FOR NATIONWIDE ASSOCIATE USE ONLY

Transcription

1 New Account Application For Nationwide Associate use only Please do not use this application for IRA s FOR NATIONWIDE ASSOCIATE USE ONLY Mail your application to: Nationwide Funds P.O. Box 701 Milwaukee, WI For special delivery or overnight services, mail to: Nationwide Funds 615 E. Michigan St., FL3 Milwaukee, WI Questions? Call

2 New Account Application For Nationwide Associate use only Please do not use this application for IRA s In compliance with the USA PATRIOT Act, all financial institutions (including mutual funds) are required to obtain, verify and record the following information for all registered owners or others who may be authorized to act on an account: full name, date of birth, Social Security Number and permanent street address. Corporate, trust, and other entity accounts require additional documentation. This information will be used to verify your true identity. We will return your application if any of this information is missing, and we may request additional information from you for verification purposes. In the rare event that we are unable to verify your identity, Nationwide Funds reserves the right to redeem your account at the current day s net asset value. Mail this form, along with any required documents to: Mail: Nationwide Funds c/o U.S. Bancorp Fund Services, LLC PO Box 701 Milwaukee, WI Overnight Express Mail: Nationwide Funds c/o U.S. Bancorp Fund Services, LLC 615 E. Michigan St., FL3 Milwaukee, WI For additional information please call toll-free or visit us on the Web at nationwide.com/mutualfunds. 1 Investor Information Select one Please print clearly in blue or black ink. Individual First Name Social Security Number Joint Owner Please include additional sheets if more than two owners. First Name Social Security Number Registration will be Joint Tenancy with Rights of Survivorship (JTWROS) unless otherwise specified. To designate a Transfer on Death beneficiary, complete and attach a Nationwide Transfer on Death Form available at nationwide.com/mutualfunds. Gift to Minor (UGMA/UTMA) Custodian s First Name (ONLY ONE) Custodian s Social Security Number Minor s First Name (ONLY ONE) Minor s Social Security Number Minor s State of Residence Designation of Successor Custodian or Successor Responsible Individual Successor Custodian s First Name (ONLY ONE) Successor Custodian s Social Security Number In the event of my incapacity or death, I hereby designate the individual named above to act as successor custodian or successor responsible individual for the minor listed on the account being established with this application. Page 1 of 6

3 1 Investor Information Select one (continued) Additional Account Types: S Corporation Tax Exempt Organization C Corporation Trust Partnership Other Entity Limited Liability Company Name Of Trust / Corporation / Partnership and State of Origination Name(s) Of Trustee(s) Social Security Number / Tax I.D. Number Date of Agreement (MM/DD/YYYY) You must supply documentation to substantiate existence of your organization (i.e., Articles of Incorporation/Formation/Organization, Trust Agreements [including the powers and limitations section(s)], Partnership Agreement, or other official documents). Remember to include a separate sheet detailing the full name, date of birth, Social Security Number and permanent street address for all authorized individuals. Check here if you are a government entity or affiliated with a government entity. 2 Permanent Street Address Residential Address or Principal Place of Business - Foreign addresses and P.O. Boxes are not allowed. Street Apt / Suite Mailing Address 1 (if different from Permanent Address) If completed, this address will be used as the Address of Record for all statements, checks and required mailings. Foreign addresses are not allowed. Street Apt / Suite City State ZIP Code City State ZIP Code Daytime Phone Number Evening Phone Number 1 A P.O. Box may be used as the mailing address. Address* *Please note, you must provide your address to enroll in edelivery. 3 E-Delivery Options I would like to: Receive all documents electronically Or Select Document Type: Receive prospectuses, annual reports and semiannual reports electronically Receive statements electronically Receive tax forms electronically By selecting any of the above options, you agree to waive the physical delivery of the prospectus, fund reports, account statements and/or tax forms. If you have opted to receive your statements or tax forms electronically, you will need to establish online access to your account, which you may do once your account has been been established by visiting nationwide.com/mutualfunds and selecting Sign Up for Account Access. Please note, you must provide your address in Section 2 to enroll in edelivery. 4 Cost Basis Method The Cost Basis Method you elect applies to all covered shares acquired from January 1, 2012 forward and to all identically registered existing and future accounts you may establish, unless otherwise noted. The Cost Basis Method you select will determine the order in which shares are redeemed and how your cost basis information is calculated and subsequently reported to you and to the Internal Revenue Service (IRS). Please consult your tax advisor to determine which Cost Basis Method best suits your specific situation. Note: If you do not elect a Cost Basis Method, your account will default to Average Cost. Primary Method (Select only one) Average Cost averages the purchase price of acquired shares First In, First Out oldest shares are redeemed first Last In, First Out newest shares are redeemed first Low Cost least expensive shares are redeemed first High Cost most expensive shares are redeemed first Loss/Gain Utilization depletes shares with losses prior to shares with gains and short-term shares prior to long-term shares Specific Lot Identification you must specify the share lots to be sold at the time of a redemption (This method requires you elect a Secondary Method below, which will be used for systematic redemptions and in the event the lots you designate for a redemption are unavailable.) Secondary Method applies only if Specific Lot Identification was elected as the Primary Method (Select only one) First In, First Out Last In, First Out Low Cost High Cost Loss/Gain Utilization Note: If a Secondary Method is not elected, First In, First Out will be used. Page 2 of 6

