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Self-Directed SEP IRA
Employer Information
Adopting Employer Name
*
Adopting Employer Federal Tax ID#
*
Address (Employer)
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Effective Dates
Effective or Initial Adoption Date of SEP Plan
*
MM slash DD slash YYYY
Amendment & Restatement Date of Existing SEP Plan
MM slash DD slash YYYY
Eligibility Requirements (5305-SEP Article I and II)
Service Requirements
*
Duration of time an employee must perform service for the Employer in order to achieve eligibility to become a Participant in the SEP Plan (not to exceed 3 years) of the immediately preceding five years.
Age Requirements
*
An employee will be eligible to become a Participant in the SEP Plan after attaining age (Not to exceed 21 years)
Plan Requirements
This SEP Plan includes the following:
Employees covered under a collective bargaining agreement
Non-resident aliens
Employees whose total compensation during the year is less than $550*
This SEP Plan does not include the following:
This SEP Plan does not include the following:
Employees covered under a collective bargaining agreement
Non-resident aliens
Employees whose total compensation during the year is less than $550*
Contributions & Allocations
The Employer agrees that contributions made on behalf of each eligible employee will comply with Form 5305-SEP (Rev. December 2004) contribution based only on the first $205,000* of employee compensation, the same percentage of compensation for every employee, limited annually to the smaller of $41,000* or 25% of compensation, and paid to the employee's IRA trustee, custodian, or insurance company (for annuity contract). * Subject to IRS annual cost-of-living adjustments.
Select the contribution formula:
*
Discretionary Formula (For each SEP Plan year the Employer will contribute an amount to be determined from year to year.)
Fixed Percentage of Profits Formula (% of the Employer's portion that are in excess of a specified dollar amount)
If you've selected "Fixed Percentage" above, you must fill out these two fields
If you've selected "Fixed Percentage" above, you must fill out these two fields
Percentage of the Employer's portion
that are in excess of $
Employer Signature
I acknowledge that I have relied upon my own advisors regarding the completion of this Adoption Agreement and the potential legal and tax implications of adopting the SEP Plan. I understand that my failure to properly complete this Adoption Agreement may result in adverse tax consequences. I have retained a copy of this Adoption Agreement. I further acknowledge that as the SEP Plan Employer that the Employer is responsible for the annual IRA Account Administration Fee based upon the total SEP Plan Account Value.
Adopting Employer Signature
Authorized Signor Name
Date
*
MM slash DD slash YYYY
SECTION 1: Type of Account and Title
Account Type
*
Traditional Associated with SEP Plan
Vesting (Ownership Title)
Example: TRADITIONAL: Preferred Trust Company, LLC FBO (For the Benefit Of) Jane Doe, IRA or INHERITED: Preferred Trust Company, LLC FBO Jane Doe , Inherited IRA John Doe
SECTION 2: IRA Account Owner Information
Name
*
First
Middle
Last
SSN
*
Date of Birth
*
MM slash DD slash YYYY
Email
*
Phone
*
Cell Phone
Address (IRA Account Holder)
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Where did you hear about us?
*
Enter referring company, advertisement, individual or resource code.
Promotional Code
GOVERNMENT ISSUED PHOTO IDENTIFICATION
Photo Identification Type
Please complete the information below; approved documents include any unexpired, government issued photo ID including a driver’s license, U.S. passport, state issued photo ID card or military ID. To help the government fight the funding of terrorism and money laundering activities, Federal law (Section 326 of the USA PATRIOT Act of 2001) requires all financial institutions to obtain, verify and record information that identifies each individual or institution who opens an account with Preferred Trust Company. When you open an account, we are required to obtain your name, address, date of birth, social security number or tax identification number and other information that will allow us to identify you. As appropriate, we may also ask to see your driver’s license or other identifying documents. This information will be verified to ensure the identity of all persons opening an account. The information may be compared to information obtained through third party sources, as permitted by law. If we cannot verify this information, your account may not be opened, or it may be restricted and/or closed. Preferred Trust Company is not responsible for any losses or damages including, but not limited to, lost opportunities you may incur.
