IRA Application. Class C and S Shares

Transcription

1 IRA Application Class C and S Shares Instructions Use this form for IRA individual, custodial, trust,profit-sharing and pension plan accounts. Do not use this form for ICON Funds Class A accounts. For additional information, please call ICON Funds at. IMPORTANT: To help the government fight the funding of terrorism and money laundering, federal law requires all financial institutions (including mutual funds) to obtain, verify, and record the following information for all registered owners or others who may be authorized to act on an account: Full Name, Date of Birth, Social Security Number, and Permanent Address. Corporate, trust, and other accounts require additional documentation. In some cases, the ICON Funds may also take additional steps to verify the identities of individuals with authority or control over the registered owner. This information will be used to verify your identity or the identity of a person with authority or control over the registered owner. We can return your application if any of this information is missing, and we may request additional information from you or the person having authority or control over you or the account for verification purposes. In the event that we are unable to verify your identity, or the person having authority or control over you or the account, ICON reserves the right to: (i) place limits on transactions; or (ii) refuse an investment in the Funds; or (iii) voluntarily redeem your account at the current business day s net asset value. We recommend that you consult your tax adviser regarding the particular tax consequences of any investment option. Read the entire application, complete, and sign. Return the completed application and your investment check to one of the following addresses: Direct Mail: ICON Funds P.O. Box Boston, MA OR Overnight Express Mail: ICON Funds 30 Dan Road Canton, MA

2 1 Investor Information If account holder is a minor, please provide a supplemental letter listing the Responsible Party's, Social Security number, date of birth, address and phone number. NAME (First, middle, last) address (p.o. box is not acceptable) city/state/zip daytime phone number APT/suite SOCIAL SECURITY NUMBER BIRThdate (MO/DY/YR) Address Permits the Fund to send you information and Fund updates. You must check one: U.S. Citizen Resident Alien Only citizens, legal residents, and legal entities of the United States providing a valid Social Security or tax identification number will be allowed to purchase shares of the Funds. 3 Type of IRA Please select only one of the following account types: Individual Retirement Account ($1,000 minimum) Rollover IRA SEP-IRA SIMPLE IRA (Must be accompanied by IRS forms 5305 SA and 5304 SIMPLE) Roth IRA New contribution for tax year Transfer from another Roth IRA (please complete IRA Transfer Form) Rollover within 60 days (shareholder has receipt of funds) Conversion of a Traditional IRA to a Roth IRA (please complete IRA Transfer Form) 4 Type of Contribution Please select one of the following types of contributions: Yearly Contribution for Tax Year (If prior year, must be postmarked on or before tax filing deadline). passport # or alien ID country of issuance Transfer (assets are a direct transfer from another custodian). Please attach IRA Transfer Form. 2 Investment Professional Information If applicable, this section should be completed by your Investment Representative. Incomplete information will cause a delay in processing the investment. This application for the purchase of shares complies with the terms of the applicable agreement with ICON Distributors, Inc., and with the current ICON Funds prospectus. I hereby authorize Boston Financial Data Services, Inc., to act as my Agent in connection with transactions under this IRA Application and I agree to notify ICON Funds of any purchases of shares which may be eligible for a reduced or eliminated sales charge. I hereby make, constitute, appoint and authorize the Investment Professional listed below to constitute my true lawful agent, for me in my, place and stead to act on my behalf in connection with all transactions under this account application. Rollover (You had physical receipt of assets for less than 60 days) from another IRA. Direct Rollover from your employer-sponsored plan (you did not have receipt of assets). Please indicate previous account type. (Direct rollovers not allowed into a Roth IRA.) Corporate Pension Plan Profit-Sharing Plan 401(k) 403(b) Other (please specify) Rollover Roth (Rollover of Traditional IRA to Conversion Roth IRA) DEALER NAME REPRESENTATIVE S Name REPRESENTATIVE S Number representative s crd number (FINRA) REPRESENTATIVE S BRANCH OFFICE representative s ADDRESS representative s CITY/STATE/ZIP representative s TELEPHONE NUMBER PAGE 2 of 6

