Fillable INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (LGE Community Credit Union)

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INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (LGE Community Credit Union)

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Page 1 of 15

Traditional IRA Simplifier

INDIVIDUAL RETIREMENT ACCOUNT APPLICATION

PART 1. IRA OWNER

Name (First/MI/Last)

Address Line 1

Address Line 2

City/State/ZIP

Social Security Number

Date of Birth Phone

Email Address

Account Number

PART 2. IRA CUSTODIAN

To be completed by the IRA custodian

Name

Address Line 1

Address Line 2

City/State/ZIP

Phone Organization Number

This is an amendment to an existing IRA.

This IRA contains only simplified employee pension (SEP) plan assets.

PART 3. CONTRIBUTION INFORMATION

Contribution Amount Contribution Date

CONTRIBUTION TYPE (Select one)

Regular (Includes catch-up contributions)

Contribution for Tax Year

Rollover (Distribution from an IRA or eligible employer-sponsored retirement plan that is being deposited into this Traditional IRA)

By selecting this transaction, I irrevocably designate this contribution as a rollover.

Transfer (Direct movement of assets from a Traditional IRA or a SIMPLE IRA into this Traditional IRA)

Recharacterization (A nontaxable movement of a Roth IRA contribution into this Traditional IRA)

By selecting this transaction, I irrevocably designate this contribution as a recharacterization.

SEP Contribution (Contribution made under a SEP plan; SEP contributions are reported for the year in which the contribution is made)

IF YOU ARE REQUIRED TO TAKE A REQUIRED MINIMUM DISTRIBUTION THIS YEAR, COMPLETE THE FOLLOWING, IF APPLICABLE

(Checking any of the following will require adjusting your required minimum distribution.)

This is a rollover or transfer of assets removed last year. Date of Removal

This is a transfer from my deceased spouse’s Traditional IRA and the assets were removed from the IRA in any year after death.

The value of my portion of my deceased spouse’s IRA on December 31 of last year .

PART 4. INVESTMENT AND DEPOSIT INFORMATION

INVESTMENT INFORMATION (Complete this section as applicable.)

Investment Description Quantity or Amount Investment Number Term or Maturity Date Interest Rate

DEPOSIT METHOD

Cash or Check (If the contribution type is transfer, the check must be from a financial organization made payable to the custodian for this IRA.)

Internal Account

Account Number Type (e.g., checking, savings, IRA)

External Account (e.g., EFT, ACH, wire) (Additional documentation may be required and fees may apply.)

Name of Organization Sending the Assets Routing Number (Optional)

Account Number Type (e.g., checking, savings, IRA)

Deposit Taken by

98 / 2300-C (Rev. 4/2020)

Page 2 of 15

Name of IRA Owner , Account Number

PART 5. BENEFICIARY DESIGNATION

I designate that upon my death, the assets in this account be paid to the beneficiaries named below. The interest of any beneficiary that predeceases

me terminates completely, and the percentage share of any remaining beneficiaries will be increased on a pro rata basis. If no beneficiaries are named,

my estate will be my beneficiary.

I elect not to designate beneficiaries at this time and understand that I may designate beneficiaries at a later date.

PRIMARY BENEFICIARIES (The total percentage designated must equal 100%. If more than one beneficiary is designated and no percentages are

indicated, the beneficiaries will be deemed to own equal share percentages in the IRA.)

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

CONTINGENT BENEFICIARIES (The total percentage designated must equal 100%. If more than one beneficiary is designated and no percentages are

indicated, the beneficiaries will be deemed to own equal share percentages in the IRA. The balance in the account will be payable to these beneficiaries

if all primary beneficiaries have predeceased the IRA owner.)

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Check here if additional beneficiaries are listed on an attached addendum. Total number of addendums attached to this IRA

PART 6. SPOUSAL CONSENT

Spousal consent should be considered if either the trust or the residence

of the IRA owner is located in a community or marital property state.

CURRENT MARITAL STATUS

I Am Not Married – I understand that if I become married in the

future, I should review the requirements for spousal consent.

I Am Married – I understand that if I choose to designate a primary

beneficiary other than or in addition to my spouse, my spouse should

sign below.

CONSENT OF SPOUSE

I am the spouse of the above-named IRA owner. I acknowledge that I have

received a fair and reasonable disclosure of my spouse’s property and

financial obligations. Because of the important tax consequences of giving

up my interest in this IRA, I have been advised to see a tax professional.

I hereby relinquish any interest that I may have in this IRA and consent to

the beneficiary designation indicated above. I assume full responsibility

for any adverse consequences that may result.

Signature of Spouse Date (mm/dd/yyyy)

Signature of Witness Date (mm/dd/yyyy)

PART 7. SIGNATURES

Important: Please read before signing.

I understand the eligibility requirements for the type of IRA contribution I am

making, and I state that I do qualify to make the contribution. I have received

a copy of the IRA Application, the 5305-A Custodial Account Agreement, the

Financial Disclosure, and the Disclosure Statement. I understand that the

terms and conditions that apply to this IRA are contained in this Application

and the Custodial Account Agreement. I agree to be bound by those terms

and conditions. Within seven days from the date I open this IRA I may revoke

it without penalty by mailing or delivering a written notice to the custodian.

I assume complete responsibility for

• determining that I am eligible for an IRA each year I make a

contribution,

• ensuring that all contributions I make are within the limits set forth

by the tax laws, and

• the tax consequences of any contributions (including rollover

contributions) and distributions.

Signature of IRA Owner Date (mm/dd/yyyy)

Signature of Witness Date (mm/dd/yyyy)

Signature of Custodian Date (mm/dd/yyyy)

98 / 2300-C (Rev. 4/2020)

Page 3 of 15

INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT AGREEMENT

Form 5305-A under section 408(a) of the Internal Revenue Code. FORM (Rev. April 2017)

The depositor named on the application is establishing a Traditional

individual retirement account under section 408(a) to provide for his or

her retirement and for the support of his or her beneficiaries after death.

The custodian named on the application has given the depositor the

disclosure statement required by Regulations section 1.408-6.

The depositor has assigned the custodial account the sum indicated on

the application.

The depositor and the custodian make the following agreement:

ARTICLE I

Except in the case of a rollover contribution described in section 402(c),

403(a)(4), 403(b)(8), 408(d)(3), or 457(e)(16), an employer contribution to

a simplified employee pension plan as described in section 408(k) or a

recharacterized contribution described in section 408A(d)(6), the

custodian will accept only cash contributions up to $5,500 per year for tax

years 2013 through 2017. For individuals who have reached the age of 50

by the end of the year, the contribution limit is increased to $6,500 per

year for tax years 2013 through 2017. For years after 2017, these limits

will be increased to reflect a cost-of-living adjustment, if any.

ARTICLE II

The depositor’s interest in the balance in the custodial account is

nonforfeitable.

ARTICLE III

1. No part of the custodial account funds may be invested in life insurance

contracts, nor may the assets of the custodial account be commingled

with other property except in a common trust fund or common

investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested in collectibles

(within the meaning of section 408(m)) except as otherwise permitted

by section 408(m)(3), which provides an exception for certain gold,

silver, and platinum coins, coins issued under the laws of any state,

and certain bullion.

ARTICLE IV

1. Notwithstanding any provision of this agreement to the contrary, the

distribution of the depositor’s interest in the custodial account shall be

made in accordance with the following requirements and shall

otherwise comply with section 408(a)(6) and the regulations thereunder,

the provisions of which are herein incorporated by reference.

2. The depositor’s entire interest in the custodial account must be, or

begin to be, distributed not later than the depositor’s required

beginning date, April 1 following the calendar year in which the

depositor reaches age 70½. By that date, the depositor may elect, in a

manner acceptable to the custodian, to have the balance in the

custodial account distributed in: (a) A single sum or (b) Payments over

a period not longer than the life of the depositor or the joint lives of

the depositor and his or her designated beneficiary.

3. If the depositor dies before his or her entire interest is distributed to

him or her, the remaining interest will be distributed as follows:

(a) If the depositor dies on or after the required beginning date and:

(i) the designated beneficiary is the depositor’s surviving spouse,

the remaining interest will be distributed over the surviving

spouse’s life expectancy as determined each year until such

spouse’s death, or over the period in paragraph (a)(iii) below if

longer. Any interest remaining after the spouse’s death will be

distributed over such spouse’s remaining life expectancy as

determined in the year of the spouse’s death and reduced by

one for each subsequent year, or, if distributions are being

made over the period in paragraph (a)(iii) below, over such

period.

(ii) the designated beneficiary is not the depositor’s surviving

spouse, the remaining interest will be distributed over the

beneficiary’s remaining life expectancy as determined in the

year following the death of the depositor and reduced by one

for each subsequent year, or over the period in paragraph

(a)(iii) below if longer.

(iii) there is no designated beneficiary, the remaining interest will

be distributed over the remaining life expectancy of the

depositor as determined in the year of the depositor’s death

and reduced by one for each subsequent year.

(b) If the depositor dies before the required beginning date, the

remaining interest will be distributed in accordance with paragraph

(i) below or, if elected or there is no designated beneficiary, in

accordance with paragraph (ii) below.

(i) The remaining interest will be distributed in accordance with

paragraphs (a)(i) and (a)(ii) above (but not over the period in

paragraph (a)(iii), even if longer), starting by the end of the

calendar year following the year of the depositor’s death. If,

however, the designated beneficiary is the depositor’s surviving

spouse, then this distribution is not required to begin before

the end of the calendar year in which the depositor would

have reached age 70½. But, in such case, if the depositor’s

surviving spouse dies before distributions are required to

begin, then the remaining interest will be distributed in

accordance with paragraph (a)(ii) above (but not over the

period in paragraph (a)(iii), even if longer), over such spouse’s

designated beneficiary’s life expectancy, or in accordance with

paragraph (ii) below if there is no such designated beneficiary.

(ii) The remaining interest will be distributed by the end of the

calendar year containing the fifth anniversary of the depositor’s

death.

4. If the depositor dies before his or her entire interest has been

distributed and if the designated beneficiary is not the depositor’s

surviving spouse, no additional contributions may be accepted in the

account.