4 5 investments Associate Information I certify that I am a full-time associate of Nationwide Associate Number I certify that I am an immediate family member of a full-time associate of Nationwide Associate Name Indicate fund(s), investment amount(s) in dollars and share class(es). Checks must be made payable to Nationwide Funds. Type of Investment Net Asset Value privilege (Class A shares only): As a Nationwide Associate you are entitled to purchase shares at NAV. Type of Payment Check (in U.S. dollars) payable to Nationwide Funds By wire (Call for further instructions.) Transfer funds from another Nationwide Funds account Account Number Payroll Deduction (Please complete and sign this application as instructed, then call our transfer agent at (800) for instructions. Please keep the attached Associate Direct Deposit Form.) Nationwide Funds (Minimum investments do not apply to Nationwide Associates or certain other individuals as stated in each Fund s prospectus and SAI.) A complete list of fund names and numbers can be found on the Nationwide Funds list page of this application. I wish to open my account with a monthly Automatic Investment Plan (Complete Section 8). 6 DISTRIBUTION OPTIONS If you check the Reinvest box below, all dividend and capital gain distributions will be reinvested in additional shares. If you prefer that distributions be paid in cash, check the Pay in cash box below. If you do not make an election, all dividends and capital gains distributions will be reinvested. Dividends: Reinvest Pay in cash Capital Gains: Reinvest Pay in cash 7 telephone and internet options You automatically have the ability to make telephone and/or Internet purchases*, redemptions* or exchanges per the prospectus, unless you specifically decline below. See the prospectus for minimum and maximum amounts. *You must provide bank instructions and a voided check in Section 9. Please check the box below if you wish to decline these options. If the options are not declined, you are acknowledging acceptance of these options. I decline telephone and/or Internet transaction privileges. Should you wish to add the options at a later date, a signature guarantee may be required. Please refer to the prospectus or call our shareholder services department for more information. Page 3 of 6

