IRA Application To begin the application process, please complete the appropriate application and mail it with your deposit. Once we receive your application and deposit, we will call you to complete the process. You may also visit your nearest Valley branch office to apply. The FDIC will insure your IRA up to $250,000. If you have any questions, please contact our local 24/7 Customer Service Center at 800-522-4100. Type of Payment: o Check Make check payable to Valley National Bank Mail check to: Valley National Bank Attn: Customer Service Center 1445 Valley Road Wayne, NJ 07470 o Debit my Valley account IRA Limits & Deadlines Annual Contribution Limits: 2011: $5,000 2012: $5,000 If you are 50 years or older as of 12/31/11 you may contribute an additional $1,000 a year as catch-up contributions. Education Savings Account limit is $2,000. 2011 Contribution Deadlines: U.S. mail must be postmarked by Tuesday, April 17, 2012. Valley Checking Account Number: or Valley Savings Account Number: Applicant Information: Name Social Security # Date of Birth Address City State Zip Primary Phone (required) Alternate Phone IRA Type: o Traditional IRA (complete pages 1 & 2) o Roth IRA (complete pages 1 & 3) o Education Savings Account (complete pages 1 & 4) IRA Term: page 1
Traditional IRA Application o Rollover from Traditional IRA o Direct Rollover from Qualified Plan o Trustee Transfer from Traditional IRA (if checked, complete page 5) I certify that the aggregate of all deposits made during the current taxable year is not in excess of the maximum permitted by law, as fully explained in the Disclosure Statement. Unless otherwise indicated, this deposit will be credited to the calendar year in which the deposit has been received. I understand that excess contributions affect my eligibility for tax deductions and may be subject to Federal excise taxes. If a rollover, I certify that these funds are being deposited within 60 days after receipt and it has been twelve months since I last received a rollover distribution from the distributing IRA. I understand that if I am 70 ½ or older in this calendar year, I will take the minimum distribution as required by the IRS before the required beginning date. I also understand that required minimum distributions are not to be included in the rollover amount. Under penalties of perjury, I certify that the above information (including my social security number) is correct. I hereby agree to participate in the Individual Retirement Custodial Account offered by the Custodian. I direct that my contribution be invested as indicated above. In the event that this is a rollover contribution, the undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. Within seven (7) days from the date this IRA is opened, I may revoke it without penalty by mailing or delivering a written notice to the Custodian. funding of the Traditional IRA and I agree to complete, sign and return the account documentation that will be provided by mail. Applicant s Signature Date: page 2
Roth IRA Application o Rollover from Roth IRA o Trustee Transfer from Roth IRA (if checked, complete page 5) I certify that the aggregate of all deposits made during the current taxable year is not in excess of the maximum permitted by law, as fully explained in the Disclosure Statement. Unless otherwise indicated, this deposit will be credited to the calendar year in which the deposit has been received. I understand that excess contributions may be subject to Federal excise taxes. If a rollover, I certify that these funds are being deposited within 60 days after receipt and it has been twelve months since I last received a rollover distribution from the distributing Roth IRA. Under penalties of perjury, I certify that the above information (including my social security number) is correct. I hereby agree to participate in the Roth Individual Retirement Custodial Account offered by the Custodian. I direct that my contribution be invested as indicated above. In the event that this is a rollover contribution, the undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. Within seven (7) days from the date this IRA is opened, I may revoke it without penalty by mailing or delivering a written notice to the Custodian. funding of the Roth IRA and I agree to complete, sign and return the account documentation that will be provided by mail. Applicant s Signature Date: page 3
Education Savings Account Application o Rollover from Education Savings Account o Trustee Transfer from Education Savings Account (if checked, complete page 5) Minor s Name (Designated Beneficiary) Minor s Social Security # Minor s date of birth The applicant is the contributor Responsible Individual s Name (Must be parent or legal guardian) Responsible Individual s Social Security # Responsible Individual s Address I certify that the aggregate of all deposits made during the current taxable year are not in excess of the maximum permitted by law, as fully explained in the Disclosure Statement. If a rollover, I certify that these funds are being deposited within 60 days after receipt and it has been twelve months since I last received a rollover distribution from the distributing Education Savings Account. Under penalties of perjury, I certify that the above information (including my social security number and the Designated Beneficiary s and the Responsible Individual s social security number) is correct. I hereby agree to participate in the Education Savings Custodial Account offered by the Custodian. In the event that this is a rollover contribution, the Undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. I hereby appoint the above named person a Responsible Individual with the rights, powers and responsibilities set out in the Education Savings Custodial Account Agreement. Within seven (7) days from the date this IRA is opened, I may revoke it without penalty by mailing or delivering a written notice to the Custodian. funding of the ESA and I agree to complete, sign and return the account documentation that will be provided by mail. Applicant s Signature Date: page 4
Request to Transfer Funds Date: Present Trustee/Custodian/Administrator Name Address City/State Zip Owner Information Name Address City/State Zip Social Security Number Date of Birth Home Phone Number Daytime Phone Number Transfer Authorization to Present Custodian/Trustee/Administrator This is to direct you as the present: o Custodian/Trustee of my IRA o Plan Administrator of my QRP/TSA o Transfer from Traditional IRA o Rollover from Traditional IRA to Roth IRA o Transfer from Roth IRA to Roth IRA o Direct Rollover from QRP/TSA to Traditional IRA o Transfer from Education IRA to Education IRA Please transfer the following: o the entire balance o only the balance in these account(s): #, #, # o other (specify): IRA Terms: Please transfer the assets: o immediately o on maturity date of (Date) Make check payable to: Valley National Bank, successor custodian for IRA (Name of IRA owner) Send check to: (Address of Institution) (City/State/Zip) (Attention) NOTE: Please return one copy of this form with your check. Also complete the following section, if applicable. To Present Custodian/Trustee regarding Required Minimum Distribution Required minimum distributions may not be transferred or rolled over to Valley National Bank. This is to certify that the individual named above has established or will establish an IRA and has elected to send the funds to us. As Custodian of the IRA, we agree to accept a transfer of funds from you. IRA Custodian Signature (date) Individual s Signature (date) page 5