5. The minimum amount that must be distributed each year, beginning

with the year containing the depositor’s required beginning date, is

known as the “required minimum distribution” and is determined as

follows.

(a) The required minimum distribution under paragraph 2(b) for any

year, beginning with the year the depositor reaches age 70½, is the

depositor’s account value at the close of business on December 31

of the preceding year divided by the distribution period in the

uniform lifetime table in Regulations section 1.401(a)(9)-9.

However, if the depositor’s designated beneficiary is his or her

surviving spouse, the required minimum distribution for a year

shall not be more than the depositor’s account value at the close

of business on December 31 of the preceding year divided by the

number in the joint and last survivor table in Regulations section

1.401(a)(9)-9. The required minimum distribution for a year under

this paragraph (a) is determined using the depositor’s (or, if

applicable, the depositor and spouse’s) attained age (or ages) in

the year.

98 / 2300-C (Rev. 4/2020)

Page 4 of 15

(b) The required minimum distribution under paragraphs 3(a) and 3(b)

(i) for a year, beginning with the year following the year of the

depositor’s death (or the year the depositor would have reached

age 70½, if applicable under paragraph 3(b)(i)) is the account value

at the close of business on December 31 of the preceding year

divided by the life expectancy (in the single life table in Regulations

section 1.401(a)(9)-9) of the individual specified in such paragraphs

3(a) and 3(b)(i).

reaches age 70½ can be made as late as April 1 of the following

year. The required minimum distribution for any other year must

be made by the end of such year.

6. The owner of two or more Traditional IRAs may satisfy the minimum

distribution requirements described above by taking from one

Traditional IRA the amount required to satisfy the requirement for

another in accordance with the regulations under section 408(a)(6).

ARTICLE V

1. The depositor agrees to provide the custodian with all information

necessary to prepare any reports required by section 408(i) and

Regulations sections 1.408-5 and 1.408-6.

2. The custodian agrees to submit to the Internal Revenue Service (IRS)

and depositor the reports prescribed by the IRS.

ARTICLE VI

Notwithstanding any other articles which may be added or incorporated,

the provisions of Articles I through III and this sentence will be controlling.

Any additional articles inconsistent with section 408(a) and the related

regulations will be invalid.

ARTICLE VII

This agreement will be amended as necessary to comply with the

provisions of the Code and the related regulations. Other amendments

may be made with the consent of the persons whose signatures appear

on the application.

ARTICLE VIII

8.01 Definitions – In this part of this agreement (Article VIII), the words

“you” and “your” mean the depositor. The words “we,” “us,” and

“our” mean the custodian. The word “Code” means the Internal

Revenue Code, and “regulations” means the Treasury regulations.

8.02 Notices and Change of Address – Any required notice regarding

this IRA will be considered effective when we send it to the

intended recipient at the last address that we have in our records.

Any notice to be given to us will be considered effective when we

actually receive it. You, or the intended recipient, must notify us of

any change of address.

8.03 Representations and Responsibilities – You represent and warrant

to us that any information you have given or will give us with

respect to this agreement is complete and accurate. Further, you

agree that any directions you give us or action you take will be

proper under this agreement, and that we are entitled to rely upon

any such information or directions. If we fail to receive directions

from you regarding any transaction, if we receive ambiguous

directions regarding any transaction, or if we, in good faith, believe

that any transaction requested is in dispute, we reserve the right to

take no action until further clarification acceptable to us is received

from you or the appropriate government or judicial authority. We

will not be responsible for losses of any kind that may result from

your directions to us or your actions or failures to act, and you

agree to reimburse us for any loss we may incur as a result of such

directions, actions, or failures to act. We will not be responsible for

any penalties, taxes, judgments, or expenses you incur in connection

with your IRA. We have no duty to determine whether your

contributions or distributions comply with the Code, regulations,

rulings, or this agreement.

We may permit you to appoint, through written notice acceptable

to us, an authorized agent to act on your behalf with respect to

this agreement (e.g., attorney-in-fact, executor, administrator,

investment manager), but we have no duty to determine the

validity of such appointment or any instrument appointing such

authorized agent. We will not be responsible for losses of any kind

that may result from directions, actions, or failures to act by your

authorized agent, and you agree to reimburse us for any loss we

may incur as a result of such directions, actions, or failures to act

by your authorized agent.

You will have 60 days after you receive any documents, statements,

or other information from us to notify us in writing of any errors or

inaccuracies reflected in these documents, statements, or other

information. If you do not notify us within 60 days, the documents,

statements, or other information will be deemed correct and

accurate, and we will have no further liability or obligation for such

documents, statements, other information, or the transactions

described therein.

By performing services under this agreement we are acting as your

agent. You acknowledge and agree that nothing in this agreement

will be construed as conferring fiduciary status upon us. We will not

be required to perform any additional services unless specifically

agreed to under the terms and conditions of this agreement, or as

required under the Code and the regulations promulgated

thereunder with respect to IRAs. You agree to indemnify and hold

us harmless for any and all claims, actions, proceedings, damages,

judgments, liabilities, costs, and expenses, including attorney’s fees

arising from or in connection with this agreement.

To the extent written instructions or notices are required under

this agreement, we may accept or provide such information in any

other form permitted by the Code or applicable regulations

including, but not limited to, electronic communication.

8.04 Disclosure of Account Information – We may use agents and/or

subcontractors to assist in administering your IRA. We may release

nonpublic personal information regarding your IRA to such

providers as necessary to provide the products and services made

available under this agreement, and to evaluate our business

operations and analyze potential product, service, or process

improvements.

8.05 Service Fees – We have the right to charge an annual service fee or

other designated fees (e.g., a transfer, rollover, or termination fee)

for maintaining your IRA. In addition, we have the right to be

reimbursed for all reasonable expenses, including legal expenses,

we incur in connection with the administration of your IRA. We

may charge you separately for any fees or expenses, or we may

deduct the amount of the fees or expenses from the assets in your

IRA at our discretion. We reserve the right to charge any additional

fee after giving you 30 days’ notice. Fees such as subtransfer agent

fees or commissions may be paid to us by third parties for assistance

in performing certain transactions with respect to this IRA.

Any brokerage commissions attributable to the assets in your IRA

will be charged to your IRA. You cannot reimburse your IRA for

those commissions.

8.06 Investment of Amounts in the IRA – You have exclusive responsibility

for and control over the investment of the assets of your IRA. All

transactions will be subject to any and all restrictions or limitations,

direct or indirect, that are imposed by our charter, articles of

incorporation, or bylaws; any and all applicable federal and state

laws and regulations; the rules, regulations, customs and usages of

98 / 2300-C (Rev. 4/2020)

Page 5 of 15

any exchange, market or clearing house where the transaction is

executed; our policies and practices; and this agreement. After

your death, your beneficiaries will have the right to direct the

investment of your IRA assets, subject to the same conditions that

applied to you during your lifetime under this agreement

(including, without limitation, Section 8.03 of this article). We will

have no discretion to direct any investment in your IRA. We

assume no responsibility for rendering investment advice with

respect to your IRA, nor will we offer any opinion or judgment to

you on matters concerning the value or suitability of any

investment or proposed investment for your IRA. In the absence of

instructions from you, or if your instructions are not in a form

acceptable to us, we will have the right to hold any uninvested

amounts in cash, and we will have no responsibility to invest

uninvested cash unless and until directed by you. We will not

exercise the voting rights and other shareholder rights with respect

to investments in your IRA unless you provide timely written

directions acceptable to us.

You will select the investment for your IRA assets from those

investments that we are authorized by our charter, articles of

incorporation, or bylaws to offer and do in fact offer for IRAs (e.g.,

term share accounts, passbook accounts, certificates of deposit,

money market accounts.)

8.07 Beneficiaries – If you die before you receive all of the amounts in

your IRA, payments from your IRA will be made to your

beneficiaries. We have no obligation to pay to your beneficiaries

until such time we are notified of your death by receiving a valid

death certificate.

You may designate one or more persons or entities as beneficiary

of your IRA. This designation can only be made on a form provided

by or acceptable to us, and it will only be effective when it is filed

with us during your lifetime. Each beneficiary designation you file

with us will cancel all previous designations. The consent of your

beneficiaries will not be required for you to revoke a beneficiary

designation. If you have designated both primary and contingent

beneficiaries and no primary beneficiary survives you, the

contingent beneficiaries will acquire the designated share of your

IRA. If you do not designate a beneficiary or if all of your primary

and contingent beneficiaries predecease you, your estate will be

the beneficiary.

A spouse beneficiary will have all rights as granted under the Code

or applicable regulations to treat your IRA as his or her own.

We may allow, if permitted by state law, an original IRA beneficiary

(the beneficiary who is entitled to receive distributions from an

inherited IRA at the time of your death) to name successor

beneficiaries for the inherited IRA. This designation can only be

made on a form provided by or acceptable to us, and it will only be

effective when it is filed with us during the original IRA beneficiary’s

lifetime. Each beneficiary designation form that the original IRA

beneficiary files with us will cancel all previous designations. The

consent of a successor beneficiary will not be required for the

original IRA beneficiary to revoke a successor beneficiary

designation. If the original IRA beneficiary does not designate a

successor beneficiary, his or her estate will be the successor

beneficiary. In no event will the successor beneficiary be able to

extend the distribution period beyond that required for the

original IRA beneficiary.

If we so choose, for any reason (e.g., due to limitations of our

charter or bylaws), we may require that a beneficiary of a deceased

IRA owner take total distribution of all IRA assets by December 31

of the year following the year of death.

8.08 Required Minimum Distributions – Your required minimum

distribution is calculated using the uniform lifetime table in

Regulations section 1.401(a)(9)-9. However, if your spouse is your

sole designated beneficiary and is more than 10 years younger

than you, your required minimum distribution is calculated each

year using the joint and last survivor table in Regulations section

1.401(a)(9)-9.

If you fail to request your required minimum distribution by your

required beginning date, we can, at our complete and sole

discretion, do any one of the following.