Driver's License
Passport
State Issued ID Card
Identification Number
*
Issue Date
*
Month
Day
Year
Expiration Date
*
Month
Day
Year
Upload Passport
*
Upload a Scan / Photocopy of your Government issued Passport here
Max. file size: 50 MB.
Section 3: Automatic Contribution (not applicable to Inherited IRAs)
Preferred Trust Company accepts automatic cash contributions to an IRA account. There is no fee associated with automatic contribution transactions. Funds are deducted from a checking or savings account. The financial institution must be a member of the Automated Clearing House (ACH). Deductions will be processed on or about the 5th and/or the 20th of each month. The minimum automatic contribution is $25.00 and the maximum is dependent on the allowable maximum amount in accordance with IRS rules and regulations of Publication 590 for the current year. Preferred Trust Company reserves the right to cancel an automatic contribution should the ACH deduction be rejected due to insufficient funds or incorrect account information.
Frequency
Monthly on the 5th
Monthly on the 20th
Twice Monthly on 5th and 20th
Annual Contribution
Deduction Amount
Bank Information
Preferred Trust Company requires a copy of a VOIDED check for Automatic Contributions to be setup. Notify Preferred Trust Company if the bank information changes. An ACH that is rejected will be assessed a $30.00 ACH Automatic Contribution Rejection Fee.
Name of Financial Institution
Account Type
Checking
Savings
Bank Account Number
Bank Routing Number
Voided Check
Max. file size: 50 MB.
Section 4: Beneficiary Designation Information
At the time of my death, the primary beneficiaries named below will receive my IRA assets. If all of my primary beneficiaries die before me, the contingent beneficiaries named below will receive my IRA assets. In the event a beneficiary dies before me, such beneficiaries share will be reallocated on a pro-rata basis to the other beneficiaries that share the deceased beneficiaries classification as a primary or contingent beneficiary. If all of the beneficiaries die before me, my IRA assets will be paid to my estate. If no percentages are assigned to beneficiaries, the beneficiaries will share equally. If the percentage total for each beneficiary classification does not equal 100%, any remaining percentage will be divided equally among the beneficiaries within such class. This designation revokes and supersedes all earlier beneficiary designations which may apply to this IRA.
Beneficiary Type (#1)
*
Primary
Contingent
Share Percentage (Beneficiary #1)
*
Please DO NOT include “%” in your field. Please enter percentage as a number only: example: 100
Name of Beneficiary (Beneficiary #1)
*
Maximum of 30 characters per field
First
Last
Beneficiary Date of Birth (Beneficiary #1)
*
MM slash DD slash YYYY
SSN or Taxpayer ID (Beneficiary #1)
*
Relationship to IRA Owner (Beneficiary #1)
*
Address (Beneficiary #1)
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone (Beneficiary #1)
Email (Beneficiary #1)
Beneficiary Type (#2)
Primary
Contingent
Share Percentage (Beneficiary #2)
Please DO NOT include “%” in your field. Please enter percentage as a number only: example: 100
Name of Beneficiary (Beneficiary #2)
Maximum of 30 characters per field
First
Last
Beneficiary Date of Birth (Beneficiary #2)
MM slash DD slash YYYY
SSN or Taxpayer ID (Beneficiary #2)
Relationship to IRA Owner (Beneficiary #2)
Address (Beneficiary #2)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone (Beneficiary #2)
Email (Beneficiary #2)
Beneficiary Type (#3)
Primary
Contingent
Share Percentage (Beneficiary #3)
Please DO NOT include “%” in your field. Please enter percentage as a number only: example: 100
Name of Beneficiary (Beneficiary #3)
Maximum of 30 characters per field
First
Last
Beneficiary Date of Birth (Beneficiary #3)
MM slash DD slash YYYY
SSN or Taxpayer ID (Beneficiary #3)
Relationship to IRA Owner (Beneficiary #3)
Address (Beneficiary #3)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone (Beneficiary #3)
Email (Beneficiary #3)
Section 5: Spousal Consent
This section should be reviewed if either the trust or the residence of the account owner is located in a community or marital property state and the account owner is married. Due to the important tax consequences of giving up one's community property interest, the individual signing this section should consult with a tax or legal professional. I am the spouse of the above-named account owner. I acknowledge that I have received a fair and reasonable disclosure of my spouse's property and financial obligations. Due to the important tax consequences of giving up my interest in this account, I have been advised to see a tax or legal professional. I hereby give the account owner any interest I have in the funds or property deposited in this account and consent to the beneficiary designations(s) indicated above. I assume full responsibility for any adverse consequences that may result. No tax or legal advice was given to me by Preferred Trust Company.
