Print your responses in the fields below, including the Spousal Consent section (if applicable). If you have any questions regarding this form, contact a Customer Care Associate at 877-7-ALLY (9). IRA Owner Information Married (including legally separated) Unmarried (single, divorced, widowed) NAME SSN / TAX ID NUMBER DATE OF BIRTH ADDRESS PERSONAL PHONE WORK PHONE CITY STATE ZIP CODE Beneficary Designation All Primary and/or Contingent beneficiary allocations must equal 00% for each beneficiary type. 0 PMC QUESTIONS? CALL -877-7-9 OR VISIT ALLY.COM UPDATED 0/08
Beneficary Designation (continued) Signatures I, the undersigned IRA Owner, hereby designate the above persons/entities as my primary and contingent beneficiary(ies) for this 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. SIGNATURE OF IRA OWNER DATE 0 PMC QUESTIONS? CALL -877-7-9 OR VISIT ALLY.COM UPDATED 0/08
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 spouse, the IRA Owner, has and will name a primary beneficiary or a percentage of less than 00% to someone other than me for the 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 State of County of The foregoing Spousal Consent was signed and acknowledged before me this day of, 0 by. Sworn to and subscribed before me this day of, Notary Public: My commission expires: 0 PMC QUESTIONS? CALL -877-7-9 OR VISIT ALLY.COM UPDATED 0/08
0-RA Form (Rev. April 07) Department of the Treasury Internal Revenue Service Roth Individual Retirement Custodial Account (Under Section 08A of the Internal Revenue Code) Do not with the Internal Revenue Service Introduction The Depositor whose name appears on the Application to Participate is establishing a Roth Individual Retirement Account (Roth IRA) under section 08A to provide for his or her the Application to Participate has given the Depositor the disclosure statement required by ARTICLE I ARTICLE II. The annual contribution limit described in Article I is gradually reduced to 0 for higher. ARTICLE III ARTICLE IV.. ARTICLE V. If the Depositor dies before his or her entire interest is distributed to him or her and (a) (b) The remaining interest will be distributed by the end of the calendar year containing the. The minimum amount that must be distributed each year under paragraph (a) above is. ARTICLE VI.. ARTICLE VII ARTICLE VIII ARTICLE IX If the Depositor dies before his or her entire interest is distributed to Depositor is deemed to have automatically consented to any amendment unless the Depositor The General Instructions Purpose of Form Roth individual retirement account (Roth IRA) is established after the form is fully executed by both the individual Do not Pub. 90-A Pub. 90- B Custodian. Depositor. The Depositor is the person who establishes the Article I. excess contributions if () contributions to other individual retirement arrangements of the Depositor have been made () income exceeds the applicable limits in Article II for the () the Depositor's and spouse's compensation is less than the amount contributed by or on behalf of them Article V. This article describes how distributions will be made pursuant to this article should be reviewed periodically to ensure Article IX. Article IX and any that follow it may incorporate additional provisions that are agreed to by the Depositor and
