Goldman Sachs IRA IRA

Transcription

1 Goldman Sachs IRA A P P L I C A T I O N IRA

2 Instructions for Opening Your Account New Accounts If you are opening a Traditional IRA, Roth IRA or SEP IRA, review this booklet and complete the Goldman Sachs IRA Application. te: If your Traditional IRA is to receive a mandatory rollover transfer from an employer plan (or a mandatory distribution upon termination of such a plan), the plan sponsor, plan administrator or another plan fiduciary is responsible for establishing the IRA in your name. You do not complete or sign an IRA Application. IRA Transfers and Rollovers TRADITIONAL IRA TRANSFER If transferring assets directly from a Traditional IRA at another fnancial institution to a Traditional IRA at Goldman Sachs, complete the Transfer Form and attach it to your Application. ROTH IRA TRANSFER If transferring assets directly from a Roth IRA at another fnancial institution to a Roth IRA at Goldman Sachs, complete the Transfer Form and attach it to your Application. DIRECT ROLLOVER If rolling over assets directly from a 401(k), 403(b), or other eligible employer plan to a Goldman Sachs Traditional IRA, complete either the Goldman Sachs Direct Rollover Form or a direct rollover form supplied by your employer or plan provider and attach it to your Application. INDIRECT ROLLOVER If rolling over assets that have already been distributed to you from another IRA, 401(k), 403(b), or other eligible employer plan to a Goldman Sachs Traditional IRA, simply complete the Goldman Sachs IRA Application, and make sure the Traditional IRA Rollover box is checked in Section 2. Roth Conversions If you are converting a Traditional IRA (including rollover IRAs) to a Roth IRA at Goldman Sachs, complete the Goldman Sachs Conversion Form and attach it to your Application. Fees The annual fee for this Goldman Sachs IRA is $10. If you wish to pre-pay this amount, enclose a check payable to State Street Bank and Trust Company FBO [Your Name] IRA. If not prepaid, the Fund(s) will automatically deduct the $10 fee from your account at year-end (usually in December), and every year thereafter. If you terminate your account prior to yearend, the $10 fee will automatically be deducted from your account. Return the completed Application and Form(s), with your check(s), to: Goldman Sachs Funds P.O. Box Kansas City, MO Or for overnight mail to: Goldman Sachs Funds 330 West 9th Street, First Floor Poindexter Building Kansas City, MO For assistance completing this form, please contact a Representative at , Monday through Friday 7:00 a.m. to 5:30 p.m. Central.

3 Goldman Sachs IRA Application GOLDMAN SACHS FUNDS P.O. Box Kansas City, MO CUSTOMER IDENTIFICATION PROGRAM Important Information About Procedures for Opening a New Account To help the government fight the funding of terrorism and money laundering, Federal Law requires all financial institutions to obtain, verify and record information that identifies each registered owner of an account. In some cases, the Goldman Sachs Funds may also take additional steps to verify the identities of individuals with authority or control over the registered owner, including person(s) able to effect securities transactions on behalf of the registered owner. What this means for you: When you open an account, the Funds will ask for the registered owner s name, address, and identification number and other information that will allow us to identify the registered owner, and the Funds may ask for similar information regarding individuals with authority or control over the registered owner. The Funds may also ask to see governmentissued identifying documents. To the extent permitted by applicable law, Goldman Sachs Funds reserves the right (i) to place limits on transactions in any account until the identity of the investor is verified; or (ii) to refuse an investment in the Funds or (iii) to involuntarily redeem an investor s shares and close an account in the event that the Funds are unable to verify an investor s identity. 1a INVESTOR INFORMATION Please type or print. (All fields required) First Name M.I. Last Name Social Security Number Daytime Phone Evening Phone US Citizen Source of Wealth (Required) (i.e. Employement, Investment, Inheritance) Line of Business (i.e. Teacher, Accountant) Street Address Apartment # Date of Birth City State Zip Code Mailing Address (If mailing address is a post office box, a street address is also required by the USA Patriot Act). Apartment # City State Zip Code NAV Purchases (i.e., waiver of sales load) As described in the prospectus, certain classes of account holders are eligible to purchase Class A shares of Goldman Sachs Funds at net asset value. If you fall into any of these eligible categories, please state the reason below: Reason for NAV purchase 1b MINOR IRA ACCOUNT Minor s First Name M.I. Minor s Last Name Minor s Social Security Number Minor s Date of Birth (mm/dd/year) Guardian s First Name M.I. Guardian s Last Name Guardian s Social Security Number Guardian s Date of Birth (mm/dd/year) (required) Source of Wealth of the Minor (Required) (i.e. Employment, Investment, Inheritance) (where the funds are coming from) 2 TYPE OF IRA Check one. Under the Uniform Gift/Transfer to Minor Act State of Minor s Residence Traditional IRA Roth IRA Traditional Rollover IRA SEP IRA CONTINUED