Marital Status
I am Married. I understand that if I designate a primary beneficiary other than my spouse, my spouse must consent by signing below.
I am Not Married. I understand that if I marry in the future, I must complete a new Designation of Beneficiary form, which includes the spousal consent documentation.
IRA Owner Initials
Signature of IRA Owner Spouse (if applicable)
Date
MM slash DD slash YYYY
Section 6: Interested Party Designation
Complete the information below only if you wish to authorize an individual to receive information on your account. I herby designate the below-mentioned Interested Party Designee subject to all applicable terms and provisions stated in the Custodial Agreement. I authorize this Interested Party Designee to receive statements and other account information from Preferred Trust Company as Custodian via written, telephonic or electronic communications. I agree that Preferred Trust Company as Custodian is under no duty to investigate or inquire about the Interested Party Designee. I understand that this individual is not authorized to execute transactions on my behalf. I understand that I may revise this information at any time by giving written notice to Preferred Trust Company. If an IRA Account Owner would like to grant an Interested Party Agent authorization to execute transactions on their behalf, Preferred Trust Company as Custodian requires a Limited Power of Attorney on file.
Individual/Financial Representative Name
Company/Broker Dealer Affiliation (if applicable)
Address (Interested Party Designation)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Interested Party Phone
Interested Party Email
Section 7: Disclosures & Agreements
You must read and agree to the following documents before you can successfully complete this application.
I have read and agree to the following:
*
Privacy Policy
Privacy Policy
I have read and agree to the following:
*
Disclosure Statement
Company Disclosure Statement
I have read and agree to the following:
*
Custodial Agreement
Custodial Agreement
I have read and agree to the following:
*
Fee Schedule
Fee Schedule
Section 10: Signatures
I certify that the information provided by me on this Application is accurate, and that I have received a copy and agree to be bound by the terms and amendment thereto of the Privacy Policy, Disclosure Agreement, Custodial Agreement, Fee Schedule, and Form 5305 (Individual Retirement Trust Account). I assume sole responsibility for all consequences relating to my actions concerning this IRA. I understand that I may revoke this IRA on or before seven (7) days after the date of establishment. I have not received any financial, tax or legal advice from Preferred Trust Company, LLC, and will seek the advice of my own tax or legal professional to ensure my compliance with related laws. I release and agree to hold Preferred Trust Company, LLC harmless against any and all claims or losses arising from my actions.
Important Information About Procedures for Opening a New Account
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. Application and signatures are valid for 120 days from the date of original signature.
Signature of IRA Account Owner
Date
*
MM slash DD slash YYYY
Signature of Custodian
Date
MM slash DD slash YYYY
Δ
What Are You Waiting For?
Schedule a Consultation
Open an Account
About PTC
Client Testimonials
Forms, Forms, Forms
Forms
Fee Schedule
IRA LLC Fee Schedule
Pay Your Fees
Investment Community
Become a Company Partner
Investment Services
Investment Resources
IRA LLC with Checkbook Control
Digital Currency
Oil and Gas
Precious Metals
Real Estate
Get the 411
Why Self-Direct?
Frequently Asked Questions
Blog
YouTube Videos
Inherited IRAs
Prohibited Transactions
Retirement Industry Glossary
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