• Make no distribution until you give us a proper withdrawal

request

• Distribute your entire IRA to you in a single sum payment

• Determine your required minimum distribution from your IRA

each year based on your life expectancy, calculated using the

uniform lifetime table in Regulations section 1.401(a)(9)-9, and

pay those distributions to you until you direct otherwise

We will not be liable for any penalties or taxes related to your

failure to take a required minimum distribution.

8.09 Termination of Agreement, Resignation, or Removal of Custodian –

Either party may terminate this agreement at any time by giving

written notice to the other. We can resign as custodian at any time

effective 30 days after we send written notice of our resignation to

you. Upon receipt of that notice, you must make arrangements to

transfer your IRA to another financial organization. If you do not

complete a transfer of your IRA within 30 days from the date we

send the notice to you, we have the right to transfer your IRA assets

to a successor IRA trustee or custodian that we choose in our sole

discretion, or we may pay your IRA to you in a single sum. We will

not be liable for any actions or failures to act on the part of any

successor trustee or custodian, nor for any tax consequences you

may incur that result from the transfer or distribution of your assets

pursuant to this section.

If this agreement is terminated, we may charge to your IRA a

reasonable amount of money that we believe is necessary to cover

any associated costs, including but not limited to one or more of

the following.

• Any fees, expenses, or taxes chargeable against your IRA

• Any penalties or surrender charges associated with the early

withdrawal of any savings instrument or other investment in

your IRA

If we are a nonbank custodian required to comply with Regulations

section 1.408-2(e) and we fail to do so or we are not keeping the

records, making the returns, or sending the statements as are

required by forms or regulations, the IRS may require us to

substitute another trustee or custodian.

We may establish a policy requiring distribution of the entire

balance of your IRA to you in cash or property if the balance of

your IRA drops below the minimum balance required under the

applicable investment or policy established.

8.10 Successor Custodian – If our organization changes its name,

reorganizes, merges with another organization (or comes under

the control of any federal or state agency), or if our entire

organization (or any portion that includes your IRA) is bought by

another organization, that organization (or agency) will

automatically become the trustee or custodian of your IRA, but

only if it is the type of organization authorized to serve as an IRA

trustee or custodian.

98 / 2300-C (Rev. 4/2020)

Page 6 of 15

8.11 Amendments – We have the right to amend this agreement at any

time. Any amendment we make to comply with the Code and

related regulations does not require your consent. You will be

deemed to have consented to any other amendment unless,

within 30 days from the date we send the amendment, you notify

us in writing that you do not consent.

8.12 Withdrawals or Transfers – All requests for withdrawal or transfer

will be in writing on a form provided by or acceptable to us. The

method of distribution must be specified in writing or in any other

method acceptable to us. The tax identification number of the

recipient must be provided to us before we are obligated to make

a distribution. Withdrawals will be subject to all applicable tax and

other laws and regulations, including but not limited to possible

early distribution penalty taxes, surrender charges, and withholding

requirements.

8.13 Transfers From Other Plans – We can receive amounts transferred

to this IRA from the trustee or custodian of another IRA. In

addition, we can accept rollovers of eligible rollover distributions

from employer-sponsored retirement plans as permitted by the

Code. We reserve the right not to accept any transfer or direct

rollover.

8.14 Liquidation of Assets – We have the right to liquidate assets in

your IRA if necessary to make distributions or to pay fees,

expenses, taxes, penalties, or surrender charges properly

chargeable against your IRA. If you fail to direct us as to which

assets to liquidate, we will decide, in our complete and sole

discretion, and you agree to not hold us liable for any adverse

consequences that result from our decision.

8.15 Restrictions on the Fund – Neither you nor any beneficiary may

sell, transfer, or pledge any interest in your IRA in any manner

whatsoever, except as provided by law or this agreement.

The assets in your IRA will not be responsible for the debts,

contracts, or torts of any person entitled to distributions under

this agreement.

8.16 What Law Applies – This agreement is subject to all applicable

federal and state laws and regulations. If it is necessary to apply

any state law to interpret and administer this agreement, the law

of our domicile will govern.

If any part of this agreement is held to be illegal or invalid, the

remaining parts will not be affected. Neither your nor our failure

to enforce at any time or for any period of time any of the

provisions of this agreement will be construed as a waiver of such

provisions, or your right or our right thereafter to enforce each

and every such provision.

GENERAL INSTRUCTIONS

Section references are to the Internal Revenue Code unless otherwise noted.

PURPOSE OF FORM

Form 5305-A is a model custodial account agreement that meets the

requirements of section 408(a). However, only Articles I through VII have

been reviewed by the IRS. A Traditional individual retirement account

(Traditional IRA) is established after the form is fully executed by both the

individual (depositor) and the custodian. To make a regular contribution

to a Traditional IRA for a year, the IRA must be established no later than

the due date of the individual’s income tax return for the tax year

(excluding extensions). This account must be created in the United States

for the exclusive benefit of the depositor and his or her beneficiaries.

Do not

file Form 5305-A with the IRS. Instead, keep it with your records.

For more information on IRAs, including the required disclosures the

custodian must give the depositor, see Pub. 590-A, Contributions to

Individual Retirement Arrangements (IRAs),

and Pub. 590-B, Distributions

from Individual Retirement Arrangements (IRAs).

DEFINITIONS

Custodian – The custodian must be a bank or savings and loan association,

as defined in section 408(n), or any person who has the approval of the

IRS to act as custodian.

Depositor – The depositor is the person who establishes the custodial

account.

TRADITIONAL IRA FOR NONWORKING SPOUSE

Form 5305-A may be used to establish the IRA custodial account for a

nonworking spouse.

Contributions to an IRA custodial account for a nonworking spouse must

be made to a separate IRA custodial account established by the

nonworking spouse.

SPECIFIC INSTRUCTIONS

Article IV – Distributions made under this article may be made in a single

sum, periodic payment, or a combination of both. The distribution option

should be reviewed in the year the depositor reaches age 70½ to ensure

that the requirements of section 408(a)(6) have been met.

Article VIII – Article VIII and any that follow it may incorporate additional

provisions that are agreed to by the depositor and custodian to complete

the agreement. They may include, for example, definitions, investment

powers, voting rights, exculpatory provisions, amendment and

termination, removal of the custodian, custodian’s fees, state law

requirements, beginning date of distributions, accepting only cash,

treatment of excess contributions, prohibited transactions with the

depositor, etc. Attach additional pages if necessary.

98 / 2300-C (Rev. 4/2020)

Page 7 of 15

DISCLOSURE STATEMENT

RIGHT TO REVOKE YOUR IRA

You have the right to revoke your IRA within seven days of the receipt of

the disclosure statement. If revoked, you are entitled to a full return of

the contribution you made to your IRA. The amount returned to you

would not include an adjustment for such items as sales commissions,

administrative expenses, or fluctuation in market value. You may make

this revocation only by mailing or delivering a written notice to the

custodian at the address listed on the application.

If you send your notice by first class mail, your revocation will be deemed

mailed as of the postmark date.

If you have any questions about the procedure for revoking your IRA,

please call the custodian at the telephone number listed on the application.

REQUIREMENTS OF AN IRA

A. Cash Contributions – Your contribution must be in cash, unless it is a

rollover contribution.

B. Maximum Contribution – The total amount you may contribute to an

IRA for any taxable year cannot exceed the lesser of 100 percent of

your compensation or $6,000 for 2019 and 2020, with possible cost-

of-living adjustments each year thereafter. If you also maintain a Roth

IRA (i.e., an IRA subject to the limits of Internal Revenue Code Section

(IRC Sec.) 408A), the maximum contribution to your Traditional IRAs is

reduced by any contributions you make to your Roth IRAs. Your total

annual contribution to all Traditional IRAs and Roth IRAs cannot

exceed the lesser of the dollar amounts described above or

100 percent of your compensation.

C. Contribution Eligibility – For tax years beginning before 2020, you are

eligible to make a regular contribution to your IRA if you have

compensation and have not attained age 70½ by the end of the

taxable year for which the contribution is made. For 2020 and later

tax years, you may make a regular contribution to your IRA at any age

if you have compensation.

D. Catch-Up Contributions – If you are age 50 or older by the close of the

taxable year, you may make an additional contribution to your IRA.

The maximum additional contribution is $1,000 per year.

E. Nonforfeitability – Your interest in your IRA is nonforfeitable.

F. Eligible Custodians – The custodian of your IRA must be a bank,

savings and loan association, credit union, or a person or entity

approved by the Secretary of the Treasury.

G. Commingling Assets – The assets of your IRA cannot be commingled

with other property except in a common trust fund or common

investment fund.

H. Life Insurance – No portion of your IRA may be invested in life

insurance contracts.

I. Collectibles – You may not invest the assets of your IRA in collectibles

(within the meaning of IRC Sec. 408(m)). A collectible is defined as any

work of art, rug or antique, metal or gem, stamp or coin, alcoholic

beverage, or other tangible personal property specified by the Internal

Revenue Service (IRS). However, specially minted United States gold

and silver coins, and certain state-issued coins are permissible

investments. Platinum coins and certain gold, silver, platinum, or

palladium bullion (as described in IRC Sec. 408(m)(3)) are also

permitted as IRA investments.

J. Required Minimum Distributions – You are required to take minimum

distributions from your IRA at certain times in accordance with

Treasury Regulation 1.408-8. Below is a summary of the IRA distribution

rules.

1. If you were born before July 1, 1949, you are required to take a

minimum distribution from your IRA for the year in which you reach

age 70½ and for each year thereafter. You must take your first

distribution by your required beginning date, which is April 1 of the

year following the year you attain age 70½. If you were born on or

after July 1, 1949, you are required to take a minimum distribution

from your IRA for the year in which you reach age 72 and for each

year thereafter. You must take your first distribution by your

required beginning date, which is April 1 of the year following the

year you attain age 72. The minimum distribution for any taxable

year is equal to the amount obtained by dividing the account

balance at the end of the prior year by the applicable divisor.

