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- Scot Maximillian Walsh
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1 Thank you for choosing to roll over your retirement plan (e.g., 401k, 403b, 457) assets to an Ariel Investments IRA. Please take the steps outlined below to complete the roll over process. 1. If you do not have an eisting IRA at Ariel Investments to receive the assets, please complete a Retirement Account Application to establish an account. Once completed, please send the application to: Regular Mail Overnight Mail Ariel Investment Trust Ariel Investment Trust c/o U.S. Bancorp Fund Services, LLC c/o U.S. Bancorp Fund Services, LLC P.O. Bo East Michigan Street, Floor 3 Milwaukee, WI Milwaukee, WI Please note: You do not need to complete a Retirement Account Application if you already have an eisting Ariel Investments IRA to which you would like to roll over the assets. 2. You will need to contact your current retirement plan administrator to notify them that you wish to roll over your assets to an Ariel Investments IRA and inquire about the paperwork necessary to complete this transaction. As a part of this process, you will need to provide your Ariel Investments IRA account information, which is located on the confirmation statement (if you are setting up a new account) or on a recent account statement (if you have an eisting Ariel Investments IRA). If you have any questions or need assistance, please do not hesitate to contact us at
2 RETIREMENT ACCOUNT APPLICATION Please use this application to open only the types of IRAs listed in Section 1. If this is a transfer of assets from an eisting IRA, please also complete the IRA Transfer Form. If you have any questions or need assistance filling out this application, please call us at Once completed, mail this application to Ariel Investment Trust, c/o U.S. Bancorp Fund Services, LLC, P.O. Bo 701, Milwaukee, WI For overnight delivery, send to Ariel Investment Trust, c/o U.S. Bancorp Fund Services, LLC, 615 East Michigan Street, Floor 3, Milwaukee, WI Do not use this application to open an Education Savings Account. Please visit arielinvestments.com or call us for the correct application. THE USA PATRIOT ACT In accordance with the regulations issued under the USA Patriot Act, Ariel Investments and its transfer agent are required to obtain, verify and record information that identifies each person or entity that opens an account in an effort to ensure that the Funds are not used as a vehicle for money laundering. For this reason, when you open an account, we will ask for your name, address, Social Security number, date of birth and other information. 1 2 IMPORTANT NOTE: An incomplete application will be returned. PLEASE PRINT ALL ITEMS EXCEPT SIGNATURE(S) TYPE OF IRA If no ta year is indicated below, we will assume it is for the current ta year. Please refer to the IRA Disclosure Statement and Custodial Account Agreement for eligibility requirements and contribution limits. Choose one of the following account types and provide the applicable details about your contribution: TRADITIONAL IRA New contribution: For ta year Transfer from another IRA (please complete IRA Transfer Form) Direct rollover from qualified employer plan, such as a 401(k), 403(b) or 457 (please complete any additional forms required by your plan administrator) Inherited IRA: Name of decedent Date of death Date of birth ROTH IRA New contribution: For ta year Transfer from another Roth IRA (please complete IRA Transfer Form) Inherited IRA: Name of decedent Date of death Date of birth Transfer of previous Roth IRA conversion: Year in which Traditional IRA was converted to Roth IRA Conversion of a Traditional IRA to Roth IRA (please complete IRA Transfer Form) SEP-IRA New contribution Transfer from another SEP-IRA (please complete IRA Transfer Form) SIMPLE IRA New contribution Transfer from another SIMPLE IRA (please complete IRA Transfer Form) (please complete IRA Transfer Form) ACCOUNT OWNER If mailing address is a post office bo, a street address is also required by the USA Patriot Act. APO and FPO addresses will be accepted. Foreign addresses are not allowed. First Name Middle Initial Last Name Street Address Mailing Address (if different from above) Address Daytime Phone Evening Phone Please select one: U.S. Citizen Resident Alien (must attach a copy of Alien ID, Green Card or Passport)
3 3 DUPLICATE STATEMENTS This section should be completed only if you would like another individual or financial advisor to receive copies of your quarterly account statements. First Name Middle Initial Last Name Company Mailing Address DELIVERY PREFERENCES With edelivery, you can receive quarterly reports, prospectuses and/or account statements online rather than by regular mail. Not only does this service decrease the clutter in your mailbo, it also reduces Fund epenses by lowering printing and postage costs. Yes, I would like to (please check all boes that apply): Receive my annual prospectus and quarterly fund reports electronically Receive my quarterly account statements electronically Receive my year-end ta forms electronically By selecting any of the above options, you must provide your address: Additionally, you agree to waive the physical delivery of the prospectus, fund reports, account statements and/or ta forms. You can request a hard copy of any of these materials at anytime by calling If you have opted to receive your account statements and/or ta forms electronically, you will need to establish online access to your account. To do so, once you receive confirmation of your initial investment which will include your account number simply visit arielinvestments.com and click on Create a Username. You will need your account number and Social Security number to register. If you do not opt for electronic