3 5 INVESTMENT INSTRUCTIONS By check made payable to ICON Funds. By wire: Call or see the prospectus for wiring instructions. Indicate total amount and date of wire: $ Date By ACH Transfer. Upon receipt of this application, we will initiate an electronic funds transfer from the account you indicate in Section 9, Bank Account Information. Please indicate the ICON Fund(s) in which you would like to invest, and the investment amount(s) or allocation(s) for each. Minimum initial investment amount for all Funds is $1,000 with $100 subsequent investment. Note: If an Automatic Investment Plan (AIP) is established, other minimums may apply. Please refer to Section 12 of the application. Share purchases by check or Automated Clearing House (ACH) transfer are subject to a hold of up to 10 business days. S E L E C T S H A R E C L A S S Class C Class S Investment Amount OR Allocation U.S. DIVERSIFIED FUNDS ICON Bond Fund $ % ICON Equity Income Fund $ % ICON Fund $ % ICON High Yield Bond Fund 3415 $ % ICON Long/Short Fund $ % ICON Opportunities Fund 3414 $ % ICON Risk-Managed Balanced Fund $ % INTERNATIONAL FUNDS ICON Emerging Markets Fund ICON International Equity Fund $ $ % % SECTOR FUNDS ICON Consumer Discretionary Fund $ % ICON Consumer Staples Fund $ % ICON Energy Fund $ % ICON Financial Fund $ % ICON Healthcare Fund $ % ICON Industrials Fund $ % ICON Information Technology Fund $ % ICON Materials Fund $ % ICON Utilities Fund $ % TOTAL $ 100% PAGE 3 of 6

4 6 Income/Capital Gain Distributions Income Dividends/Short-Term Capital Gains and Long-Term Capital Gains distributions may be paid in cash or reinvested into the Fund paying the distribution. Reinvestments of distributions are made at the net asset value (NAV) determined on the day the distributions are deducted from the Fund s NAV. ICON Funds will automatically reinvest distributions into the same Fund and share class if you do not indicate an alternative distribution option. Note: Distributions that are $10 or less will automatically be reinvested into the same Fund and share class. Income Dividends/Short-Term Capital Gain Dividends: Pay in Cash Reinvest into the Fund Long-Term Capital Gain Dividends: Pay in Cash Reinvest into the Fund For distributions paid in cash, please choose one of the options below. If a selection is not made, we will send the check to your current address of record. Send distributions to my address of record. Send distributions to my bank account of record (refer to Section 9 of this application). 7 Mail Delivery Options Household Delivery Option The Funds will automatically mail a single proxy statement, prospectus, annual report and semiannual report to a household, thus eliminating duplicate mail, unless you decline this option below. I/We consent to the delivery of a single prospectus, annual or semiannual report, as well as any proxy statement, to my/our household. I/We understand that by providing this consent, if more than one family member in my/our household owns the same Fund or Funds described in a single prospectus, report, or proxy statement, we will receive one mailing. Additional copies of the prospectuses, reports, and proxy statements may be obtained by calling. I/We understand that my/our consent to mailing documents on the basis of the household will remain in effect until such time as I/we revoke it. Consent may be revoked at anytime. If you revoke your consent, we will resume mailing individual prospectuses, reports, and proxy statements to each investor in your household within 30 days of your request. Please do NOT mail on a household basis (check all that apply): prospectuses and annual/semiannual reports proxy statement 8 Duplicate Statements (optional) You have the option to send duplicate confirmation statements to another address. Please indicate below: NAME company (if applicable) address CITY/STATE/ZIP 9 Bank Account Information 10 Telephone Options APT/SUITE To ensure proper debiting/crediting of your bank account, please attach an unsigned voided check (for checking accounts) or a savings account deposit slip or check authorization at right. Please use my purchase check for bank of record information. Please fill out if banking information is not included on purchase check. (s) on bank account BANK NAME BANK ADDRESS CITY/STATE/ZIP ACCOUNT NUMBER BANK ROUTING/ABA NUMBER (PRINTED IN LOWER LEFT CORNER OF YOUR CHECK) SIGNATURE OF BANK ACCOUNT OWNER or authorized signer SIGNATURE OF JOINT BANK ACCOUNT OWNER (if applicable) Your signed Application must be received at least 15 business days prior to initial telephone transaction. I decline telephone PURCHASE (ACH) and will submit all purchase requests in writing. I decline telephone REDEMPTION privileges and will submit all redemption requests in writing. I decline telephone ECHANGE privileges and will submit all exchange requests in writing. If no election is made, Telephone Redemption and Telephone Exchange will be added to your account and all checks will be sent to the address of record. Additionally, if no election is made and Section 9 is completed, Telephone Purchase will be added to your account. You must complete Section 9 to have telephone purchase privileges added to your account. PAGE 4 of 6 Attach a voided check from your bank account here.