2. The applicable divisor generally is determined using the Uniform

Lifetime Table provided by the IRS. If your spouse is your sole

designated beneficiary for the entire calendar year, and is more

than 10 years younger than you, the required minimum distribution

is determined each year using the actual joint life expectancy of

you and your spouse obtained from the Joint Life Expectancy Table

provided by the IRS, rather than the life expectancy divisor from

the Uniform Lifetime Table.

We reserve the right to do any one of the following by your

required beginning date.

(a) Make no distribution until you give us a proper withdrawal

request

(b) Distribute your entire IRA to you in a single sum payment

based on your life expectancy calculated using the Uniform

Lifetime Table, and pay those distributions to you until you

direct otherwise

If you fail to remove a required minimum distribution, an additional

penalty tax of 50 percent is imposed on the amount of the required

minimum distribution that should have been taken but was not.

You must file IRS Form 5329 along with your income tax return to

report and remit any additional taxes to the IRS.

K. Beneficiary Distributions – Upon your death, your beneficiaries are

required to take distributions according to IRC Sec. 401(a)(9) and

Treasury Regulation 1.408-8. These requirements are described below.

1. Death of IRA Owner Before January 1, 2020 – Your designated

beneficiary is determined based on the beneficiaries designated as

of the date of your death, who remain your beneficiaries as of

September 30 of the year following the year of your death.

If you die on or after your required beginning date, distributions

must be made to your beneficiaries over the longer of the single life

expectancy of your designated beneficiaries, or your remaining life

expectancy. If a beneficiary other than a person or qualified trust as

defined in the Treasury Regulations is named, you will be treated as

having no designated beneficiary of your IRA for purposes of

determining the distribution period. If there is no designated

beneficiary of your IRA, distributions will commence using your

single life expectancy, reduced by one in each subsequent year.

If you die before your required beginning date, the entire amount

remaining in your account will, at the election of your designated

beneficiaries, either

(a) be distributed by December 31 of the year containing the fifth

anniversary of your death, or

(b) be distributed over the remaining life expectancy of your

designated beneficiaries.

98 / 2300-C (Rev. 4/2020)

Page 8 of 15

If your spouse is your sole designated beneficiary, he or she must

elect either option (a) or (b) by the earlier of December 31 of the

year containing the fifth anniversary of your death, or December 31

of the year life expectancy payments would be required to begin.

Your designated beneficiaries, other than a spouse who is the sole

designated beneficiary, must elect either option (a) or (b) by

December 31 of the year following the year of your death. If no

election is made, distribution will be calculated in accordance with

option (b). In the case of distributions under option (b), distributions

must commence by December 31 of the year following the year of

your death. Generally, if your spouse is the designated beneficiary,

distributions need not commence until December 31 of the year

you would have attained age 72 (age 70½ if you would have

attained age 70½ before 2020), if later. If a beneficiary other than a

person or qualified trust as defined in the Treasury Regulations is

named, you will be treated as having no designated beneficiary of

your IRA for purposes of determining the distribution period. If

there is no designated beneficiary of your IRA, the entire IRA must

be distributed by December 31 of the year containing the fifth

anniversary of your death.

2. Death of IRA Owner On or After January 1, 2020 – The entire

amount remaining in your account will generally be distributed by

December 31 of the year containing the tenth anniversary of your

death unless you have an eligible designated beneficiary or you

have no designated beneficiary for purposes of determining a

distribution period. This requirement applies to beneficiaries

regardless of whether you die before, on, or after your required

beginning date.

If your beneficiary is an eligible designated beneficiary, the entire

amount remaining in your account may be distributed (in

accordance with the Treasury Regulations) over the remaining life

expectancy of your eligible designated beneficiary (or over a period

not extending beyond the life expectancy of such beneficiary).

An eligible designated beneficiary is any designated beneficiary

who is

• your surviving spouse,

• your child who has not reached the age of majority,

• disabled (A physician must determine that your impairment

can be expected to result in death or to be of long, continued,

and indefinite duration.),

• an individual who is not more than 10 years younger than you, or

• chronically ill (A chronically ill individual is someone who (1) is

unable to perform (without substantial assistance from another

individual) at least two activities of daily living for an indefinite

period due to a loss of functional capacity, (2) has a level of

disability similar to the level of disability described above

requiring assistance with daily living based on loss of functional

capacity, or (3) requires substantial supervision to protect the

individual from threats to health and safety due to severe

cognitive impairment.)

Note that certain trust beneficiaries (e.g., certain trusts for disabled

and chronically ill individuals) may take distribution of the entire

amount remaining in your account over the remaining life

expectancy of the trust beneficiary.

Generally, life expectancy distributions to an eligible designated

beneficiary must commence by December 31 of the year following

the year of your death. However, if your spouse is the eligible

designated beneficiary, distributions need not commence until

December 31 of the year you would have attained age 72, if later.

If your eligible designated beneficiary is your minor child, life

expectancy payments must begin by December 31 of the year

following the year of your death and continue until the child

reaches the age of majority. Once the age of majority is reached,

the beneficiary will have 10 years to deplete the account.

If a beneficiary other than a person (e.g., your estate, a charity, or

a certain type of trust) is named, you will be treated as having no

designated beneficiary of your IRA for purposes of determining the

distribution period. If you die before your required beginning date

and there is no designated beneficiary of your IRA, the entire IRA

must be distributed by December 31 of the year containing the fifth

anniversary of your death. If you die on or after your required

beginning date and there is no designated beneficiary of your IRA,

distributions will commence using your single life expectancy,

reduced by one in each subsequent year.

A spouse who is the sole designated beneficiary of your entire IRA will

be deemed to elect to treat your IRA as his or her own by either (1)

making contributions to your IRA or (2) failing to timely remove a

required minimum distribution from your IRA. Regardless of whether

or not the spouse is the sole designated beneficiary of your IRA, a

spouse beneficiary may roll over his or her share of the assets to his

or her own IRA.

If we so choose, for any reason (e.g., due to limitations of our charter

or bylaws), we may require that a beneficiary of a deceased IRA owner

take total distribution of all IRA assets by December 31 of the year

following the year of death.

If your beneficiary fails to remove a required minimum distribution

after your death, an additional penalty tax of 50 percent is imposed

on the amount of the required minimum distribution that should have

been taken but was not. Your beneficiary must file IRS Form 5329

along with his or her income tax return to report and remit any

additional taxes to the IRS.

L. Qualifying Longevity Annuity Contracts and RMDs – A qualifying

longevity annuity contract (QLAC) is a deferred annuity contract that,

among other requirements, must guarantee lifetime income starting

no later than age 85. The total premiums paid to QLACs in your IRAs

must not exceed 25 percent (up to $125,000) of the combined value

of your IRAs (excluding Roth IRAs). The $125,000 limit is subject to

cost-of-living adjustments each year.

When calculating your RMD, you may reduce the prior year end

account value by the value of QLACs that your IRA holds as investments.

For more information on QLACs, you may wish to refer to the IRS

website at www.irs.gov.

M. Waiver of 2020 RMD – In spite of the general rules described above,

if you are an IRA owner age 70½ or older, you are not required to

remove an RMD for calendar year 2020. This RMD waiver also applies

to IRA owners who attained age 70½ in 2019 but did not take their

first RMD before January 1, 2020. In addition, no beneficiary life

expectancy payments are required for calendar year 2020. If the five-

year rule applies to an IRA with respect to any decedent, the five-year

period is determined without regard to calendar year 2020. For

example, if an IRA owner died in 2017, the beneficiary’s five-year

period ends in 2023 instead of 2022.

INCOME TAX CONSEQUENCES OF ESTABLISHING AN IRA

A. IRA Deductibility – If you are eligible to contribute to your IRA, the

amount of the contribution for which you may take a tax deduction

will depend upon whether you (or, in some cases, your spouse) are an

active participant in an employer-sponsored retirement plan. If you

(and your spouse, if married) are not an active participant, your entire

IRA contribution will be deductible. If you are an active participant (or

are married to an active participant), the deductibility of your IRA

contribution will depend on your modified adjusted gross income

(MAGI) and your tax filing status for the tax year for which the

contribution was made. MAGI is determined on your income tax return

using your adjusted gross income but disregarding any deductible IRA

contribution and certain other deductions and exclusions.

Page 9 of 15

Definition of Active Participant. Generally, you will be an active

participant if you are covered by one or more of the following

employer-sponsored retirement plans.

1. Qualified pension, profit sharing, 401(k), or stock bonus plan

2. Qualified annuity plan of an employer

3. Simplified employee pension (SEP) plan

4. Retirement plan established by the federal government, a state, or a

political subdivision (except certain unfunded deferred compensation

plans under IRC Sec. 457)

5. Tax-sheltered annuity for employees of certain tax-exempt

organizations or public schools

6. Plan meeting the requirements of IRC Sec. 501(c)(18)

7. Savings incentive match plan for employees of small employers

(SIMPLE) IRA plan or a SIMPLE 401(k) plan

If you do not know whether your employer maintains one of these

plans or whether you are an active participant in a plan, check with

your employer or your tax advisor. Also, the IRS Form W-2, Wage and

Tax Statement, that you receive at the end of the year from your

employer will indicate whether you are an active participant.

If you are an active participant, are single, and have MAGI within the

applicable phase-out range listed below, the deductible amount of your

contribution is determined as follows. (1) Begin with the appropriate

phase-out range maximum for the applicable year (specified below)

and subtract your MAGI; (2) divide this total by the difference between

the phase-out maximum and minimum; and (3) multiply this number by

the maximum allowable contribution for the applicable year, including

catch-up contributions if you are age 50 or older. The resulting figure

will be the maximum IRA deduction you may take. For example, if you

are age 30 with MAGI of $66,000 in 2020, your maximum deductible

contribution is $5,400 (the 2020 phase-out range maximum of $75,000

minus your MAGI of $66,000, divided by the difference between the

maximum and minimum phase-out range limits of $10,000, and

multiplied by the contribution limit of $6,000).

