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RETURN INSTRUCTIONS

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Ally Bank

PO Box 13625

Philadelphia, PA 19101

Fax

Subject Line: Operations

Fax Number: 866-699-2969

INHERITED ROTH IRA APPLICATION TO PARTICIPATE

Married (including legally separated) Unmarried (single, divorced, widowed)

NAME SSN / TAX ID NUMBER DATE OF BIRTH

ADDRESS PERSONAL PHONE

WORK PHONE (OPTIONAL)

CITY STATE ZIP CODE

Successor Primary Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Successor Primary Beneficiary Successor Contingent Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Successor Primary Beneficiary Successor Contingent Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Ally Bank Member FDIC

QUESTIONS? CALL 1-877-247-2559 OR VISIT ALLY.COM

UPDATED 6/2020

Page 1 of 3

Decedent Information

DECEDENT NAME

SSN / TAX ID NUMBER DATE OF BIRTH DATE OF DEATH RELATIONSHIP

Print your responses in the data fields, including the Spousal Consent

section (if applicable).

Return the completed, signed form (all three pages) to Ally Bank at PO Box 13625, Philadelphia, PA 19101-9946 OR fax to 866-699-2969 with subject line:

Operations

OCCUPATION EMPLOYER

Successor Beneficiary Designation

All Primary and/or Contingent beneficiary allocations must equal 100% for each beneficiary type.

Inherited IRA Owner Information

INHERITED ROTH IRA APPLICATION TO PARTICIPATE

Successor Primary Beneficiary Successor Contingent Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Successor Primary Beneficiary Successor Contingent Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Signatures

INHERITED IRA OWNER SIGNATURE

DATE

Ally Bank Member FDIC

QUESTIONS? CALL 1-877-247-2559 OR VISIT ALLY.COM

UPDATED 6/2020

I, the undersigned IRA Owner, hereby designate the above persons/entities as my primary and contingent beneficiary(ies) for this Inherited Roth IRA Plan,

payable by reason of my death. (If a trust is a named beneficiary, a copy of the trust document must be provided.) If primary or contingent is not indicated,

each beneficiary will be designated a primary. Unless otherwise requested herein, each payment made pursuant to this designation: (a) shall be paid to

the primary beneficiary(ies) who are living at the time of my death; or (b) if no primary beneficiary(ies) shall be living at the time of my death, such payment

shall be made to the contingent beneficiary(ies) who are then living. I have the right to change this beneficiary designation at any time. If a beneficiary is

not properly designated or if no primary or contingent beneficiary survives the IRA owner, payments shall be made to my surviving spouse or, if I do not

have a surviving spouse, to my estate.

I certify that the information provided by me is true, complete and accurate, and that I have received a copy of the Application to Participate, Custodial

Account Agreement and Disclosure Statement, Financial Disclosure and the Deposit Account Agreement (collectively the “Documents”). I have read the

Documents and agree to be bound by their terms and conditions. I understand that the designation of the tax year for my contribution and my election to

treat a contribution as a rollover (if applicable) are irrevocable. I have not received any tax or legal advice from Ally Bank (“Custodian”) and assume sole

responsibility for all tax consequences associated with my contributions and distributions, determining that I am eligible for all IRA deposits (contributions,

transfers or rollovers) to this IRA, and ensuring that such deposits are in compliance with all tax laws. I will seek the advice of my tax professional when

appropriate. I understand that within seven (7) days from the date I open this IRA I may revoke it without penalty as described in the Documents. I will

not, nor will my spouse, heir, beneficiaries, or any other party, hold the Custodian liable for any adverse consequences that may result from my actions

or designations. I release the Custodian and agree to hold the Custodian harmless against any and all claims and situations arising from actions taken

by me.

Page 2 of 3

Successor Primary Beneficiary Successor Contingent Beneficiary

NAME ADDRESS CITY STATE ZIP CODE

PERCENTAGE (%) DATE OF BIRTH SSN / TAX ID NUMBER RELATIONSHIP

Successor Beneficiary Designation (continued)

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signature

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INHERITED ROTH IRA APPLICATION TO PARTICIPATE

Spousal Consent

For use in community/marital property states AZ, CA, ID, LA, NV, NM, TX, WA, WI (marital property state)

and AK (a married couple can make a community property election)

IRA OWNER

I am married. I understand that if I want to name a primary beneficiary other than my spouse, my spouse’s notarized signature appears below.

I am not married. I understand that if I become married in the future, I must complete an IRA Change of Beneficiary form which includes spousal

consent documentation.

