T CGM FUNDS IRA ACCOUNT APPLICATION Use this form to establish a Traditional, Roth, Custodial, or Beneficiary (DCD) IRA account. To establish a SEP-IRA, please call 800-598-0782 for the proper forms. 1. ACCOUNT INFORMATION If bold fields are not completed, this application will not be processed. IF YOU ARE ESTABLISHING A CUSTODIAL IRA ACCOUNT: Please complete section 1 with the minor s information and attach a separate sheet of paper with the same information for the custodian. Also, in section 3 check Custodial IRA, select the type of IRA you wish to establish for the minor, and fill in the minor s state of residence. IF YOU ARE ESTABLISHING A TRUST OR ESTATE BENEFICIARY (DCD) IRA ACCOUNT: Please attach a separate sheet of paper with the name, date and Tax ID number of the trust or estate. Also include the first name, last name, date of birth and social security number of all trustees/executors. For a Trust DCD IRA, a copy of the title and signature pages of the Trust Agreement must be attached. For an Estate DCD IRA, a copy of the Letters of Administration, Letters Testamentary, or court appointment is required to establish the account and to verify the estate. Please Note: if you are the beneficiary of a Profit Sharing Plan or Money Purchase Pension Plan, you are not allowed to establish a Beneficiary (DCD) IRA account in the name of the estate. Please consult your tax advisor for more information. First Name MI Last Name Date of Birth M M M1M M1M M M M Social Security Number (If SS# has been applied for, provide a copy of the application.) You must check one: M U.S. Citizen or M Resident Alien (Only U.S. citizens and Resident Aliens are permitted to open an account) Resident Aliens only: Alien ID# or Passport Number and Country of Issuance 2. ADDRESS If your mailing address is a post office box, a street address is also required by the USA PATRIOT Act of 2001. APO and FPO addresses are acceptable. If bold fields are not completed, this application will not be processed. Street Address City State Zip Code Daytime Telephone Mailing Address City State Zip Code 3. TYPE OF IRA Please check one box. If you wish to establish more than one type of IRA you must complete a separate CGM Funds IRA Account Application for each type. If no box is selected, a Traditional IRA will be established. M Traditional IRA A Traditional IRA is used to make an annual contribution to your IRA or to transfer or roll over assets from another Traditional IRA, an employer s qualified plan (e.g. 401(k), Profit Sharing or Pension plan, 403(a) annuity plan, 403(b) tax-sheltered annuity plan or 457(b) eligible governmental deferred compensation plan. A Traditional IRA may receive and commingle any type of Traditional IRA contributions found in section 4. M Roth IRA A Roth IRA is used to make an annual contribution to your IRA or to transfer or roll over assets from another Roth IRA, an employer s qualified plan or to convert from a Traditional IRA or an employer s qualified plan. There are eligibility requirements for contributions made into a Roth IRA regarding gross income and tax-filing status. Please see a professional tax advisor to determine if you meet these requirements. (section 3, Type of IRA, continued on next page) PAGE 1
3. TYPE OF IRA (continued) M Custodial IRA A Custodial IRA is used to make an annual contribution to a minor s IRA or to transfer or roll over assets from another Custodial IRA. The Custodial IRA will be established under the minor s social security number for tax reporting purposes. Please check one box below with the type of Custodial IRA you wish to establish and fill in the minor s state of residence. I wish to establish a: M Traditional IRA for the minor listed in section 1 OR; M Roth IRA for the minor listed in section 1 Under the Uniform Gift/Transfer to Minor Act (Minor s State of Residence) M Beneficiary (DCD) IRA A Beneficiary (DCD) IRA is used if you are the spouse or non-spouse beneficiary of a decedent s CGM IRA and you wish to establish an inherited Traditional or Roth IRA. Beneficiary (DCD) IRA rules are very complex, please consult your tax advisor or visit the IRS website, www.irs.gov, to make sure you understand your account options. To establish a Beneficiary (DCD) IRA please complete this form and the CGM Inheriting IRA Beneficiary Re-Registration Form. If you are a spouse or non-spouse beneficiary of a decedent s Non-CGM IRA and you wish to move your Beneficiary (DCD) IRA to CGM, complete this form and the CGM IRA Transfer Form. This is the only option available for a non-spouse beneficiary. 