5 8 automatic investment plan (aip) Your signed application must be received at least 15 business days prior to initial transaction. If you choose this option, funds will be automatically transferred from your bank account. Please attach a voided check or savings deposit slip to Section 9 of this application. We are unable to debit mutual fund or pass-through ( for further credit ) accounts. Draw money for my AIP (check one): Monthly Bimonthly Quarterly Biannually Annually If no option is selected, the frequency will default to monthly. Amount Per Draw ($50 minimum) AIP Start Month AIP Start Day Amount Per Draw ($50 minimum) AIP Start Month AIP Start Day Amount Per Draw ($50 minimum) AIP Start Month AIP Start Day Amount Per Draw ($50 minimum) AIP Start Month AIP Start Day Please keep in mind that: Participation in the plan will be terminated upon redemption of all shares. If the date you choose to start your AIP falls on a weekend or holiday the transfer will move to the next business day after your selected date. Nationwide Funds reserves the right to terminate the AIP if purchases cannot be made. 9 bank information If you have selected an automatic investment plan, wire redemptions, EFT purchases, EFT redemptions or cash distributions, a voided bank check or preprinted savings deposit slip (not a counter deposit slip) is required. We are unable to debit or credit mutual fund or pass-through ( for further credit ) accounts. Please contact your financial institution to determine if it participates in the Automated Clearing House system (ACH). John Doe Jane Doe 123 Main St. Anytown, USA Pay to the order of $ DOLLARS Memo VOID Signed 10 check writing option You may elect to establish check writing privileges for the Nationwide Money Market Fund Prime Shares. Checks will be mailed within 10 (ten) business days after your account is opened. The minimum amount for any check written is $500. All authorized account owners must sign below exactly as their names appear in Section 1. Nationwide Money Market Fund Prime Shares I/We guarantee the authenticity of each signature and understand the request is subject to the terms below. Authorized Signatures (For joint accounts, all owners must sign.) One signature required Two signatures required X X I/We authorize U.S. Bank to honor these share drafts and to redeem sufficient shares in my/our account to cover payment of such checks. I/We understand that: (1) this privilege may be terminated at any time by Nationwide Funds or the bank and that neither shall incur any liability for loss or expense or cost to me/us for honoring checks, or for effecting redemptions to pay checks, or for returning checks which have not been accepted; (2) by signing this card I/We certify that each of the statements set forth on the purchase application are true and accurate. Page 4 of 6

6 11 signature and certification required by the internal revenue service I have received and understand the prospectus for the Nationwide Funds. I understand Nationwide Funds investment objectives and policies and agree to be bound by the terms of the prospectus. I acknowledge and consent to the householding (i.e. consolidation of mailings) of regulatory documents such as prospectuses, shareholder reports, proxies, and other similar documents. I may contact Nationwide Funds to revoke my consent. I agree to notify Nationwide Funds of any errors or discrepancies within 45 days after the date of the statement confirming a transaction. The statement will be deemed to be correct, and Nationwide Funds and its transfer agent shall not be liable if I fail to notify Nationwide Funds within such time period. I certify that I am of legal age and have legal capacity to make this purchase. Nationwide Funds, its transfer agent, and any officers, directors, employees, or agents of these entities (collectively Nationwide Funds ) will not be responsible for banking system delays beyond their control. By completing Sections 5, 6, 7, 8, or 9, I authorize my bank to honor all entries to my bank account initiated through U.S. Bank, NA, on behalf of the applicable Fund. The Nationwide Funds will not be liable for acting upon instruction believed to be genuine and in accordance with the procedures described in the prospectus or the rules of the Automated Clearing House. When AIP or Telephone Purchase transactions are presented, sufficient collected funds must be in my account to pay them. I agree that my bank s treatment and rights to respect each entry shall be the same as if it were signed by me personally. I agree that if any such entries are dishonored with good or sufficient cause, my bank shall be under no liability whatsoever. I further agree that any such authorization, unless previously terminated by my bank in writing, is to remain in effect until Nationwide Funds transfer agent receives and has had reasonable amount of time to act upon a written notice of revocation. The assets in your account are subject to state unclaimed property laws which provide that if no activity occurs in your account within the time period specified by the particular state law, your assets must be transferred to the appropriate state. We are required by law to advise you that your assets may be transferred to an appropriate state in compliance with these state laws. Under penalty of perjury, I certify that (1) the Social Security or taxpayer identification number shown on this form is my correct Social Security taxpayer identification number, and (2) I am not subject to backup withholding as a result of either being exempt from backup withholding, not being notified by the IRS of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding,, (3) I am a U.S. person (including a U.S. resident alien), and (4) I am exempt from FATCA reporting. (Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding due to a failure to report all interest and dividends.) The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature of Owner* Date (MM/DD/YYYY) Signature of Joint Owner* Date (MM/DD/YYYY) * If shares are to be registered in: (1) joint names, both persons must sign; (2) a custodian for a minor, the custodian should sign; (3) a trust, the trustee(s) should sign; or (4) for a corporation or other entity, an officer should sign and print name and title on the space provided for the authorized signer(s). 12 dealer information Dealer Name Representative s First Name Dealer s Number Branch Number Representative s Number DEALER MAIN OFFICE INFORMATION: Address REPRESENTATIVE BRANCH OFFICE INFORMATION: Address Code City State ZIP Code City State ZIP Code Telephone Number Telephone Number! before you mail, have you: Completed all USA PATRIOT Act required information? Social Security or Tax ID Number in Section 1? Date of Birth in Section 1? Full name in Section 1? Permanent street address in Section 2? Enclosed your personal check made payable to Nationwide Funds? Included a voided check, if applicable? Signed your application in Section 11? Kept the direct deposit form (if applicable)? Registered for Online Account Access and edelivery? Why you should register for Online Account Access and edelivery Accessing and receiving your account and fund information electronically is easy, secure, efficient and environmentally friendly. Online Account Access enables you to access all of your account and fund information from your computer at any time. edelivery sends you an each time a new account transaction confirmation, quarterly account statement, tax form or regulatory document is available for you to view. Each contains a link to these documents. Once you key in your security information, you will be connected immediately to your account-related information. To register, go to nationwide.com/mutualfunds and select Sign Up for Account Access. For additional information please call toll-free or visit us on the Web at nationwide.com/mutualfunds. Mail: Nationwide Funds c/o U.S. Bancorp Fund Services, LLC PO Box 701 Milwaukee, WI Overnight Express Mail: Nationwide Funds c/o U.S. Bancorp Fund Services, LLC 615 E. Michigan St., FL3 Milwaukee, WI Page 5 of 6

