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Mail
Ally Bank
PO Box 13625
Philadelphia, PA 19101-9946
Fax
Subject Line: Operations
Fax Number: 866-699-2969
IRA Plan Owner Information
Please review all information below and complete the fields below,as applicable. If you have any questions regarding the
information on this form, please contact one of our Customer Care Associates at 877 247-ALLY (2559)
IRA Contribution Form
Name
Social Security Number
Birth (Month/Year)
Address
Home Phone Number
City, State, ZIP
Daytime Phone Number
Contribution Information
Account Number
Contribution Amount
Reportable - Current Tax Year
Reportable - Prior Tax Year
My Contribution, Check #
Contribution Options for Ally Traditional and Roth IRAs:
Transfer funds from my existing Ally Bank Account
#
These funds will be wired from the following financial institution:
is included with this form.
Contribution Options for Ally SEP IRAs:
These are not my personal funds but are funds provided by my employer as a SEP contribution.
(If this is an initial contribution, please include a copy of the 5305-SEP provided by your employer).
Signatures
I certify that, to the best of my knowledge, the information provided on this form is true and correct and may be relied upon by Ally
Bank, the Custodian. I agree to seek the advice of a legal or tax professional, as needed. The Custodian has not provided me
with any legal or tax advice, and I assume full responsibility for this transaction. I will not hold the Custodian liable for any adverse
consequences that may result from this transaction.
Please Note: This form must be signed before any distributions can occur in the future from this IRA Plan.
Signature of IRA Plan Owner Date
If your contribution is by check, please be sure your check is made payable to : Ally Bank FBO [Your name as it appears on the
IRA plan] and be sure to include your account number in the memo field on your check.
Mail your signed form and check, if applicable, to: Ally Bank
PO Box 13625
Philadelphia, PA 19101
TRADITIONAL SEP ROTH
Ally Bank
Version 1.7. Last revised on 08/20/2011
Member FDIC
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Completed 30 July 2020

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