4. TYPE OF TRANSACTION Check the transaction(s) that apply below. M Annual Contribution for the tax year of in the amount of $. M Transfer IRA: If you are transferring assets from another IRA to CGM, complete this form and the CGM IRA Transfer Form. Or, If you are the beneficiary of a deceased IRA holder s account and are moving it into a Beneficiary (DCD) IRA, please complete this form and the CGM Inheriting IRA Beneficiary Re-Registration Form. M Spouse Beneficiary Transfer IRA: If you are the spouse beneficiary of a decedent s CGM IRA and you wish to transfer the decedent s assets into your own IRA, complete this form and the CGM Inheriting IRA Beneficiary Re-Registration Form. M IRA to IRA Rollover: If you distributed assets from another IRA and you wish to re-deposit them into a CGM IRA, complete this form and refer to the IRA to IRA Rollover Rules brochure. M Direct Rollover to an IRA: If you wish to have assets sent from an employer s qualified plan, 403(a) annuity plan, 403(b) tax-sheltered annuity plan or 457(b) eligible governmental deferred compensation plan to a CGM IRA by you or your employer, complete this form and the CGM Direct Rollover Form. Or, If you are the beneficiary of a deceased CGM qualified plan or 403(b) tax-sheltered annuity plan holder s account and are moving it into a Beneficiary (DCD) IRA, please complete this form and the appropriate CGM Qualified Plans Distribution Form or the CGM 403(b)(7) Distribution Form. M Indirect Rollover to an IRA: If you distributed assets from an employer s qualified plan, 403(a) annuity plan, 403(b) tax-sheltered annuity plan or 457(b) eligible governmental deferred compensation plan and wish to re-deposit them into a CGM IRA, complete this form. Assets must be deposited within 60 days of receipt. M Conversion from Traditional IRA to Roth IRA: If you wish to convert your Traditional IRA assets into a new Roth IRA, complete this form and the CGM Direct Conversion Form. M Recharacterization: If you wish to open your IRA by changing all or part of your existing Traditional IRA or Roth IRA to a different type of IRA or if you are reversing a Roth conversion, complete this form and the CGM IRA Recharacterization Request Form. 5. INVESTMENT SELECTION ($1,000 minimum per fund) CGM Mutual Fund % or $ CGM Realty Fund % or $ CGM Focus Fund % or $ Include a $5.00 Establishment Fee (Required for all new plans, one fee per application) Amount of Check Enclosed $ Make all checks payable to State Street Bank and Trust Co. or to the specific fund in which you are investing. The Funds do not accept money orders, starter, credit card, or third party checks. The Automatic Investment Plan or Telephone Investment Plan cannot be used to satisfy the minimum initial investment requirements. BANK ACCOUNT OF RECORD (applies to sections 6, 7, and 8) Banking information will be taken from your purchase check unless a void check is enclosed. Starter checks, money market checks, deposit slips, and counter checks are not acceptable. A void check is only required to establish Telephone Redemption by Wire, Telephone Redemption by ACH, Automatic Investment Plan and Telephone Investment Plan. Debits from savings banks and credit unions require special information; please call CGM Shareholder Services at 800-343-5678. PAGE 2
6. TELEPHONE EXCHANGE PRIVILEGE AND TELEPHONE REDEMPTION PRIVILEGE IMPORTANT NOTE FOR BENEFICIARY (DCD) IRAs: If you are establishing a Beneficiary (DCD) IRA, you must first complete the CGM Funds IRA Beneficiary Distribution Form to elect a beneficiary distribution option before any distributions can be taken over the phone. Please call 800-598-0782 for more information. Unless indicated below, you authorize the Transfer Agent to accept instructions to exchange or redeem shares in your account(s) by telephone, in accordance with the procedures and conditions set forth in the current Prospectus as amended from time to time. Yes H Telephone Exchange To move assets from one CGM Fund to another CGM Fund. This feature applies automatically to all accounts. Check here M if you do not want this service. Yes H Telephone Redemption By Check This feature applies automatically to all accounts. Check here M if you do not want this service. Yes M No M Telephone Redemption By Wire Note: If proceeds are being wired to a savings bank, it must have only one correspondent bank that is a member of the Federal Reserve System. Please see the Bank Account of Record section of this application for more information. Yes M No M Telephone Redemption By ACH Your redemption proceeds will be sent directly to your bank account by Automated Clearing House (ACH). Please confirm eligibility, fees and applicable routing number(s) for ACH transactions with your financial institution. Note: If proceeds are being sent to a savings bank, it must have only one correspondent bank that is a member of the Federal Reserve System. Please see the Bank Account of Record section of this application for more information. Neither the Fund nor the Transfer Agent will be liable for properly acting upon telephone instructions believed to be genuine. Should the Fund or its Transfer Agent fail to utilize reasonable procedures, it may be liable for any losses due to unauthorized or fraudulent instructions. 