delivery, you can easily edit your delivery preferences at any time by calling or logging into your account on our website. INVESTMENT SELECTION There is a $1,000 minimum investment for each Fund unless you enroll in an Automatic Investment Program (AIP). Please make check payable to Ariel Investment Trust. We cannot accept cash, cashier s checks, Treasury checks, money orders, starter checks, third-party checks, business checks or credit card checks. If you choose to enroll in an AIP and do not wish to make an initial investment, please skip this section and complete Section 6. Please indicate the amount to be invested in each Fund. If transferring or rolling over assets, indicate the percentage to be invested in each Fund. Please make sure the percentages add up to 100%. Fund Fund Number Dollar Amount Invested or % to be Invested Ariel Fund 2220 $ % Ariel Appreciation Fund 2221 $ % Ariel Focus Fund 2222 $ % SSgA Money Market Fund 2223 $ % TOTAL INVESTMENT $ % In order to invest in the SSgA Money Market Fund, an account in one of the Ariel mutual Funds must be established prior to, or in conjunction with, opening a SSgA account. Shares of the SSgA Money Market Fund are not insured by the FDIC or by any other governmental agency; they are not obligations of the FDIC nor are they deposits or obligations of or guaranteed by State Street Bank and Trust Company. The SSgA Money Market Fund pays State Street Bank and Trust Company for its services as investment adviser, custodian, transfer agent and shareholder servicing. AUTOMATIC INVESTMENT PROGRAM (AIP) To make investing easier, you may choose to have a specified amount ($50 minimum per Fund) automatically transferred from your bank account and invested in your Ariel Investments account on a monthly basis. Please be sure to provide your banking information in Section 7. Also, indicate below which month you would like to begin the program and which day of the month you would like such transfers to be made. If you do not designate a specific day, your money will be transferred on the 5 th day of every month. Please allow at least 15 business days after receipt of this application before your Ariel Investments AIP will be effective. Fund Amount to be Invested Month to Begin Day of the Month Ariel Fund $ Ariel Appreciation Fund $ Ariel Focus Fund $ Alternatively, if you would like to automatically invest from your paycheck, check this bo and we will send you instructions to set-up payroll deductions If you cancel your monthly Automatic Investment Program prior to reaching the account minimum, the Funds reserve the right to close your account and send you the proceeds with 30 days prior written notice, unless a balance of $1,000 or more is restored within that 30 day period.
4 7 BANK ACCOUNT OF RECORD Banking information is required for an Automatic Investment Program and to perform transactions by telephone or arielinvestments.com. By completing this section, you authorize Ariel to deduct money from your bank account via ACH to purchase shares into your Ariel account and to send redemption proceeds via wire or ACH to your bank account of record. There is a $10 fee for net-day wire and no fee for ACH (transfer takes 2 3 days). CHECKING SAVINGS 8 9 ATTACH VOIDED CHECK HERE Your request cannot be processed without a voided check or encoded deposit slip for the account you wish to designate as your bank account of record. Note: Checks must be preprinted with your name and address. We cannot accept starter checks. Check this bo if you wish to use your attached purchase check to establish banking instructions instead of including an additional voided check. CUSTODIAL FEES PAYMENT OPTIONS For the additional ta reporting and record-keeping services associated with IRAs, shareholders pay a $15 annual fee or a $60 one-time lifetime fee. This fee is assessed per Social Security number (not per account) and covers all your Ariel Investments retirement accounts (Traditional, Roth, Rollover, etc.). If you do not select a fee option below, the $15 fee will be deducted from your account after November 30 th of each year. FEE OPTIONS (select one) Lifetime IRA fee $60 Annual IRA fee $15 FEE PAYMENT METHOD Fee deducted (from my enclosed investment check payable to Ariel Investment Trust) Fee included (in a separate personal check payable to Ariel Investment Trust) I am an eisting Ariel IRA shareholder and have already paid the annual or lifetime fee BROKER/DEALER INFORMATION This section should be completed only if shares are being purchased through a financial representative at an outside broker/dealer. Broker/Dealer Name Broker Branch # Representative # Representative s First Name Middle Initial Last Name 10 Mailing Address BENEFICIARY DESIGNATION Please provide your primary and secondary beneficiaries. The totals for each must equal 100%. Secondary beneficiaries will receive distributions only if no primary beneficiaries survive you. I designate the individual(s) named below as the beneficiary(ies) of this IRA. I revoke all prior IRA beneficiary designations, if any, made by me for these assets. I understand that I may change or add beneficiaries at any time with written notice to the custodian. If I am not survived by any beneficiary, my beneficiary shall be my estate. Primary Beneficiary(ies) Secondary Beneficiary(ies) 1) Name 1) Name 2) Name 2) Name Please complete other side
