IRA APPLICATION Please complete the appropriate application and mail it with your deposit. Once we receive your application and deposit, we will contact you to complete the process. You may also visit your nearest Valley branch office to apply. If you have any questions, please contact a Bank representative or call Customer Service at 800-522-4100 from 6 AM - 11 PM ET, 7 days a week. For calls made from outside of the U.S. and Canada, please call 973-305-8800. To open your account: o If mailing a check deposit, please send check and application to: Mail check to: Valley National Bank, Attn: Customer Service 1445 Valley Road, Wayne, NJ 07470 Make check payable to: Valley National Bank o If depositing from existing Valley account please provide: Valley Checking Account Number: or Valley Savings Account Number: Applicant Information: IRA Limits & Deadlines Annual Contribution Limits: 2017: $5,500 2018: $5,500 If you are 50 years or older as of 12/31/17 you may contribute an additional $1,000 a year as catch-up contributions. Education Savings Account limit is $2,000. 2017 Contribution Deadlines: U.S. mail must be postmarked by Tuesday, April 17, 2018. The FDIC will insure your IRA up to $250,000. Social Security #: Date of Birth: Address: City: State: Zip: Email: 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: 2018 Valley National Bank. Member FDIC. Equal Opportunity Lender. All Rights Reserved. VCS-7782
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. since I last received a rollover distribution from any 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. I acknowledge that the preliminary information provided will be used to facilitate the initial set-up and funding of the Traditional IRA and I agree to complete, sign and return the account documentation that will be provided by mail. Page 2 to 5
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. since I last received a rollover distribution from any 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. I acknowledge that the preliminary information provided will be used to facilitate the initial set-up and funding of the Roth IRA and I agree to complete, sign and return the account documentation that will be provided by mail. Page 3 to 5
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. 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. I acknowledge that the preliminary information provided will be used to facilitate the initial set-up and funding of the ESA and I agree to complete, sign and return the account documentation that will be provided by mail. Page 4 to 5
REQUEST TO TRANSFER FUNDS Present Trustee/Custodian/Administrator Address: City/State: Zip: Owner Information Address: City/State: Zip: Social Security #: Date of Birth: Home Phone #: Daytime Phone #: Transfer Authorization to Present Trustee/Custodian/Administrator This is to direct you as the present: o Plan Administrator of my QRP/TSA o Rollover from Traditional IRA to Roth IRA o Direct Rollover from QRP/TSA to Traditional IRA o Custodian/Trustee of my IRA o Transfer from Traditional IRA o Transfer from Roth IRA to Roth 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 Make check payable to: Valley National Bank, successor custodian for: (Date) (Name of IRA Owner) IRA 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 to 5