7. AUTOMATIC INVESTMENT PLAN ( AIP ) Automatic Investment Plan M YES M NO Once your account has been established, you may have $50 or more debited on or about the same day(s) each month from your checking account to purchase shares in your CGM Fund account. Please see the Bank Account of Record section of this application for more information. Debits from savings banks and credit unions require special information; please call CGM Shareholder Services at 800-343-5678. Allow 14 days for the plan to start. IMPORTANT NOTE FOR BENEFICIARY (DCD) IRAs: The Automatic Investment Plan option is not available if you are establishing a Beneficiary (DCD) IRA. Debit Amount: Invest $ Fund Name: into Frequency (Select Month or Months) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec All months M 5th day of each month (default if none checked) or; M 20th day of each month or; M 5th and 20th day of each month Debit Amount: Invest $ Fund Name: into Frequency (Select Month or Months) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec All months M 5th day of each month (default if none checked) or; M 20th day of each month or; M 5th and 20th day of each month Debit Amount: Invest $ Fund Name: into Frequency (Select Month or Months) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec All months M 5th day of each month (default if none checked) or; M 20th day of each month or; M 5th and 20th day of each month By signing this application, you authorize debits from the bank account referenced in conjunction with the Automatic Investment Plan option. CGM shall be fully protected in honoring any such transaction. PAGE 3
8. TELEPHONE INVESTMENT PLAN ( TIP ) Telephone Investment Plan M YES M NO Once your account has been established, you may make telephone purchases of $50 or more into your CGM Fund account with payment by Automated Clearing House ( ACH ) from your designated checking account with a U.S. bank. Please see the Bank Account of Record section of this application for more information. Debits from savings banks and credit unions require special information; please call CGM Shareholder Services at 800-343-5678. IMPORTANT NOTE FOR BENEFICIARY (DCD) IRAs: The Telephone Investment Plan option is not available if you are establishing a Beneficiary (DCD) IRA. Please note: The trade date for a Telephone Investment Plan purchase will generally be the business/banking day of your request. Restrictions apply. By signing this application, you authorize debits from the bank account referenced in conjunction with the Telephone Investment Plan option. CGM shall be fully protected in honoring any such transaction. 9. BENEFICIARY DESIGNATION A beneficiary designation is used to indicate the individual(s) or entity(ies) that will receive your IRA assets in the event of your death. In the event of your death, the full value of your IRA account(s) (in equal proportions in the case of multiple beneficiaries, unless you indicated otherwise) will be paid to the Primary Beneficiary(ies) as designated in this section. If a Primary Beneficiary predeceases you, the remaining portion will be divided proportionally to any surviving Primary Beneficiaries. If no Primary Beneficiary survives you, the full value of your IRA account(s) (in equal proportions in the case of multiple beneficiaries, unless you indicated otherwise) will be paid to the Contingent Beneficiary(ies) as designated in this section. If a Contingent Beneficiary predeceases you, the remaining portion will be divided proportionally to any surviving Contingent Beneficiaries. If no designated beneficiary survives you, or if you do not designate a beneficiary, the full amount of your IRA account(s) will be paid to your estate. Please refer to section 10. Please check Primary or Contingent for each additional beneficiary listed below. If neither is checked, the individual or entity will be deemed an additional Primary Beneficiary. Please make sure that the share % total equals 100% per beneficiary type. If no percentages are given, assets will be split equally among each type of beneficiary. IMPORTANT NOTE: To add additional beneficiaries, please attach a separate sheet of paper with all the necessary information. T PRIMARY Name Share % Check one and enter the number: M Social Security Number or M Tax ID M M M M M M M M M Relationship M Spouse M Non-Spouse M Trust M Estate M Charity or Other Entity Date of Birth or Date of Trust Address City State Zip M PRIMARY M CONTINGENT Share % Name Check one and enter the number: M Social Security Number or M Tax ID M M M M M M M M M Relationship M Spouse M Non-Spouse M Trust M Estate M Charity or Other Entity Date of Birth or Date of Trust Address City State Zip CONSENT OF SPOUSE (if applicable): Required if Non-Spouse Beneficiary(ies) are named as Primary Beneficiary(ies) and you live in a community or marital property state. I am the spouse of the participant named in section 1. I hereby consent to the above designation of beneficiary. I understand that if anyone other than me is designated as Primary Beneficiary on this form, I am waiving any rights I may have to receive benefits under the Plan when my spouse dies. X Participant s Spouse Signature Date PAGE 4