4 3 GOLDMAN SACHS FUND SELECTION If you do not choose a fund, purchase will be in FSQ Prime Obligation Funds. If you do not choose a share class, purchase will be for class A shares of the fund chosen. The minimum initial investment is $250 per fund. Please see the Fund Selection Guide on the inside back cover. Fund names and numbers must be entered. Please select carefully. Fund Name Fund Number Amount Or Percent* $ $ $,.,.,. % % % Total Contribution Amount $,,. Annual Custodial Fee: $10.00 (automatically deducted from your account, if not paid by separate check.) Make checks payable to State Street Bank and Trust Company FBO [Your Name] IRA. 4 BENEFICIARY DESIGNATION $,. % *Whole percents only. Must total 100%. Tax Year I have listed additional beneficiaries on the attached Optional Services Form. I revoke all prior beneficiary designations, if any, made by me for these assets. If I am not survived by any designated beneficiary, my beneficiary shall be my estate. Reserving the right to revoke or change this beneficiary designation at any time by written notice to the Custodian, I direct that all fund accounts held in this IRA be distributed upon my death as follows: Primary Beneficiary Full Legal Name Date of Birth Social Security Number Relationship: % if Less Than 100% Spouse Other % US Citizen Beneficiary Primary Contingent Full Legal Name US Citizen Relationship: Date of Birth Social Security Number % if Less Than 100% / / Spouse Other % Unless otherwise specified, multiple surviving primary beneficiaries or multiple surviving contingent beneficiaries, as the case may be, will share equally. Spousal Consent (This section should be reviewed if the Depositor is married and designates a beneficiary other than the spouse. It is the Depositor s responsibility to determine if this section applies. The Depositor may need to consult with legal counsel. Neither the Custodian nor the Sponsor is liable for any consequences resulting from a failure of the Depositor to provide proper spousal consent.) I am the spouse of the above-named Depositor. 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 or marital property interest in this IRA, I have been advised to see a tax professional or legal adviser. I hereby consent to the beneficiary designation(s) indicated above. I assume full responsibility for any adverse consequence that may result. tax or legal advice was given to me by the Custodian or Sponsor. Signature of Spouse Signature of Witness for Spouse 5 TELEPHONE ECHANGE Unless otherwise indicated, Telephone Exchange Privileges are automatically included as a feature of your Goldman Sachs IRA. I DO NOT want the Telephone Exchange Privilege. CONTINUED

5 6 INVESTOR SIGNATURE I hereby establish an IRA account with State Street Bank and Trust Company as Custodian, subject to the terms and conditions of the State Street Bank and Trust Company Universal IRA Custodial Account Agreement, a copy of which I have received and read. I have also received and read the Disclosure State - ment for this IRA and the current prospectus for each Fund selected in Section 3. I acknowledge that I am responsible for determining and applying the tax laws that apply to amounts contributed to, held in and withdrawn from this IRA. I certify under penalty of perjury that my social security number listed in Section 1 is correct. I certify under penalties of perjury that:(1) The number shown on this form is my correct TIN (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest and dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a resident alien). You must cross out part (2) above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Investor s Signature If the Investor is a minor under the laws of the Investor s state of residence, a parent or guardian must also sign the Application here. Until the Investor reaches the age of majority, the parent or guardian will exercise the powers and duties of the Investor. Signature of Parent or Guardian 7 CUSTODIAN ACCEPTANCE State Street Bank and Trust Company accepts appointment as Custodian of the Depositor s account. However, this Application is not binding upon the Custodian until the Depositor has received a statement of the transaction. By: /s/bob LaValley 8 FINANCIAL ADVISOR Required We authorize Goldman, Sachs & Co., and BFDS to act as our agent in connection with transactions made under this IRA Application and agree to notify Goldman, Sachs & Co. of any purchases made under a Statement of Intent or Right of Accumulation as set forth in the enclosed Optional Services Form. Rep Name Rep Number Branch Address City State Zip Code Branch Number Rep Phone Number Dealer Firm Name Financial Advisor Signature For assistance completing this form, please contact a Representative at , Monday through Friday 7:00 a.m. to 5:30 p.m. Central.