5 SPOUSAL CONSENT This section should be reviewed if the account owner is married and is a resident of a community property or marital property state (AZ, CA, ID, LA, NV, NM, TX, WA and WI) and designates a beneficiary other than the spouse. It is the account owner s responsibility to determine if this section applies. The account owner may need to consult legal counsel. Neither the custodian nor the sponsor are liable for any consequences resulting from a failure of the account owner to provide proper spousal consent. I am the spouse of the above-named account owner. I acknowledge that I have received a full and reasonable disclosure of my spouse s property and financial obligations. Due to any possible consequences of giving up my community property interest in this IRA, I have been advised to see a ta professional or legal advisor. I hereby consent to the beneficiary designation(s) indicated on the previous page. I assume full responsibility for any adverse consequence that may result. No ta or legal advice was given by the custodian or sponsor. Signature of Spouse Date Signature of Witness for Spouse Date HOW DID YOU HEAR ABOUT ARIEL INVESTMENTS? Please let us know how you learned about Ariel Investments (please check all boes that apply). Conference Financial Advisor Friend Other SIGNATURE AND OTHER REQUIRED INFORMATION Important: Please read before signing Magazine/Newspaper Radio Television By signing this application establishing an Ariel Investments IRA, I hereby: (1) establish an Individual Retirement Account pursuant to the Internal Revenue Code of 1986, as amended, and in accordance with all the terms of the Disclosure Statement and Custodial Account Agreement; (2) certify that all contributions to the IRA meet the requirements of the Internal Revenue Code governing such contributions; (3) appoint U.S. Bank, NA, or its successors, as custodian on the account; (4) state that I have received, read and understand the Custodial Account Agreement; (5) adopt the Custodial Account Agreement, as it may be revised from time to time; (6) agree to promptly give instructions to the custodian necessary to enable the custodian to carry out its duties under the Custodial Account Agreement; (7) agree that I have received and read the prospectus(es) for the investment(s) selected and if I am purchasing shares of SSgA Money Market Fund, I understand I will receive the prospectus with the confirmation of my purchase; and (8) hereby consent to the delivery of one copy of prospectuses, financial reports and other regulatory materials to all investors who share my same address. I understand that if I want to receive individual copies of materials, I can call I recognize that neither U.S. Bank, NA nor any mutual fund in which my IRA account may be invested is a bank and further that mutual fund shares are not backed or guaranteed by a bank or insured by FDIC. If I have indicated a Regular IRA Rollover or Direct Rollover above, Depositor certifies that any assets transferred in kind by Depositor are the same assets received by the Depositor in the distribution being rolled over; if the distribution is from another Regular IRA, that Depositor has not made another rollover within the one-year period immediately preceding this rollover; that such distribution was received within 60 days of making the rollover to this Account; and that no portion of the amount rolled over is a required minimum distribution under the required distribution rules. If I have indicated a conversion, transfer or rollover of an eisting traditional IRA to a Roth IRA, I acknowledge that the amount converted will be treated as taable income (ecept for prior nondeductible contributions) for federal income ta purposes. If I have indicated a rollover from another Roth IRA, I certify that the information given is correct and acknowledge that adverse ta consequences or penalties could result from giving incorrect information. I understand that a $15 annual maintenance fee may be collected by redeeming sufficient shares from my fund account balance, if not prepaid by November 30 th of each year. I also understand that I may pay the $60 nonrefundable Ariel lifetime IRA fee or have it deducted from my account at my request in lieu of the annual fees. The custodian may change the fee schedule from time to time. I acknowledge that Ariel is required by law to obtain certain personal information from me, which will be used to verify my identity. My account may not be opened if I do not provide this information. I further acknowledge that Ariel reserves the right to close my account, or take other reasonable steps, if it is unable to verify my identity. I hereby ratify any instructions given on this account and any account into which echanges are made and acknowledge that neither the Funds, their agents nor U.S. Bank, NA will be liable for action upon such instructions (by telephone or in writing) believed to be genuine and in accordance with the procedures described in the prospectus. Such entities will employ reasonable procedures to confirm that instructions communicated by telephone are genuine and may be liable for losses due to unauthorized or fraudulent instructions only if such procedures are not followed. Such procedures may include, among others, requiring personal identification prior to acting upon telephone instructions, providing written confirmation of telephone transactions, and tape recording telephone conversations. I hereby agree to cooperate with respect to such procedures as requested by the above-mentioned entities. Under penalties of perjury, by signing this application, I certify (a) that I am a U.S. Person (a U.S. Citizen or a Resident Alien), and (b) that the Social Security number shown on this application in Section 2 is my correct Tapayer Identification Number, and (c) I have read the applicable prospectus(es), Custodial Account Agreement and this application and agree to their terms. I also agree that any shares purchased now or later are and will be subject to the terms of the Fund s prospectus as in effect from time to time. Signature of Account Owner Appointment as custodian accepted: U.S. Bank, NA Date Joe D. Redwine RETAPP 2/10
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