If you are an active participant, are married to an active participant

and you file a joint income tax return, and have MAGI within the

applicable phase-out range listed below, the deductible amount of

your contribution is determined as follows. (1) Begin with the

appropriate phase-out maximum for the applicable year (specified

below) and subtract your MAGI; (2) divide this total by the difference

between the phase-out range maximum and minimum; and (3)

multiply this number by the maximum allowable contribution for the

applicable year, including catch-up contributions if you are age 50 or

older. The resulting figure will be the maximum IRA deduction you may

take. For example, if you are age 30 with MAGI of $107,000 in 2020,

your maximum deductible contribution is $5,100 (the 2020 phase-out

maximum of $124,000 minus your MAGI of $107,000, divided by the

difference between the maximum and minimum phase-out limits of

$20,000, and multiplied by the contribution limit of $6,000).

If you are an active participant, are married and you file a separate

income tax return, your MAGI phase-out range is generally $0

– $10,000.

However, if you lived apart for the entire tax year, you are treated as a

single filer.

Tax Year

Joint Filers

Phase-Out Range*

Single Taxpayers

Phase-Out Range*

(minimum)(maximum) (minimum)(maximum)

2013 $95,000

– 115,000 $59,000 – 69,000

2014 $96,000

– 116,000 $60,000 – 70,000

2015 $98,000

– 118,000 $61,000 – 71,000

2016 $98,000

– 118,000 $61,000 – 71,000

2017 $99,000

– 119,000 $62,000 – 72,000

2018 $101,000

– 121,000 $63,000 – 73,000

2019 $103,000

– 123,000 $64,000 – 74,000

2020 $104,000

– 124,000 $65,000 – 75,000

*MAGI limits are subject to cost-of-living adjustments each year.

The MAGI phase-out range for an individual that is not an active

participant, but is married to an active participant, is $193,000

– $203,000

(for 2019) and $196,000

– $206,000 (for 2020). This limit is also subject

to cost-of-living increases for tax years after 2020. If you are not an

active participant in an employer-sponsored retirement plan, are

married to someone who is an active participant, and you file a joint

income tax return with MAGI between the applicable phase-out range

for the year, your maximum deductible contribution is determined as

follows. (1) Begin with the appropriate MAGI phase-out maximum for

the year and subtract your MAGI; (2) divide this total by the difference

between the phase-out range maximum and minimum; and (3) multiply

this number by the maximum allowable contribution for the applicable

year, including catch-up contributions if you are age 50 or older. The

resulting figure will be the maximum IRA deduction you may take.

You must round the resulting deduction to the next highest $10 if the

number is not a multiple of 10. If your resulting deduction is between

$0 and $200, you may round up to $200.

B. Contribution Deadline – The deadline for making an IRA contribution

is your tax return due date (not including extensions). You may

designate a contribution as a contribution for the preceding taxable

year in a manner acceptable to us. For example, if you are a calendar-

year taxpayer and you make your IRA contribution on or before your

tax filing deadline, your contribution is considered to have been made

for the previous tax year if you designate it as such.

If you are a member of the Armed Forces serving in a combat zone,

hazardous duty area, or contingency operation, you may have an

extended contribution deadline of 180 days after the last day served

in the area. In addition, your contribution deadline for a particular tax

year is also extended by the number of days that remained to file that

year’s tax return as of the date you entered the combat zone. This

additional extension to make your IRA contribution cannot exceed the

number of days between January 1 and your tax filing deadline, not

including extensions.

C. Tax Credit for Contributions – You may be eligible to receive a tax

credit for your Traditional IRA contributions. This credit will be allowed

in addition to any tax deduction that may apply, and may not exceed

$1,000 in a given year. You may be eligible for this tax credit if you are

• age 18 or older as of the close of the taxable year,

• not a dependent of another taxpayer, and

• not a full-time student.

The credit is based upon your income (see chart below), and will range

from 0 to 50 percent of eligible contributions. In order to determine

the amount of your contributions, add all of the contributions made to

your Traditional IRA and reduce these contributions by any distributions

that you have taken during the testing period. The testing period

begins two years prior to the year for which the credit is sought and

ends on the tax return due date (including extensions) for the year for

which the credit is sought. In order to determine your tax credit,

multiply the applicable percentage from the chart below by the

amount of your contributions that do not exceed $2,000.

Page 10 of 15

2019 Adjusted Gross Income*

Applicable

Percentage

Joint

Return

Head of a

Household

All Other

Cases

– 38,500 $1 – 28,875 $1 – 19,250 50

$38,501

– 41,500 $28,876 – 31,125 $19,251 – 20,750 20

$41,501

– 64,000 $31,126 – 48,000 $20,751 – 32,000 10

Over $64,000 Over $48,000 Over $32,000 0

2020 Adjusted Gross Income*

Applicable

Percentage

Joint

Return

Head of a

Household

All Other

Cases

– 39,000 $1 – 29,250 $1 – 19,500 50

$39,001

– 42,500 $29,251 – 31,875 $19,501 – 21,250 20

$42,501

– 65,000 $31,876 – 48,750 $21,251 – 32,500 10

Over $65,000 Over $48,750 Over $32,500 0

*Adjusted gross income (AGI) includes foreign earned income and

income from Guam, America Samoa, North Mariana Islands, and Puerto

Rico. AGI limits are subject to cost-of-living adjustments each year.

D. Excess Contributions – An excess contribution is any amount that is

contributed to your IRA that exceeds the amount that you are eligible

to contribute. If the excess is not corrected timely, an additional

penalty tax of six percent will be imposed upon the excess amount.

The procedure for correcting an excess is determined by the timeliness

of the correction as identified below.

1. Removal Before Your Tax Filing Deadline. An excess contribution

may be corrected by withdrawing the excess amount, along with

the earnings attributable to the excess, before your tax filing

deadline, including extensions, for the year for which the excess

contribution was made. An excess withdrawn under this method is

not taxable to you, but you must include the earnings attributable

to the excess in your taxable income in the year in which the

contribution was made. The six percent excess contribution

penalty tax will be avoided.

2. Removal After Your Tax Filing Deadline. If you are correcting an

excess contribution after your tax filing deadline, including

extensions, remove only the amount of the excess contribution.

The six percent excess contribution penalty tax will be imposed on

the excess contribution for each year it remains in the IRA. An

excess withdrawal under this method will only be taxable to you if

the total contributions made in the year of the excess exceed the

annual applicable contribution limit.

3. Carry Forward to a Subsequent Year. If you do not withdraw the

excess contribution, you may carry forward the contribution for a

subsequent tax year. To do so, you under-contribute for that tax

year and carry the excess contribution amount forward to that

year on your tax return. The six percent excess contribution

penalty tax will be imposed on the excess amount for each year

that it remains as an excess contribution at the end of the year.

You must file IRS Form 5329 along with your income tax return to

report and remit any additional taxes to the IRS.

E. Tax-Deferred Earnings – The investment earnings of your IRA are not

subject to federal income tax until distributions are made (or, in

certain instances, when distributions are deemed to be made).

F. Nondeductible Contributions – You may make nondeductible

contributions to your IRA to the extent that deductible contributions

are not allowed. The sum of your deductible and nondeductible IRA

contributions cannot exceed your contribution limit (the lesser of the

allowable contribution limit described previously, or 100 percent of

compensation). You may elect to treat deductible IRA contributions as

nondeductible contributions.

If you make nondeductible contributions for a particular tax year, you

must report the amount of the nondeductible contribution along with

your income tax return using IRS Form 8606. Failure to file IRS Form

8606 will result in a $50 per failure penalty.

If you overstate the amount of designated nondeductible contributions

for any taxable year, you are subject to a $100 penalty unless

reasonable cause for the overstatement can be shown.

G. Taxation of Distributions – The taxation of IRA distributions depends

on whether or not you have ever made nondeductible IRA

contributions. If you have only made deductible contributions, all IRA

distribution amounts will be included in income.

If you have ever made nondeductible contributions to any IRA, the

following formula must be used to determine the amount of any IRA

distribution excluded from income.

(Aggregate Nondeductible Contributions)

 x (AmountWithdrawn)

––––––––––––––––––––––––––––––––––= AmountExcludedFromIncome

Aggregate IRA Balance

NOTE: Aggregate nondeductible contributions include all nondeductible

contributions made by you through the end of the year of the

distribution that have not previously been withdrawn and excluded

from income. Also note that the aggregate IRA balance includes the

total balance of all of your Traditional and SIMPLE IRAs as of the end of

the year of distribution and any distributions occurring during the year.

H. Income Tax Withholding – Any withdrawal from your IRA is subject to

federal income tax withholding. You may, however, elect not to have

withholding apply to your IRA withdrawal. If withholding is applied to

your withdrawal, not less than 10 percent of the amount withdrawn

must be withheld.

I. Early Distribution Penalty Tax – If you receive an IRA distribution

before you attain age 59½, an additional early distribution penalty tax

of 10 percent will apply to the taxable amount of the distribution unless

one of the following exceptions apply. 1) Death. After your death,

payments made to your beneficiary are not subject to the 10 percent

early distribution penalty tax. 2) Disability. If you are disabled at the

time of distribution, you are not subject to the additional 10 percent

early distribution penalty tax. In order to be disabled, a physician must

determine that your impairment can be expected to result in death or

to be of long, continued, and indefinite duration. 3) Substantially equal

periodic payments. You are not subject to the additional 10 percent

early distribution penalty tax if you are taking a series of substantially

equal periodic payments (at least annual payments) over your life

expectancy or the joint life expectancy of you and your beneficiary. You

must continue these payments for the longer of five years or until you

reach age 59½. 4) Unreimbursed medical expenses. If you take

payments to pay for unreimbursed medical expenses that exceed a

specified percentage of your adjusted gross income, you will not be

subject to the 10 percent early distribution penalty tax. For further

detailed information and effective dates you may obtain IRS Publication

590-B, Distributions from Individual Retirement Arrangements (IRAs),

from the IRS. The medical expenses may be for you, your spouse, or

any dependent listed on your tax return. 5) Health insurance premiums.

If you are unemployed and have received unemployment compensation

for 12 consecutive weeks under a federal or state program, you may

take payments from your IRA to pay for health insurance premiums

without incurring the 10 percent early distribution penalty tax.