7 nationwide funds LIST class A SHARES fund number INTERNATIONAL Nationwide Bailard Emerging Markets 6263 Equity Fund Nationwide Bailard International 6230 Equities Fund Nationwide Global Equity Fund 3568 Nationwide International Index Fund 3405 small cap Nationwide Bailard Cognitive Value Fund 6211 Nationwide Geneva Small Cap Growth Fund 6227 Nationwide HighMark Small Cap Core Fund 6251 Nationwide Small Cap Index Fund 3402 Nationwide Small Company Growth Fund 3554 Nationwide U.S. Small Cap Value Fund 3276 MID CAP Nationwide Geneva Mid Cap Growth Fund 6223 Nationwide Herndon Mid Cap Value Fund 6271 Nationwide Mid Cap Market Index Fund 3415 class A SHARES fund number Fixed-Income Nationwide Amundi Global High Yield Fund 6275 Nationwide Amundi Strategic Income Fund 6279 Nationwide Bond Fund 3535 Nationwide Bond Index Fund 3408 Nationwide Core Plus Bond Fund 3586 Nationwide Government Bond Fund 3529 Nationwide High Yield Bond Fund 3572 Nationwide HighMark Bond Fund 6204 Nationwide HighMark California Intermediate Tax Free Bond Fund 6208 Nationwide HighMark National Intermediate Tax Free Bond Fund 6241 Nationwide HighMark Short Term Bond Fund 6248 Nationwide Inflation-Protected Securities Fund 3576 Nationwide Money Market Fund 3530 Nationwide Ziegler Wisconsin Tax Exempt Fund 6259 large CAP Nationwide Bailard Technology & Science Fund 6215 Nationwide Fund 3533 Nationwide Growth Fund 3528 Nationwide HighMark Large Cap Core 6234 Equity Fund Nationwide S&P 500 Index Fund 3418 Nationwide Ziegler Equity Income Fund 6219 Nationwide Ziegler NYSE Arca Tech 100 Index Fund 6244 ASSET ALLOCATION Nationwide Destination 2010 Fund 3266 Nationwide Destination 2015 Fund 3267 Nationwide Destination 2020 Fund 3268 Nationwide Destination 2025 Fund 3269 Nationwide Destination 2030 Fund 3270 Nationwide Destination 2035 Fund 3271 Nationwide Destination 2040 Fund 3272 Nationwide Destination 2045 Fund 3273 Nationwide Destination 2050 Fund 3274 Nationwide Destination 2055 Fund 3278 Nationwide Destination 2060 Fund 3840 Aggressive Fund 3389 Conservative Fund 3410 Moderate Fund 3395 Moderately Aggressive Fund 3392 Moderately Conservative Fund 3398 Nationwide Portfolio Completion Fund 3556 Nationwide Retirement Income Fund 3275 Nationwide Funds distributed by Nationwide Fund Distributors LLC, member FINRA, King of Prussia, Pa. Nationwide and the Nationwide N and Eagle are service marks of Nationwide Mutual Insurance Company Nationwide Page 6 of 6

