F14aV6Copyright © 2019 Madison Trust Company Inc. All Rights Reserved.
madisontrust.com
Corporate Headquarters: 401 E. 8
th
St. Suite 200, Sioux Falls, SD 57103
F. ACKNOWLEDGEMENT, AUTHORIZATION, & SIGNATURE
With my signature I acknowledge the following:
• I confirm that I have received, read, and agree to the terms and condiions contained in the Tradiional IRA and SEP Custodial Agreement, the Roth IRA
Custodial Agreement, or the SIMPLE IRA Custodial Agreement for the type of account I selected in Part C of my Account Applicaion, and that those terms
and condiions are fully incorporated into this Investment Authorizaion as if fully set forth herein. (The Custodial Agreements can be found at https://www.
• I confirm that Madison Trust has furnished and I have received, read, and understood the following documents: (a) the Madison Trust Privacy Noice, (b) the
•
stand and afirm that Madison Trust does not provide any legal advice, tax advice, or investment advice, nor has it provided me any such advice. I under
stand and afirm that Madison Trust does not perform any due diligence related to any investments or transacions I wish to make, nor has it performed any
such due diligence for my benefit. I understand and afirm that Madison Trust does not endorse any investments. I acknowledge that, in accordance with
the terms of the Custodial Agreement, I am obligated to defend, indemnify, and hold harmless Madison Trust, its employees, directors, shareholders, oficers,
agents, and representaives from and against any and all damages, losses, liabiliies, claims, acions, costs, and expenses, including but not limited to attor
neys’ fees, court costs, and witness fees, that Madison Trust, or any of such persons may be subject to, incur or pay, based on, as a result of, arising out of, or
otherwise related in any way to (i) any act of Madison Trust or any other such person with respect to the Custodial Account; or (ii) any claim, suit, acion, or
liability asserted against Madison Trust or any such person in connecion with any act taken by Madison Trust or any such person pursuant to any direcion
from me or my Authorized Representaive or for failing to act in the absence of any direcion.
• I understand that (i) Madison Trust reserves the right to not implement certain investment or transacion direcions; (ii) the decision of Madison Trust to not
implement any direcion shall not be construed as a determinaion by Madison Trust regarding the benefit, prudence, risk, legality, tax, or other consequenc
es of the directed investment or transacion; and (iii) any administraive review conducted by Madison Trust in connecion with any directed investment or
transacion is strictly for Madison Trust’s benefit and shall not consitute, and shall not obligate Madison Trust to provide, any opinion, recommendaion,
predicion, or advice regarding the directed investment or transacion.
• I understand that I may designate an Authorized Representaive and Interested Party pursuant to the Custodial Agreement, and that such a designaion is
solely my responsibility, and afirm that Madison Trust has not and will not perform any due diligence related to my decision to designate an Authorized
Representaive and Interested Party. I understand and afirm that any person(s) that I designate as an Authorized Representaive or Interested Party is my
agent and is not an employee, agent, or afiliate of Madison Trust, nor is anyone I designate as an Authorized Representaive or Interested Party controlled,
approved, recommended, or endorsed by Madison Trust. I understand and afirm that Madison Trust may rely on any written or oral direcions provided by
my Authorized Representaive or Interested Party as if such direcions were given by me, and that Madison Trust is enitled to all of the same protecions and
indemniies provided under the Custodial Agreement when relying upon and execuing the direcives of my Authorized Representaive or Interested Party as
if such direcives were given by me.
• Certain investments being held by Madison Trust in an IRA are: (a) not insured by the FDIC or any other federal or state deposit guaranteed fund; (b) not guaran
teed by Madison Trust, its subsidiaries, parent, and/or agents; and (c) are subject to investment risk, including the possible loss of the principal invested.
• I confirm that assets to be transferred into the Custodial Account do not include any illegal or impermissible investments under South Dakota or Federal law,
including, but not limited to, holdings of marijuana or other illegal substances, illegal gambling, or illegal arifacts. I further confirm that the Custodial Ac
count will not hold or engage in transacions involving illegal holdings while Madison Trust Company serves as custodian, and should the Custodial Account
ever come to hold an illegal or impermissible investment under South Dakota or Federal law, I will noify Madison Trust Company immediately.
• I am solely responsible for the investment instrucions I am making. I agree to indemnify, hold harmless, and release Madison Trust and Madison Adminis
traion Company from any and all liabiliies that either or both may incur directly or indirectly from my investment. I further acknowledge that I am solely
responsible for the success or failure of this investment. I hereby authorize the purchase of the asset listed above for my Madison Trust Custodial Account.
Accountholder signature Date (mm/dd/yy)
INVESTMENT AUTHORIZATION
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E. EXPEDITED SERVICE
Madison Trust processes every form in an eficient and quality manner. However, if you have special ime constraints and require expedited processing ime, select
this service:
Expedited Service: Madison Trust will expedite the funding of your investment ($50 Expedited fee applies)
** Please note that any forms received ater 1PM EST will be considered received on the following business day (applies to both standard and expedited processing). **
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