10. PROVISIONS By signing this application establishing an IRA, you (i) appoint State Street Bank and Trust Company, or its successors, as Custodian of the Account, (ii) state that you have received, read, accept, and specifically incorporate the Custodial Agreement and Disclosure Statement by reference to this application, (iii) acknowledge receipt of the current prospectus of the mutual fund(s) selected, (iv) consent to the Custodian s fee, (v) agree to promptly give instructions to the Custodian necessary to enable the Custodian to carry out its duties under the Plan, (vi) affirm that your participation is completely voluntary. You certify under penalties of perjury that the social security number provided is correct. You hereby adopt The CGM Individual Retirement Account (IRA) upon the terms and conditions thereof. You acknowledge that there is an annual $15 maintenance fee per account which will be billed to you each year. If you have elected the Telephone Exchange Privilege or the Telephone Redemption Privilege, you authorize the Fund and its agents to accept and act upon telephone instructions. You understand that the Fund may terminate or modify these privileges at any time. The Fund will employ reasonable procedures to confirm that instructions received by telephone are genuine, such as requesting personal identification information that appears on your account application and recording the telephone conversation. You will bear the risk of loss due to unauthorized or fraudulent instructions regarding your account, although the Fund may be liable if reasonable procedures are not employed. If you have enrolled in the Automatic Investment Plan in section 7 or the Telephone Investment Plan in section 8, you authorize the Fund and its agents to initiate Automated Clearing House (ACH) debits against the designated account at a bank or other financial institution. You understand that: Fund shares purchased by Automatic Investment Plan or Telephone Investment Plan must be owned for 15 days before they may be redeemed. You may terminate your Automatic Investment Plan or Telephone Investment Plan by sending written notice to CGM Funds c/o BFDS, P.O. Box 8511, Boston, MA 02266 8511 or by overnight mail to 30 Dan Rd., Canton, MA 02021-2809, or by calling 800 343 5678 no later than 14 days prior to your next scheduled debit date. The CGM Funds may immediately terminate your Automatic Investment Plan or Telephone Investment Plan in the event that any item is unpaid by your financial institution. The CGM Funds may terminate or modify these privileges at any time. Additional Information about Beneficiary Designations The Beneficiaries named herein may be changed or revoked at any time by filing a new designation in writing with the Custodian. This designation, and any changes or revocation, will only be effective upon receipt by the Custodian, signed by the participant in a format acceptable to the Custodian. If you choose to change or revoke your beneficiary designation, you must complete a new CGM IRA Beneficiary Designation Form. Upon receipt of this form by the Custodian, your requested change or revocation of your beneficiary designation will cancel or supersede any prior beneficiary designation for the accounts listed on that form. 11. SIGNATURE By signing below, I certify that I agree to the provisions listed in section 10. Please retain a copy of this form for your records. (a) By execution of this application, I represent and warrant that (i) I have the full right, power and authority to make the investment applied for and (ii) I am a natural person of legal age in my state of residence. I certify that the Taxpayer Identification Number and tax status set forth in the application is correct. If I am signing on behalf of another investor, I represent and warrant that I am duly authorized to sign this application and purchase or redeem shares of the fund on behalf of the investor. (b) I have read the applicable prospectus(es), the Traditional and Roth IRA Plan Document and Disclosure Statement, and this application and agree to all their terms. I also agree that any shares purchased now or later are and will be subject to the terms of the Fund s current prospectus as amended from time to time. (c) I certify under penalty of perjury that: (1) I am a U.S. citizen, resident alien, or a representative of a U.S. entity; (2) The social security number or employer identification number shown on this form is the correct Taxpayer Identification number; and (3) I am not subject to backup withholding because I am exempt from backup withholding OR I have not been notified by the Internal Revenue Service ( IRS ) that I am subject to backup withholding as a result of Failure to report all interest or dividends OR The IRS has notified me that I am no longer subject to backup withholding. Strike out this Item (3) if you have been notified that you are subject to backup withholding. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. PLEASE SIGN HERE: Signature Date PAGE 5
12. ACCEPTANCE BY CUSTODIAN Accepted by State Street Bank and Trust Company, Custodian Sharon L. James, Vice President, State Street Bank and Trust Company A statement will be sent to you confirming the establishment of your account and will serve as State Street Bank s acceptance. Questions? Call 800-598-0782. Mail your completed application and investment check in the enclosed envelope to: The CGM Funds, c/o BFDS, P.O. Box 8511, Boston, MA 02266-8511 or by overnight mail to: 30 Dan Road, Canton, MA 02021-2809 IRAAPP1213 PAGE 6