Projection of Future Balance (Use Method or Method ) Method you can read across the table and see that your account value without penalty would be Account Values This table has been prepared assuming the initial and only contribution to your Roth Account Values Number of Years 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 No,00.00,00.00,006.00,00.0,0.0 6,0.0 7,08.06 8,06.08 9,0. 0,0.7,066.,078.9,09.7,0.6,0.6 6,6.68 7,.8 8,7.97 9,9. 0,.,.,.78,78.0,0.,7.6 6,.9 7,8.0 8,09.68 9,9.09 0,69.,0.00,.0,67.0,60.60,67.0 6,67.8 7,7. 8,70. 9,789.97 0,80.76,87.9,9.7,99.8,00. 6,00. 7,097.9 8,.9 9,9.6 0,.8,96.08,8.7,0.7 -Month,000.9,00.8,00.7,009.68,0.60 6,00. 7,07.7 8,0. 9,0.7 0,0.,06.0,077.8,090.8,0.8,9.0 6,. 7,.9 8,70.6 9,89. 0,09.6,0.78,.9,76.0,00.9,. 6,.7 7,79.0 8,07. 9,6.6 0,66.99,98.7,0.79,6.,98.7,6. 6,670.78 7,708.7 8,77.00 9,786.66 0,87.6,869.,9.89,9.7,000.9 6,06. 7,09.7 8,.8 9,90. 0,0.6,9.8,.0,97.8 -Month,000.7,00.0,00.,009.0,0.77 6,09. 7,06.0 8,0.08 9,0.86 0,0.6,06.6,07.7,088.0,0.9,6.79 6,.6 7,9. 8,67. 9,86. 0,06.9,7.,9.,7.,96.,.9 6,7.6 7,7.6 8,0.8 9,.7 0,6.9,9.,.7,8.6,9.96,68.0 6,66.68 7,70.09 8,70. 9,780.0 0,80.6,86.,90.7,98.0,99.0 6,08.8 7,08.6 8,.7 9,8. 0,.8,8.7,.0,88.8 6-Month,000.0,00.00,00.0,008.0,0. 6,08.0 7,0. 8,0.07 9,00.60 0,00.,060.69,07.,08.8,098.,.0 6,8.6 7,. 8,6.90 9,8.6 0,0.,.9,.66,66.,90.7,.96 6,0.78 7,67.6 8,9.9 9,.8 0,.,8.6,7.,0.6,8.,69.0 6,6. 7,69.67 8,70.87 9,770.0 0,80.7,8.68,89.0,97.,98.86 6,07. 7,07.87 8,. 9,70.07 0,9.7,70.,.,7.0 Number of Years 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 No,00.00,00.00,00.00,00.0,00.0,006.0,007.0,008.0,009.0,00.0,0.06,0.07,0.08,0.09,0.,06.,07.,08.,09.7,00.9,0.,0.,0.,0.8,0.0,06.,07.,08.8,09.,00.,0.7,0.0,0.,0.7,0.60,06.6,07.67,08.7,09.7,00.79,0.8,0.87,0.9,0.96,06.00,07.0,08.0,09.,00.9,0.,0.0,0. -Month,000.9,00.9,00.9,00.9,00.9,00.9,006.9,007.9,008.9,009.96,00.97,0.98,0.99,0.0,0.0,06.0,07.0,08.07,09.09,00.,0.,0.,0.7,0.9,0.,06.,07.7,08.0,09.,00.,0.8,0.,0.,0.8,0.,06.,07.9,08.6,09.66,00.70,0.7,0.79,0.8,0.87,0.9,06.96,08.0,09.06,00.,0.6,0.,0.6 -Month,000.7,00.7,00.7,00.76,00.76,00.76,006.77,007.78,008.78,009.79,00.80,0.8,0.8,0.8,0.8,0.87,06.88,07.90,08.9,09.9,00.96,0.98,0.00,0.0,0.0,06.07,07.0,08.,09.,00.8,0.,0.,0.8,0.,0.,06.8,07.,08.,09.9,00.,0.7,0.6,0.6,0.70,0.7,06.79,07.8,08.88,09.9,00.98,0.0,0.09 6-Month,000.0,00.0,00.0,00.0,00.,00.,006.,007.,008.,009.,00.,0.6,0.7,0.8,0.60,0.6,06.6,07.6,08.66,09.68,00.70,0.7,0.7,0.77,0.79,0.8,06.8,07.87,08.90,09.9,00.9,0.99,0.0,0.0,0.08,06.,07.6,08.9,09.,00.7,0.,0.,0.9,0.,0.8,06.,07.7,08.6,09.67,00.7,0.77,0.8 Method fees disc and the Investment annual percentage yield Penalty for early withdrawal of investment End of year Account Value End of year you attain age Account Value To Reorder Call -800--07