6) Higher education expenses. Payments taken for certain qualified

higher education expenses for you, your spouse, or the children or

grandchildren of you or your spouse, will not be subject to the

10 percent early distribution penalty tax. 7) First-time homebuyer. You

may take payments from your IRA to use toward qualified acquisition

costs of buying or building a principal residence. The amount you may

take for this reason may not exceed a lifetime maximum of $10,000.

The payment must be used for qualified acquisition costs within

Page 11 of 15

120 days of receiving the distribution. 8) IRS levy. Payments from your

IRA made to the U.S. government in response to a federal tax levy are

not subject to the 10 percent early distribution penalty tax. 9) Qualified

reservist distributions. If you are a qualified reservist member called to

active duty for more than 179 days or an indefinite period, the

payments you take from your IRA during the active duty period are not

subject to the 10 percent early distribution penalty tax. 10) Qualified

birth or adoption. Payments from your IRA for the birth of your child

or the adoption of an eligible adoptee will not be subject to the 10

percent early distribution penalty tax if the distribution is taken during

the one-year period beginning on the date of birth of your child or the

date on which your legal adoption of an eligible adoptee is finalized.

An eligible adoptee means any individual (other than your spouse’s

child) who has not attained age 18 or is physically or mentally incapable

of self-support. The aggregate amount you may take for this reason

may not exceed $5,000 for each birth or adoption.

You must file IRS Form 5329 along with your income tax return to the

IRS to report and remit any additional taxes or to claim a penalty tax

exception.

J. Rollovers and Conversions – Your IRA may be rolled over to another

IRA, SIMPLE IRA, or an eligible employer-sponsored retirement plan of

yours, may receive rollover contributions, or may be converted to a

Roth IRA, provided that all of the applicable rollover and conversion

rules are followed. Rollover is a term used to describe a movement of

cash or other property to your IRA from another IRA, or from your

employer’s qualified retirement plan, 403(a) annuity, 403(b) tax-

sheltered annuity, 457(b) eligible governmental deferred compensation

plan, or federal Thrift Savings Plan. The amount rolled over is not

subject to taxation or the additional 10 percent early distribution

penalty tax. Conversion is a term used to describe the movement of

Traditional IRA assets to a Roth IRA. A conversion generally is a taxable

event. The general rollover and conversion rules are summarized

below. These transactions are often complex. If you have any questions

regarding a rollover or conversion, please see a competent tax advisor.

1. Traditional IRA-to-Traditional IRA Rollovers. Assets distributed

from your Traditional IRA may be rolled over to the same Traditional

IRA or another Traditional IRA of yours if the requirements of IRC

Sec. 408(d)(3) are met. A proper IRA-to-IRA rollover is completed if

all or part of the distribution is rolled over not later than 60 days

after the distribution is received. In the case of a distribution for a

first-time homebuyer where there was a delay or cancellation of the

purchase, the 60-day rollover period may be extended to 120 days.

You are permitted to roll over only one distribution from an IRA

(Traditional, Roth, or SIMPLE) in a 12-month period, regardless of

the number of IRAs you own. A distribution may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more information on rollover limitations, you may

wish to obtain IRS Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

2. SIMPLE IRA-to-Traditional IRA Rollovers. Assets distributed from

your SIMPLE IRA may be rolled over to your Traditional IRA without

IRS penalty tax provided two years have passed since you first

participated in a SIMPLE IRA plan sponsored by your employer. As

with Traditional IRA-to-Traditional IRA rollovers, the requirements

of IRC Sec. 408(d)(3) must be met. A proper SIMPLE IRA-to-IRA

rollover is completed if all or part of the distribution is rolled over

not later than 60 days after the distribution is received.

You are permitted to roll over only one distribution from an IRA

(Traditional, Roth, or SIMPLE) in a 12-month period, regardless of

the number of IRAs you own. A distribution may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more information on rollover limitations, you may

wish to obtain IRS Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

3. Employer-Sponsored Retirement Plan-to-Traditional IRA Rollovers.

You may roll over, directly or indirectly, any eligible rollover

distribution from an eligible employer-sponsored retirement plan.

An eligible rollover distribution is defined generally as any

distribution from a qualified retirement plan, 403(a) annuity, 403(b)

tax-sheltered annuity, 457(b) eligible governmental deferred

compensation plan, or federal Thrift Savings Plan unless it is a

required minimum distribution, hardship distribution, part of a

certain series of substantially equal periodic payments, corrective

distributions of excess contributions, excess deferrals, excess annual

additions and any income allocable to the excess, deemed loan

distribution, dividends on employer securities, the cost of life

insurance coverage, or a distribution of Roth elective deferrals from

a 401(k), 403(b), governmental 457(b), or federal Thrift Savings Plan.

If you elect to receive your rollover distribution prior to placing it

in an IRA, thereby conducting an indirect rollover, your plan

administrator generally will be required to withhold 20 percent of

your distribution as a payment of income taxes. When completing

the rollover, you may make up out of pocket the amount withheld,

and roll over the full amount distributed from your employer-

sponsored retirement plan. To qualify as a rollover, your eligible

rollover distribution generally must be rolled over to your IRA not

later than 60 days after you receive the distribution. In the case of

a plan loan offset due to plan termination or severance from

employment, the deadline for completing the rollover is your tax

return due date (including extensions) for the year in which the

offset occurs. Alternatively, you may claim the withheld amount as

income, and pay the applicable income tax, and if you are under

age 59½, the 10 percent early distribution penalty tax (unless an

exception to the penalty applies).

As an alternative to the indirect rollover, your employer generally

must give you the option to directly roll over your employer-

sponsored retirement plan balance to an IRA. If you elect the

direct rollover option, your eligible rollover distribution will be

paid directly to the IRA (or other eligible employer-sponsored

retirement plan) that you designate. The 20 percent withholding

requirements do not apply to direct rollovers.

4. Beneficiary Rollovers From Employer-Sponsored Retirement Plans.

If you are a spouse or nonspouse beneficiary of a deceased

employer-sponsored retirement plan participant, or the trustee of

an eligible type of trust named as beneficiary of such participant,

you may directly roll over inherited assets from a qualified retirement

plan, 403(a) annuity, 403(b) tax-sheltered annuity, or 457(b) eligible

governmental deferred compensation plan to an inherited IRA, as

permitted by the IRS. The IRA must be maintained as an inherited

IRA, subject to the beneficiary distribution requirements.

5. Traditional IRA-to-SIMPLE IRA Rollovers. Assets distributed from

your Traditional IRA may be rolled over to a SIMPLE IRA if the

requirements of IRC Sec. 408(d)(3) are met and two years have

passed since you first participated in a SIMPLE IRA plan sponsored

by your employer. A proper Traditional IRA-to-SIMPLE IRA rollover

is completed if all or part of the distribution is rolled over not later

than 60 days after the distribution is received. In the case of a

distribution for a first-time homebuyer where there was a delay or

cancellation of the purchase, the 60-day rollover period may be

extended to 120 days.

You are permitted to roll over only one distribution from an IRA

(Traditional, Roth, or SIMPLE) in a 12-month period, regardless of

the number of IRAs you own. A distribution may be rolled over to

the same IRA or to another IRA that is eligible to receive the

Page 12 of 15

rollover. For more information on rollover limitations, you may

obtain IRS Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

6. Traditional IRA-to-Employer-Sponsored Retirement Plan Rollovers.

You may roll over, directly or indirectly, any taxable eligible rollover

distribution from an IRA to your qualified retirement plan, 403(a)

annuity, 403(b) tax-sheltered annuity, or 457(b) eligible

governmental deferred compensation plan as long as the employer-

sponsored retirement plan accepts such rollover contributions.

7. Traditional IRA-to-Roth IRA Conversions. If you convert to a Roth

IRA, the amount of the conversion from your Traditional IRA to

your Roth IRA will be treated as a distribution for income tax

purposes, and is includible in your gross income (except for any

nondeductible contributions). Although the conversion amount

generally is included in income, the 10 percent early distribution

penalty tax will not apply to conversions from a Traditional IRA to

a Roth IRA, regardless of whether you qualify for any exceptions to

the 10 percent penalty tax. If you are required to take a required

minimum distribution for the year, you must remove your required

minimum distribution before converting your Traditional IRA.

8. Qualified HSA Funding Distribution. If you are eligible to contribute

to a health savings account (HSA), you may be eligible to take a

one-time tax-free qualified HSA funding distribution from your IRA

and directly deposit it to your HSA. The amount of the qualified

HSA funding distribution may not exceed the maximum HSA

contribution limit in effect for the type of high deductible health

plan coverage (i.e., single or family coverage) that you have at the

time of the deposit, and counts toward your HSA contribution limit

for that year. For further detailed information, you may wish to

obtain IRS Publication 969, Health Savings Accounts and Other

Tax-Favored Health Plans.

9. Rollovers of Settlement Payments From Bankrupt Airlines. If you

are a qualified airline employee who has received a qualified

airline settlement payment from a commercial airline carrier

under the approval of an order of a federal bankruptcy court, you

are allowed to roll over up to 90 percent of the proceeds into your

Traditional IRA within 180 days after receipt of such amount, or by

a later date if extended by federal law. If you make such a rollover

contribution, you may exclude the amount rolled over from your

gross income in the taxable year in which the airline settlement

payment was paid to you. For further detailed information and

effective dates you may obtain IRS Publication 590-A, Contributions

to Individual Retirement Arrangements (IRAs), from the IRS or

refer to the IRS website at www.irs.gov.

10. Rollovers of Exxon Valdez Settlement Payments. If you receive a

qualified settlement payment from Exxon Valdez litigation, you

may roll over the amount of the settlement, up to $100,000,

reduced by the amount of any qualified Exxon Valdez settlement

income previously contributed to a Traditional or Roth IRA or

eligible retirement plan in prior taxable years. You will have until

your tax return due date (not including extensions) for the year in

which the qualified settlement income is received to make the

rollover contribution. To obtain more information on this type of

rollover, you may wish to visit the IRS website at www.irs.gov.

11. Rollover of IRS Levy. If you receive a refund of eligible retirement

plan assets that had been wrongfully levied, you may roll over the

amount returned up until your tax return due date (not including

extensions) for the year in which the money was returned.