IRA OWNER SPOUSE (IF APPLICABLE)

I acknowledge and agree that my s

pouse, the IRA Owne

has

and

will name a primary beneficiary or a percentage of less than 100% to someone other

than me for the inherited IRA Plan noted above. By signing below, I transfer any and all interest I may have in this IRA Plan to my spouse, the IRA

owner. I agree to seek the advice of a legal or tax professional, as needed.

SIGNATURE OF SPOUSE DATE

Ally B

ank Member FDIC

QUESTIONS? CALL 1-877-247-2559 OR VISIT ALLY.COM

UPDATED 6/2020

Page 3 of 3

State of: _______________________

County of: ______________________

On this the _____ day of _________________ , ___________ , before me, ________________________ , the undersigned Notary Public, personally

appeared __________________________________ ,

Personally known to me

Proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and has hereby

acknowledged to me that he/she/they have executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the

instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

_______________________________________________

Notary Signature

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signature

click to edit

click to sign

signature

click to edit

Introduction

The Depositor whose name appears on the Application to Participate is establishing a

Roth Individual Retirement Account (Roth IRA) under section 408A to provide for his or her

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the Application to Participate has given the Depositor the disclosure statement required by

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RQWKH$SSOLFDWLRQWR3DUWLFLSDWH

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ARTICLE I

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ARTICLE II

1. The annual contribution limit described in Article I is gradually reduced to $0 for higher

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ARTICLE III

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ARTICLE IV

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ARTICLE V

1. If the Depositor dies before his or her entire interest is distributed to him or her and

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(b) The remaining interest will be distributed by the end of the calendar year containing the

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2. The minimum amount that must be distributed each year under paragraph 1(a) above is

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ARTICLE VI

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General Instructions

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Purpose of Form

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Roth individual retirement account (Roth IRA) is established

after the form is fully executed by both the individual

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Depositor. The Depositor is the person who establishes the

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Article I.7KH'HSRVLWRU PD\EH VXEMHFWWR D  WD[ RQ

excess contributions if (1) contributions to other individual

retirement arrangements of the Depositor have been made

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income exceeds the applicable limits in Article II for the

WD[\HDURU(3) the Depositor's and spouse's compensation

is less than the amount contributed by or on behalf of them

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Article V. This article describes how distributions will be made

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pursuant to this article should be reviewed periodically to ensure

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Article IX. Article IX and any that follow it may incorporate

additional provisions that are agreed to by the Depositor and

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ARTICLE VII

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ARTICLE VIII

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Roth Individual Retirement Custodial Account

(Under Section 408A of the Internal Revenue Code)

(Rev. April 2017)

Department of the Treasury

Internal Revenue Service

Form

Do not ¿OH

with the Internal

Revenue Service

5305-RA

Inherited Roth IRA Custodial Disclosure Statement

Introduction

This disclosure statement describes the statutory and regulatory provisions applicable

to the operation and tax treatment of the inherited Roth IRA. It is intended to provide

you with a clear explanation of the rules governing the inherited Roth IRA. Please

review the disclosure carefully.

Because of the complexity of the rules, you should consult with your tax advisor if

you have any questions regarding this material. Further information concerning your

inherited Roth IRA can be obtained from any district oce of the Internal Revenue

Service (IRS).

Revocation of Account

Procedure. IRS regulations require that this disclosure statement be given to you at least

seven days before the account is established, or on the date the account is established

if you may revoke the account within at least seven days after it is established. The

inherited Roth IRA described in this statement provides for delivery of the required

disclosure statement at the time the inherited Roth IRA is established. Accordingly,

you are entitled to revoke your inherited Roth IRA for any reason within seven days

after the date it is established. Such revocation may be made only by written notice

mailed or delivered to the person and the Organization at the address indicated on your

Application to Participate. If mailed, your revocation notice shall be deemed mailed

on the date of the postmark if deposited in the mail in the United States in an envelope

or other appropriate wrapper with rst-class postage prepaid. If sent by registered

or certied mail, the date of registration or certication will be the date on which it

is deemed mailed. Upon revocation within the seven-day period, you are entitled to

a return of the entire amount paid into your inherited Roth IRA without adjustment

for administrative expenses, penalties, commissions, or uctuations in market value.

If you have any questions about revoking your inherited Roth IRA, please call the

Custodian’s contact person at the phone number on your Application to Participate.

Qualications

The Inherited Roth IRA. A Custodial inherited Roth IRA is a Custodial account

organized in the United States that allows certain eligible individuals to accumulate

funds for retirement under favorable tax conditions. Contributions to a Roth IRA made

by the deceased Roth IRA holder were not deductible, but if the funds are distributed

in a “qualied distribution,” they are tax-free; therefore, the earnings on the inherited

Roth IRA are generally tax-free.

