million or more in E*TRADE Secu rities brokerage accounts; and (iii) advisory clients of affiliated investment advisers. Qualified customers should call us at 1-800-ETRADE-1 upon account opening to sign up for this option.
E*TRADE Securities LLC receives compensation in connection with the purchase and holding of mutual fund shares by its customers . For more information regarding these payments, please go to www.etrade.com/prospectus . Receive Your Account Documents Online For your convenience, account documents such as monthly statements, trade confirmations, and tax documents will be delivered to you via a secure online file cabinet instead of by mail.
We will notify you at the primary authorized person 9s e-mail address provided in section 1 whenever a new document is available. This feature is provided automatically, unless declined below. I would prefer to receive the following items by U.S.
mail: Monthly statements Trade confirmations Prospectuses Corporate reports, proxies, and reorganization notices You must provide us with your e-mail address in section 2 to receive electronic account documents. You may change your delivery preferences at any time. With respect to documents you elect to receive electronically, you agree to all the terms of section 13 of the E*TRADE Securities Customer Agreement at etrade.com/custagree .
Tell us how you will provide your initial SEP-IRA contribution. Select one or more of the following. Fund Your IRA Account * NOTE: To initiate the process, you must notify your former employer that you wish to roll over assets to E*TRADE Securities and fill out any forms required to authorize the distribution.
By Check (make payable to E*TRADE Clearing LLC) This is a new contribution for year __________. I have enclosed a check for $ _____________. This is an indirect rollover of assets I have withdrawn from another retirement plan within the past 60 days.
I have enclosed a check for $ _____________________. By Transfer I wish to transfer an existing IRA account from another financial institution. A completed Account Transfer Form is attached.
I will transfer funds from an existing E*TRADE Securities or E*TRADE Bank account (for more information go to etrade.com/newtransfer ) By Wire I plan to wire funds from another financial institution (for instructions go to etrade.com/ newtransfer ). By Direct Rollover * I wish to directly roll over assets from my 401(k), 403(b), or other eligible employer- sponsored retire- ment plan. 4 4 99993 (04/10) SEP-IRA 7 Signature of IRA holder Date Printed Name Continued on next page System response and account access times may vary due to a variety of factors, including trading volumes, market conditions, an d system performance.
The E * TRADE FINANCIAL family of companies provides &nancial services that include trading, investing, and banking. E * TRADE Securities LLC, Member FINRA. Accounts are carried by an af&liate, E * TRADE Clearing LLC, Member FINRA/SIPC.
© 2009 E * TRADE FINANCIAL Corp. All rights reserved. E * TRADE FINANCIAL is a registered trademark and the E * TRADE FINANCIAL logo is a trademark of E * TRADE FINANCIAL Corp.
I have read the E*TRADE Securities IRA Plan Agreement and Disclosure Statement, which is available online at etrade.com/iraagree or by calling 1-800- 387-2331 . I have read and understand the terms and conditions that apply to this IRA as contained in this document and agree to be bound by those terms and conditions. Within seven days from the date I open this IRA, I may revoke it without penal ty by mailing or delivering a written notice to E*TRADE Securities.
I have received and read the prospectus and any other relevant in vestment information for the investments in which my IRA assets will be invested. I take complete responsibility for the type of investm ent instruments I choose in my IRA, and I release E*TRADE Securities from any liability regarding the performance of any investment I make. I c onsent to the beneficiaries designated in section 2.
I understand that I may change my beneficiaries by completing an IRA Designation of Bene ficiary Form and sending it to E*TRADE Securities. I assume complete responsibility for determining that I am eligible for an IRA each year I make contributions, ensuring that all contributions I make are within the limits set forth by the tax laws and paying any taxes or p enalties due on distributions or on improper contributions. I am of legal age to enter into this contract.
I acknowledge that I have received, read, and agree to be bound by the terms and conditions as currently set forth in the E*TRADE Securities Customer Agreement and as amended from time to time. The E*TRADE Securities Custo mer Agreement is available online at etrade.com/custagree or by calling 1-800- 387-2331 . I ACKNOWLEDGE THAT E*TRADE SECURITIES DOES NOT PROVIDE INVESTMENT, TAX, OR LEGAL ADVICE.
I understand that you will supply my name to issuers of any securities held in this account s o that I might receive any important information regarding them, unless I notify you in writing not to do so. Under penalty of perjury, I certify (1) that my Social Security or taxpayer ID number shown on this form is my correct number, (2) that I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the In ternal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report interest or dividends, or (c) I have been notified by the IRS that I am no longer subject to backup withholding [cross out this item 2 if you have been notified by the I RS that you are currently subject to backup withholding because you failed to report all interest and dividends on your tax returns], and ( 3) I am a U.S. person (including a U.S.
resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. I am not a U.S.
person and have attached Form W-8BE