12. Repayment of Qualified Birth or Adoption Distribution. If you

have taken a qualified birth or adoption distribution, you may

generally repay all or a portion of the aggregate amount of such

distribution to an IRA, as permitted by the IRS. For further

information, you may wish to obtain IRS Publication 590-A,

Contributions to Individual Retirement Arrangements (IRAs), by

visiting www.irs.gov on the Internet.

13. Written Election. At the time you make a rollover to an IRA, you

must designate in writing to the custodian your election to treat

that contribution as a rollover. Once made, the rollover election is

irrevocable.

K. Transfer Due to Divorce – If all or any part of your IRA is awarded to

your spouse or former spouse in a divorce or legal separation

proceeding, the amount so awarded will be treated as the spouse’s

IRA (and may be transferred pursuant to a court-approved divorce

decree or written legal separation agreement to another IRA of your

spouse), and will not be considered a taxable distribution to you. A

transfer is a tax-free direct movement of cash and/or property from

one Traditional IRA to another.

L. Recharacterizations – If you make a contribution to a Traditional IRA

and later recharacterize either all or a portion of the original

contribution to a Roth IRA along with net income attributable, you may

elect to treat the original contribution as having been made to the

Roth IRA. The same methodology applies when recharacterizing a

contribution from a Roth IRA to a Traditional IRA. The deadline for

completing a recharacterization is your tax filing deadline (including

any extensions) for the year for which the original contribution was

made. You may not recharacterize a Roth IRA conversion.

LIMITATIONS AND RESTRICTIONS

A. SEP Plans – Under a simplified employee pension (SEP) plan that meets

the requirements of IRC Sec. 408(k), your employer may make

contributions to your IRA. Your employer is required to provide you

with information that describes the terms of your employer’s SEP plan.

B. Spousal IRA – For contributions made for tax years beginning before

2020, if you are married and have compensation, you may contribute

to an IRA established for the benefit of your spouse for any year prior

to the year your spouse turns age 70½, regardless of whether or not

your spouse has compensation. For contributions made for 2020 and

later tax years, you may contribute to an IRA established for the

benefit of your spouse regardless of your spouse’s age, if you are

married and have compensation. You may make these spousal

contributions even if you are age 70½ or older. You must file a joint

income tax return for the year for which the contribution is made.

The amount you may contribute to your IRA and your spouse’s IRA is

the lesser of 100 percent of your combined eligible compensation or

$12,000 for 2019 and 2020. This amount may be increased with cost-

of-living adjustments each year. However, you may not contribute

more than the individual contribution limit to each IRA.

If your spouse is age 50 or older by the close of the taxable year, and is

otherwise eligible, you may make an additional contribution to your

spouse’s IRA. The maximum additional contribution is $1,000 per year.

C. Deduction of Rollovers and Transfers – A deduction is not allowed for

rollover or transfer contributions.

D. Gift Tax – Transfers of your IRA assets to a beneficiary made during

your life and at your request may be subject to federal gift tax under

IRC Sec. 2501.

E. Special Tax Treatment – Capital gains treatment and 10-year income

averaging authorized by IRC Sec. 402 do not apply to IRA distributions.

F. Prohibited Transactions – If you or your beneficiary engage in a

prohibited transaction with your IRA, as described in IRC Sec. 4975,

your IRA will lose its tax-deferred status, and you must include the

value of your account in your gross income for that taxable year. The

following transactions are examples of prohibited transactions with

Page 13 of 15

your IRA. (1) Taking a loan from your IRA (2) Buying property for

personal use (present or future) with IRA assets (3) Receiving certain

bonuses or premiums because of your IRA.

G. Pledging – If you pledge any portion of your IRA as collateral for a

loan, the amount so pledged will be treated as a distribution and will

be included in your gross income for that year.

OTHER

A. IRS Plan Approval – Articles I through VII of the agreement used to

establish this IRA have been approved by the IRS. The IRS approval is

a determination only as to form. It is not an endorsement of the plan

in operation or of the investments offered.

B. Additional Information – For further information on IRAs, you may wish

to obtain IRS Publication 590-A, Contributions to Individual Retirement

Arrangements (IRAs), or Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), by calling 800-TAX-FORM, or by visiting

www.irs.gov on the Internet.

C. Important Information About Procedures for Opening a New

Account – To help the government fight the funding of terrorism and

money laundering activities, federal law requires all financial

organizations to obtain, verify, and record information that identifies

each person who opens an account. Therefore, when you open an

IRA, you are required to provide your name, residential address, date

of birth, and identification number. We may require other information

that will allow us to identify you.

D. Qualified Reservist Distributions – If you are an eligible qualified

reservist who has taken penalty-free qualified reservist distributions

from your IRA or retirement plan, you may recontribute those amounts

to an IRA generally within a two-year period from your date of return.

E. Qualified Charitable Distributions – If you are age 70½ or older, you

may be eligible to take tax-free IRA distributions of up to $100,000 per

year and have these distributions paid directly to certain charitable

organizations. Special tax rules may apply. For further detailed

information you may obtain IRS Publication 590-B, Distributions from

Individual Retirement Arrangements (IRAs), from the IRS or refer to

the IRS website at www.irs.gov.

F. Disaster Related Relief – If you qualify (for example, you sustained an

economic loss due to, or are otherwise considered affected by, certain

disasters designated by Congress), you may be eligible for favorable tax

treatment on distributions, rollovers, and other transactions involving

your IRA. Qualified disaster relief may include penalty-tax free early

distributions made during specified timeframes for each disaster, the

ability to include distributions in your gross income ratably over multiple

years, the ability to roll over distributions to an eligible retirement plan

without regard to the 60-day rollover rule, and more. For additional

information on specific disasters, including a complete listing of disaster

areas, qualification requirements for relief, and allowable disaster-

related IRA transactions, you may wish to obtain IRS Publication 590-B,

Distributions from Individual Retirement Arrangements (IRAs), from the

IRS or refer to the IRS website at www.irs.gov.

G. Coronavirus-Related Distributions (CRDs) – If you qualify, you may

withdraw up to $100,000 in aggregate from your IRAs and eligible

retirement plans as a CRD, without paying the 10 percent early

distribution penalty tax. You are a qualified individual if you (or your

spouse or dependent) is diagnosed with the COVID-19 disease or the

SARS-CoV-2 virus in an approved test; or if you have experienced

adverse financial consequences as a result of being quarantined,

being furloughed or laid off or having work hours reduced due to such

virus or disease, being unable to work due to lack of child care due to

such virus or disease, closing or reduced hours of a business owned or

operated by you due to such virus or disease, or other factors as

determined by the IRS. A CRD must be made on or after January 1,

2020, and before December 31, 2020.

CRDs will be taxed ratably over a three-year period, unless you elect

otherwise, and may be repaid over three years beginning with the day

following the day a CRD is made. Repayments may be made to an

eligible retirement plan or IRA.

An eligible retirement plan is defined as a qualified retirement plan,

403(a) annuity, 403(b) tax-sheltered annuity, 457(b) eligible

governmental deferred compensation plan, or an IRA.

Page 14 of 15

FINANCIAL DISCLOSURE

The term IRA will be used below to mean Traditional IRA, Roth IRA, and SIMPLE IRA, unless otherwise specified.

The financial organization should complete the financial disclosure using Method I, Method II, or Method III.

If the growth of the IRA can reasonably be

projected, use either Method I or Method II. The account values projected using Method I or Method II must be reduced by all applicable fees and penalties.

If annual fees are assessed, such as an annual service fee, use Method II. If no projection of growth of the IRA can reasonably be shown, use Method III.

METHOD I Growth can be projected (Do not use Method I if an annual fee is charged. Instead, use Method II for financial projections.)

Your Age on Your Birth Date This Year Length of Time Deposit (If applicable)

The charts below give projections of the value of your IRA by showing the amount available at the end of each year. These projections assume an

interest rate of .25%, compounded annually. If you have invested your IRA in a time deposit, a loss-of-earnings penalty may be charged against a

withdrawal before maturity. A transaction fee may also apply to your IRA.

The Regular Contribution chart assumes that an annual contribution of $1,000 is made on the first day of each year. The Rollover, Transfer, or Conversion*

chart assumes that a one-time deposit of $1,000 is made on the first day of the first year.

Indicate the projected account value for each of the years, taking into consideration any applicable loss of earnings penalty or other fees assessed if the

IRA owner received a distribution at the end of the year for which the projection is being made. First, circle the year-end projected IRA value that is

applicable for each of the first five years. Next, circle the applicable IRA value for the years in which the IRA owner will attain ages 60, 65, and 70.

REGULAR CONTRIBUTION

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

NO.