Qualied Custodial Account. This Roth IRA Custodial Account uses the precise

language of Form 5305-RA provided by the Internal Revenue Service (including any

additional language permitted by such form) and is treated as approved. IRS approval

represents a determination as to form and not to the merits thereof.

Converting to an Inherited Roth IRA

You may be allowed to directly roll over (convert) an inherited workplace retirement

plan (WRP) (other than a designated Roth Account) to an inherited Roth IRA. The

conversion amount is subject to federal income taxation (but no 10% penalty tax).

Taxation of Conversion. The taxable portion of the WRP distribution is included

in your income for the year distributed from an inherited WRP that is directly rolled

over to an inherited Roth IRA.

Rollovers

Inherited Designated Roth Account-to-Inherited Roth IRA Rollovers. Generally,

you are allowed to directly roll over an inherited designated Roth account to an

inherited Roth IRA. For the purpose of determining the taxation of subsequent

inherited Roth IRA distributions, the nontaxable portion of an inherited designated

Roth account distribution that is rolled over to an inherited Roth IRA is treated as a

regular Roth IRA contribution for distribution purposes. The taxable portion of an

inherited designated Roth account distribution that is rolled over to an inherited Roth

IRA is treated as earnings in the Roth IRA. See the section titled, "Converting to an

Inherited Roth IRA" for the rules for rolling over from an inherited WRP (other than

an inherited designated Roth account) to another inherited Roth IRA.

Transfers

Roth IRA-to-Roth IRA Transfers. You may transfer all or any portion of the assets

from one inherited Roth IRA (including this one) to an inherited Roth IRA.

Distributions

Aggregation and Ordering Rules. When you take a distribution from an inherited

Roth IRA, that inherited Roth IRA is aggregated with all the other inherited Roth IRAs

(but not inherited Traditional IRAs) you inherited from the same deceased individual

for taxation and penalty purposes.

Also, distributions from inherited Roth IRAs are aggregated and special ordering rules

are designed to determine taxation and penalties.

Distributions from inherited Roth IRAs are treated as paid in the following order:

1. Regular and spousal Roth IRA contributions, then

2. Conversion contributions, in first-in, first-out order, (within which a

distribution is treated as rst being paid from funds that were includible in

income as a result of the conversion, then from funds that were not includible

in income as a result of the conversion (i.e., nondeductible contributions to

the Traditional IRA), then

3. Earnings.

Qualied Distributions. A distribution from an inherited Roth IRA is a qualied

distribution, and therefore the entire distribution, including the earnings, are tax- and

penalty-free, if it is paid after the ve-taxable-year period that begins with the rst

taxable year for which the deceased Roth IRA holder made any Roth IRA contribution,

including a conversion from a Traditional IRA.

Nonqualied Distributions. A distribution that is not a “qualied distribution” is

considered a nonqualied distribution and the earnings portion, if any, is taxable as

ordinary income.

Distributions of Contributions are Tax- and Penalty-Free. A distribution of regular

or spousal contributions in an inherited Roth IRA is always tax- and penalty-free,

regardless of whether the distribution is a qualied or nonqualied distribution.

Death Distribution Options

If the Deceased Roth IRA holder Died Before 2020:

You should rst seek the advice of your own tax advisor as to the tax consequences

of each option available. For deaths before 2020, you may generally elect one of the

following options: 1) to receive the balance in the account by December 31 of the fth

year following the year of the deceased Roth IRA holder's death (the ve-year rule),

or 2) to receive equal or substantially equal payments over a period not exceeding

your life expectancy (the life-expectancy rule). If you are a nonspouse beneciary,

you should elect one of these methods of distribution by December 31 of the year

following the year of the deceased Roth IRA holder's death. If you are the deceased

Roth IRA holder's spouse, you should elect one of these methods of distribution by

the earlier of (1) December 31 of the fth year following the year of the deceased

Roth IRA holder's death, or (2) December 31 of the year the deceased Roth IRA holder

would have attained age 72 (age 70½ before 2020). If an election is not timely made,

distributions will be made under the life-expectancy rule. If you are not an individual,

the Roth IRA must generally be closed using the ve-year rule. However, a special

rule applies if you are a trust that satises certain conditions. In that case, the Roth

IRA could be paid to the trust under the life-expectancy rule.

Congratulations

Contributions to a Roth IRA were not deductible, and, therefore, are not taxable when distributed. In addition, if the funds are distributed in a “qualied distribution,” the

entire distribution is tax-free; therefore, the earnings on the inherited Roth IRA are generally tax-free.