8 Nationwide Mutual funds - Associate Direct Deposit Form (Please complete if you are establishing a direct deposit.) Do not return this page with your completed application. Please keep it to record your account number and set up direct deposit. INSTRUCTIONS FOR DIRECT DEPOSIT You may authorize Nationwide to set up direct deposit payments from your paycheck into your Nationwide Mutual Funds Account by following the instructions below. In order to initiate the direct deposit feature, you must have an account number. Once you have your account number, you can begin setting up direct deposit. Please call our transfer agent at (800) for instructions on how to fax in your account application and receive a telephone call back within 24 hours with your new account number. Please record your account number below in the applicable section of the direct deposit instructions. Log onto the Nationwide HRIS system Click on the Direct Deposit link under My Payroll and Compensation. Click the Add Account button Direct Deposit Account and Routing Information NOTE: You must provide this information in order for your employer or check issuer to set up your direct deposit. All boxes must contain a number. Please add zeroes to the beginning of your Nationwide Mutual Funds Account Number if necessary to eliminate blank boxes. Associate First Name Employee Number Routing Number (found on funds list) Account Number Nationwide Mutual Funds Account Number $ $ $ $ Amount (per draw) Now, enter the combined account number above with a total of 17 digits in the Account Number field on the HRIS system. If you need assistance or have any questions regarding establishing your payroll deduction, please contact the Associate Service Center at (TDD/TYY users, call ). Signature Date

9 PRIVACY STATEMENT June 2015 We value you as a customer and respect your right to privacy. We know that you purchase our products and services because you trust that we will stand behind our promises. We pledge our commitment to treat your information responsibly, and we created this privacy policy to show you that we are working hard to protect your privacy. Confidentiality and security We use physical and technical safeguards to protect your information. We restrict access to your information to those who need it to perform their jobs. Third-party business partners are bound by law to use the information only for our purposes. They may not disclose it or use it in any other way. We comply with all data security laws. Collecting your personal information We collect personal information about you from different sources. We collect information you send us on applications and forms. We collect information from your transactions with us, our sister companies, brokers, or other financial intermediaries through whom you buy or sell shares of Nationwide Funds, or others. Based on the product or services requested, we may collect information from a consumer reporting agency. Sharing your personal information for business purposes We do not sell your information to anyone. We may share your information with other Nationwide companies and business partners that carry out services and marketing for us. We may disclose your information as required or permitted by law. We may disclose your information for a legal or regulatory purpose or to combat fraud or inappropriate trading practices in shares of Nationwide Funds. These include the following types of information. Information we receive from you on applications or other forms. This may include your name, address, beneficiaries, Social Security number, and family member information. This may also include assets, income, and the property address and value. This may include information from your transactions with us, our sister companies, or with other financial intermediaries. It may include your account balance, trading history, policy coverage, and payment history. It may also include premium paid, preferences, shares you purchase, claims, and purchase method. This may include information we receive from a consumer-reporting agency or other reporting agencies. It may include your credit report and employment data. These depend on the products you select. We may share your information with our investment adviser, investment company, broker-dealer, IRA custodian, and transfer agent affiliates, as well as to other of our affiliates. Sharing your personal information for marketing purposes We do not sell your personal information to anyone for any reason. We have chosen not to share your personal information with anyone except to service your product. Therefore, there is no need for you to opt out. If we change our policy, we will tell you and give you a chance to opt out before we share your information. Questions We value our customers and want you to understand how we use the information we collect. If you have any questions about our privacy policy, please contact us toll free at We have a process that allows you to review your information. We can only give access to information that we control and can reasonably retrieve. We also check the identity of the person making the request. You may request that we correct your information in our files. Please note that we do not control the items provided by third parties. So, you will need to contact the third party and correct their information. This privacy statement describes our privacy practices for both current and former customers. If you request, we will send more copies of this statement. Thank you for choosing us. Nationwide is On Your Side. Nationwide Funds Group Nationwide Mutual Funds Nationwide Variable Insurance Trust Nationwide Fund Advisors Nationwide Fund Management LLC Nationwide Fund Distributors LLC