6 PRIVACY NOTICE (Applicable only to individual, joint, and individual retirement account (IRA) investors) The Goldman Sachs financial services companies endeavor to maintain the highest standards of confidentiality and to respect the privacy of our client relationships. In that regard, we are providing this Privacy tice to our clients in accordance with Title V of the Gramm-Leach-Bliley Act of 1999 and its implementing regulations. This notice supplements any privacy policies or statements that we may provide in connection with specific products or services. The Information We Collect About You. The non-public personal information we collect about you (your Information ) comes primarily from the account applications or other forms you submit to us. We may also collect Information about your transactions and experiences with us, our affiliates, or others relating to the products or services we provide. Also, depending on the products or services you require, we may obtain additional Information from consumer reporting agencies. Our Disclosure Policies. We do not disclose your Information to anyone, except as permitted by law. This may include sharing your Information with non-affiliated companies that perform support services for your account or process your transactions with us or our affiliates. It may also include sharing your Information with our affiliates to bring you the full range of services and products available from the Goldman Sachs family of financial services companies, including our U.S. and international brokerage, asset management, advisory, and trust services companies. Additionally, it may include disclosing your Information pursuant to your express consent, to fulfill your instructions, or to comply with applicable laws and regulations. Our Information Security Policies. We limit access to your Information to those of our employees and service providers who are involved in offering or administering the products or services that we offer. We maintain physical, electronic, and procedural safeguards that are designed to comply with federal standards to safeguard your Information. If our relationship ends, we will continue to treat your Information as described in this Privacy tice. This notice is being provided on behalf of the following affiliates of The Goldman Sachs Group, Inc.: Goldman Sachs Asset Management, L.P. Goldman Sachs Asset Management International GS Investment Strategies, LLC Goldman Sachs Hedge Fund Strategies, LLC The family of funds managed by the affiliates listed above. PNV18TPA

7 Rev. 01/2011 FACTS Why? What? How? WHAT DOES STATE STREET BANK AND TRUST COMPANY (STATE STREET) DO WITH YOUR PERSONAL INFORMATION? Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share and protect your personal information. Please read this notice carefully to understand what we do. The types of personal information we collect and share depend on the product or service you have with us. This information can include: Social Security number assets account balances transaction history account transactions wire transfer instructions. When you are no longer our customer, we continue to share your information as described in this notice. All financial companies need to share customers personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers personal information; the reasons State Street chooses to share and whether you can limit this sharing. Reasons we can share your personal information For our everyday business purposes such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus For our marketing purposes to offer our products and services to you For joint marketing with other financial companies For our affiliates everyday business purposes information about your transactions and experiences For our affiliates everyday business purposes information about your creditworthiness For nonaffiliates to market to you Does State Street share? Yes Can you limit this sharing? Questions? Call SSBFDS2011

8 Page 2 What we do How does State Street protect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. How does State Street collect my personal information? Why can t I limit all sharing? Definitions Affiliates We collect your personal information, for example, when you open an account make a wire transfer provide account information give us your contact information make deposits and withdrawals from your account. Federal law gives you the right to limit only sharing for affiliates everyday business purposes information about your creditworthiness affiliates from using your information to market to you sharing for nonaffiliates to market to you. State laws and individual companies may give you additional rights to limit sharing. Companies related by common ownership or control. They can be financial and nonfinancial companies. State Street does not share with its affiliates. n-affiliates Joint marketing Companies not related by common ownership or control. They can be financial and nonfinancial companies. State Street does not share with non-affiliates so they can market to you. A formal agreement between nonaffiliated financial companies that together market financial products or services to you. State Street doesn t jointly market.

9 GOLDMAN SACHS ASSET MANAGEMENT 200 WEST STREET, NEW YORK, NY A prospectus for the Fund containing more complete information may be obtained from your authorized dealer or from Goldman, Sachs & Co. by calling Please consider a fund's objectives, risks, and charges and expenses, and read the prospectus carefully before investing. The prospectus contains this and other information about the Fund. Goldman, Sachs & Co. is the distributor of the Goldman Sachs Funds. Copyright 2006 Goldman, Sachs & Co. All rights reserved. Date of first use: v. 11, / IRAAPP / 06-14