This booklet, containing your Roth IRA Custodial Agreement and Disclosure Statement, is yours to keep. Please read it over carefully to understand the rules relating to

your inherited Roth IRA.

Thank you for allowing us to maintain your inherited Roth IRA. We’re here to help you in any way we can. If you have any questions, or if we can assist you on any other

matter, please let us know.

Application to Participate

The Application is used to record all of the participant information necessary

to establish the inherited Roth IRA. It is important that all of the information be

completed.

Roth IRA Custodial Agreement

This is the legal document that denes the Internal Revenue Service’s rules and

regulations for Roth IRAs. The Custodial Agreement, together with a fully completed

Application to Participate, establishes the inherited Roth IRA with our organization.

Disclosure Statement

The Disclosure Statement is a nontechnical description of the rules governing this

inherited Roth IRA. It is easy to understand, because it’s written in layman’s language.

Explanations are separated by headings that help you locate specic rules about the

inherited Roth IRA.

If distributions are made under the life-expectancy rule, they must commence by

December 31 of the year following the year of the deceased Roth IRA holder's death.

However, if you are the deceased Roth IRA holder's surviving spouse, distributions do

not have to commence until December 31 of the year the deceased Roth IRA holder

would have attained age 72 (age 70½ before 2020), if later. If you are the deceased

Roth IRA holder's surviving spouse, your single life expectancy will be based on your

attained age on your birthday each year. If you are an individual who is not the deceased

Roth IRA holder's surviving spouse, your single life expectancy will be determined

using your attained age on your birthday in the year following the year of the deceased

Roth IRA holder's death, and reduced by one each year thereafter.

If you die after 2019 and you are an individual (spouse or non-spouse), the successor

beneciary(ies) must receive the entire balance in the account by December 31 of the

tenth year following the year of your death.

Additional Options Available to the Surviving Spouse. In addition to the options

available above, if you are the deceased Roth IRA holder's surviving spouse, you

may elect to treat the inherited Roth IRA as your own Roth IRA. The result of such

an election is that you will then be considered the Roth IRA holder. The election may

be made by redesignating the inherited Roth IRA in your own name as the Roth IRA

holder, rather than the beneciary. The election will be deemed to have been made if

either of the following occurs: 1) you do not receive a required death distribution in

any calendar year following the year of the deceased Roth IRA holder's death, or 2)

you make any additional contributions to the inherited Roth IRA.

If the Deceased Roth IRA Holder Died After 2019:

You should rst seek the advice of your own tax advisor as to the tax consequences

of each option available. For deaths after 2019, the options available to you depend

on whether you are not a designated beneciary (generally, not an individual), a

designated beneciary (generally, an individual who is not an eligible designated

benecary), or an eligible designated beneciary (generally, the deceased Roth IRA

holder's surviving spouse or minor child, or if you are a disabled individual, a chroni-

cally ill individual, or an individual who is not more than ten years younger than the

deceased Roth IRA holder).

Not a Designated Beneciary. Generally, you (and any successor beneciary) must

receive the entire balance in the account by December 31 of the fth year following

the year of the deceased Roth IRA holder's death.

Designated Beneciary Who is not an Eligible Designated Beneciary. You (or any

successor beneciary) must receive the entire balance in the account by December 31

of the tenth year following the year of the deceased Roth IRA holder's death.

Eligible Designated Beneciary. You may choose 1) to receive the entire balance in

the account by December 31 of the tenth year following the year of the deceased Roth

IRA holder's death, or 2) to have the remaining funds distributed in accordance with

the life-expectancy rule. If you are the deceased Roth IRA holder's surviving spouse,

your single life expectancy is based on your attained age in the year for which the

distribution is being paid. The distributions to you must begin by the end of the year

the deceased Roth IRA holder would have attained age 72, or December 31 of the year

following the year of the deceased Roth IRA holder's death, whichever is later. If you

are an individual who is not the deceased Roth IRA holder's surviving spouse, your

single life expectancy is based on your attained age in the year following the year of

the deceased Roth IRA holder's death and then reduced by one for each subsequent year

thereafter. The distributions must begin by December 31 of the year following the year

of the deceased Roth IRA holder's death. If the eligible designated beneciary is the

deceased Roth IRA holder's minor child, the single life expectancy distributions may

continue until the year he or she reaches the age of majority, then he must receive the

entire balance in the account by December 31 of the tenth year following the year he

reaches the age of majority. Upon the death of the eligible designated beneciary, the

successor beneciary(ies) must receive the entire balance in the account by December

31 of the tenth year following the year of the eligible designated beneciary's death.