YRS

ACCOUNT

VALUE

1 MONTH

PENALTY

3 MONTH

PENALTY

6 MONTH

PENALTY

AMT. AFTER

FEES AND

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 2,007.51 2,007.09 2,006.25 2,005.00

3 3,015.03 3,014.40 3,013.14 3,011.26

4 4,025.06 4,024.22 4,022.55 4,020.03

5 5,037.63 5,036.58 5,034.48 5,031.33

6 6,052.72 6,051.46 6,048.94 6,045.15

7 7,070.35 7,068.88 7,065.93 7,061.51

8 8,090.53 8,088.84 8,085.47 8,080.41

9 9,113.25 9,111.35 9,107.56 9,101.86

10 10,138.54 10,136.42 10,132.20 10,125.86

11 11,166.38 11,164.06 11,159.40 11,152.42

12 12,196.80 12,194.26 12,189.18 12,181.55

13 13,229.79 13,227.03 13,221.52 13,213.25

14 14,265.37 14,262.39 14,256.45 14,247.53

15 15,303.53 15,300.34 15,293.96 15,284.40

16 16,344.29 16,340.88 16,334.07 16,323.86

17 17,387.65 17,384.03 17,376.78 17,365.91

18 18,433.62 18,429.78 18,422.10 18,410.58

19 19,482.20 19,478.14 19,470.02 19,457.85

20 20,533.41 20,529.13 20,520.57 20,507.74

21 21,587.24 21,582.74 21,573.75 21,560.26

22 22,643.71 22,638.99 22,629.56 22,615.40

23 23,702.82 23,697.88 23,688.00 23,673.19

24 24,764.57 24,759.42 24,749.10

24,733.62

25,828.99 25,823.61 25,812.84

25,796.70

26 26,896.06 26,890.46 26,879.25 26,862.44

27 27,965.80 27,959.97 27,948.32 27,930.84

28 29,038.21 29,032.16 29,020.06 29,001.92

29 30,113.31 30,107.04 30,094.49 30,075.67

30 31,191.09 31,184.59 31,171.60 31,152.10

31 32,271.57 32,264.85 32,251.40 32,231.23

32 33,354.75 33,347.80 33,333.90 33,313.06

33 34,440.64 34,433.46 34,419.11 34,397.58

34 35,529.24 35,521.84 35,507.03 35,484.83

35 36,620.56 36,612.93 36,597.67 36,574.78

36 37,714.61 37,706.75 37,691.04 37,667.47

37 38,811.40 38,803.31 38,787.14 38,762.88

38 39,910.93 39,902.61 39,885.98 39,861.04

39 41,013.20 41,004.66 40,987.57 40,961.94

40 42,118.24 42,109.46 42,091.91 42,065.59

41 43,226.03 43,217.03 43,199.02 43,172.00

42 44,336.60 44,327.36 44,308.89 44,281.18

43 45,449.94 45,440.47 45,421.53 45,393.13

44 46,566.06 46,556.36 46,536.96 46,507.86

45 47,684.98 47,675.04 47,655.18 47,625.37

46 48,806.69 48,796.52 48,776.19 48,745.68

47 49,931.21 49,920.81 49,900.00 49,868.79

48 51,058.54 51,047.90 51,026.62 50,994.71

49 52,188.68 52,177.81 52,156.06 52,123.45

50 53,321.65 53,310.55 53,288.33 53,255.00

51 54,457.46 54,446.11

54,423.42 54,389.39

52 55,596.10 55,584.52

55,561.35 55,526.61

53 56,737.59 56,725.77 56,702.13 56,666.67

54 57,881.94 57,869.88 57,845.76 57,809.58

55 59,029.14 59,016.84 58,992.25 58,955.35

56 60,179.21 60,166.68 60,141.60 60,103.99

57 61,332.16 61,319.38 61,293.83 61,255.50

58 62,487.99 62,474.97 62,448.94 62,409.88

59 63,646.71 63,633.45 63,606.93 63,567.15

60 64,808.33 64,794.83 64,767.82 64,727.32

61 65,972.85 65,959.11 65,931.62 65,890.38

62 67,140.28 67,126.29 67,098.32 67,056.36

ROLLOVER, TRANSFER, OR CONVERSION*

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

NO.

YRS

ACCOUNT

VALUE

1 MONTH

PENALTY

3 MONTH

PENALTY

6 MONTH

PENALTY

AMT. AFTER

FEES AND

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 1,005.01 1,004.80 1,004.38 1,003.75

3 1,007.52 1,007.31 1,006.89 1,006.26

4 1,010.04 1,009.83 1,009.41 1,008.78

5 1,012.56 1,012.35 1,011.93 1,011.30

6 1,015.09 1,014.88 1,014.46 1,013.83

7 1,017.63 1,017.42 1,017.00 1,016.36

8 1,020.18 1,019.96 1,019.54 1,018.90

9 1,022.73 1,022.51 1,022.09 1,021.45

10 1,025.28 1,025.07 1,024.64 1,024.00

11 1,027.85 1,027.63 1,027.20 1,026.56

12 1,030.42 1,030.20 1,029.77 1,029.13

13 1,032.99 1,032.78 1,032.35 1,031.70

14 1,035.57 1,035.36 1,034.93 1,034.28

15 1,038.16 1,037.95 1,037.51 1,036.87

16 1,040.76 1,040.54 1,040.11 1,039.46

17 1,043.36 1,043.14 1,042.71 1,042.06

18 1,045.97 1,045.75 1,045.32 1,044.66

19 1,048.58 1,048.37 1,047.93 1,047.27

20 1,051.21 1,050.99 1,050.55 1,049.89

21 1,053.83 1,053.61 1,053.17 1,052.52

22 1,056.47 1,056.25 1,055.81 1,055.15

23 1,059.11 1,058.89 1,058.45 1,057.79

24 1,061.76 1,061.54

1,061.09 1,060.43

1,064.41

1,064.19

1,063.75 1,063.08

26 1,067.07 1,066.85 1,066.41 1,065.74

27 1,069.74 1,069.52 1,069.07 1,068.40

28 1,072.41 1,072.19 1,071.74 1,071.07

29 1,075.10 1,074.87 1,074.42 1,073.75

30 1,077.78 1,077.56 1,077.11 1,076.44

31 1,080.48 1,080.25 1,079.80 1,079.13

32 1,083.18 1,082.95 1,082.50 1,081.82

33 1,085.89 1,085.66 1,085.21 1,084.53

34 1,088.60 1,088.37 1,087.92 1,087.24

35 1,091.32 1,091.10 1,090.64 1,089.96

36 1,094.05 1,093.82 1,093.37 1,092.68

37 1,096.79 1,096.56 1,096.10 1,095.42

38 1,099.53 1,099.30 1,098.84 1,098.15

39 1,102.28 1,102.05 1,101.59 1,100.90

40 1,105.03 1,104.80 1,104.34 1,103.65

41 1,107.80 1,107.56 1,107.10 1,106.41

42 1,110.57 1,110.33 1,109.87 1,109.18

43 1,113.34 1,113.11 1,112.65 1,111.95

44 1,116.12 1,115.89 1,115.43 1,114.73

45 1,118.92 1,118.68 1,118.22 1,117.52

46 1,121.71 1,121.48 1,121.01 1,120.31

47 1,124.52 1,124.28 1,123.81 1,123.11

48 1,127.33 1,127.09 1,126.62 1,125.92

49 1,130.15 1,129.91 1,129.44 1,128.73

50 1,132.97 1,132.74 1,132.26 1,131.56

51 1,135.80

1,135.57 1,135.09 1,134.38

52 1,138.64

1,138.41 1,137.93 1,137.22

53 1,141.49 1,141.25 1,140.78 1,140.06

54 1,144.34 1,144.11 1,143.63 1,142.91

55 1,147.20 1,146.97 1,146.49 1,145.77

56 1,150.07 1,149.83 1,149.35 1,148.64

57 1,152.95 1,152.71 1,152.23 1,151.51

58 1,155.83 1,155.59 1,155.11 1,154.39

59 1,158.72 1,158.48 1,158.00 1,157.27

60 1,161.62 1,161.37 1,160.89 1,160.16

61 1,164.52 1,164.28 1,163.79 1,163.07

62 1,167.43 1,167.19 1,166.70 1,165.97

*Conversion applies to Roth IRAs only

ADDITIONAL FINANCIAL DISCLOSURE

INFORMATION

The account values shown are projections based

on many assumptions. They are not guaranteed,

but depend upon many factors, including the

interest rates and terms of future funding

instruments.

We may charge you fees in connection with your

IRA. If we do not charge these fees now, we may

do so in the future after giving you notice. If you

do not pay these fees separately, they may be

paid from the assets of your IRA.

CURRENT FEES

98 / 2300-C (Rev. 4/2020)

Page 15 of 15

METHOD II Growth can be projected

The financial projections below show the amount that would be available

if you were to withdraw your IRA assets at the indicated times. These

projections are based on the following assumptions.

CONTRIBUTION (Select one)

Regular. An annual $1,000 deposit is made on the first day of each

year.

Rollover, Transfer, or Conversion.* A one-time $1,000 deposit is

made on the first day of the first year.

Your Age on Your Birth Date in Contribution Year

Investment Instrument

Length of Time Deposit

Rate of Interest %

Compounding Method

FINANCIAL PROJECTIONS

Number of

Years in IRA

Program

Total

Accumulation

of IRA Dollars

Amount

After Fees

and Penalties

1 Year

$ $

2 Years

$ $

3 Years

$ $

4 Years

$ $

5 Years

$ $

End of the

Year You

Reach Age

Total

Accumulation

of IRA Dollars

Amount

After Fees

and Penalties

$ $

ADDITIONAL FINANCIAL DISCLOSURE INFORMATION

The account values shown are projections based on many assumptions.

These projections have been reduced by any applicable fees. They are not

guaranteed, but depend upon many factors, including the interest rates

and terms of future funding instruments.

We may charge you an annual service fee or other fees in connection with

your IRA. If we do not charge these fees now, we may do so in the future

after giving you notice. If you do not pay these fees separately, they may

be paid from the assets of your IRA.

CURRENT FEES

*Conversion applies to Roth IRAs only

METHOD III Growth cannot be projected

The value of your IRA will be dependent solely upon the performance of

any investment instrument used to fund your IRA. Therefore, no projection

of the growth of your IRA can reasonably be shown or guaranteed.

Terms and conditions of the IRA that affect your investment are listed

below.

INVESTMENT OPTIONS

Your IRA will be invested in products that we offer directly or those we

offer through a relationship with a registered securities broker-dealer.

FEES

There are certain fees and charges connected with your IRA investments.

These fees and charges may include the following.

• Sales Commissions

• Investment Management Fees

• Distribution Fees

• Set Up Fees

• Annual Maintenance Fees

• Surrender or Termination Fees

To find out what fees apply, refer to the investment prospectus or contract.

There may be certain fees and charges connected with the IRA itself.

(Select and complete as applicable.)

Annual Service Fee $

Transfer Fee $

Rollover Fee $

Termination Fee $

Other (Explain)

We reserve the right to change any of the above fees after notice to you,

as provided in your IRA agreement.

EARNINGS

The method for computing and allocating annual earnings (e.g., interest,

dividends) on your IRA will differ based on the nature and issuer of the

investments chosen. Refer to the investment prospectus or contract for

the methods used for computing and allocating annual earnings.

OTHER

Other terms or conditions that apply to your IRA include the following.

98 / 2300-C (Rev. 4/2020)

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INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (LGE Community Credit Union)

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