5 11 Fund-to-Fund Investment Plan Each transaction must be at least $100 and you must currently have a balance of at least $1,000 in each Fund or at least $1,000 in the Fund from which you re transferring. I want to automatically transfer shares having a value of $. Transfer from: Transfer to: Fund Name Class Fund Name Class Amount C C $ S S $ C C $ S S $ 14 Beneficiary(ies) Information Proportions will be allocated equally unless otherwise specified. Primary Beneficiary(ies) NAME Frequency: Monthly Quarterly When do you want the transactions to start? (We ll transact on the 5th day of the month unless you specify otherwise.) month/day of the mo. (between 5 & 28)/year 12 Automatic Investment Plan Your signed Application must be received at least 15 business days prior to initial Automatic Investment Plan (AIP) transaction. An unsigned voided check (for checking accounts) or a voided savings account deposit slip is required with your Application (Section 9). Please start my AIP ($100 minimum per Fund) as described in the Prospectus beginning Month Year on the of every month or the first business day thereafter. 1. Invest $ into Fund Select one: Monthly Quarterly 2. Invest $ into Fund Select one: Monthly Quarterly SIGNATURE OF BANK ACCOUNT OWNER or authorized signer SIGNATURE OF JOINT BANK ACCOUNT OWNER (if applicable) If you do not specify a day of the month, your AIP draft will be made on the 20th. To ensure proper crediting of your bank account, please attach an unsigned voided check or a deposit slip in Section Contingent Deferred Sales Charge The Class C shares of the U.S. Diversified Funds, excluding the ICON Bond Fund, International Funds, and Sector Funds are all subject to a contingent deferred sales charge ( CDSC ) of 1%. The Class C shares of the ICON Bond Fund are subject to a CDSC of 0.85%. The CDSC may be applicable to shares redeemed within one year of purchase. Please see the prospectus for information on CDSC waivers. Account holder initials here Account set-up may be delayed or rejected if initials are not provided. Secondary Beneficiary(ies) (optional) NAME List additional beneficiaries on a separate sheet. This section must be completed if the account holder is married and designates a beneficiary other than the spouse. If you reside in a community or marital property state, including AZ, CA, ID, LA, NV, NM, T, WA, or WI, your spouse must consent to the beneficiary designation by signing below. It is the account holder s responsibility to determine if this section applies. The account holder may need to consult with legal counsel. Neither the Custodian nor the Sponsor is liable for any consequences resulting from a failure of the account holder to provide proper spousal consent. See your lawyer or other tax professional for additional information and advice. I am the spouse of the above-d account holder. 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 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. No tax or legal advice was given to me by the Custodian or Sponsor. signature of account holder's spouse (if applicable) signature of Witness for Spouse COMPLETE AND SIGN BACK PAGE date date PAGE 5 of 6

6 15 Signature and Certification (each owner must sign) I represent that I am of legal age and have legal capacity to make this purchase. I acknowledge and consent to the householding (i.e., consolidation of mailings) of regulatory documents such as prospectuses, shareholder reports, proxies, and other similar documents. I may contact the Funds to revoke my consent. I agree to notify the Funds of any errors or discrepancies within 45 days after the date of the statement confirming a transaction. The statement will be deemed to be correct, and the Funds and their transfer agent shall not be liable if I fail to notify the Funds within such time period. The Funds, the applicable Fund, its transfer agent and any officers, directors, employees, or agents of these entities (collectively ICON Funds ), will not be responsible for banking system delays beyond their control. By completing Section 9, and signing the IRA Account Application, I authorize my bank to honor all entries to my bank account initiated through State Street Bank and Trust Company, on behalf of the applicable Fund. ICON Funds will not be liable for acting upon instructions believed genuine and in accordance with the procedures described in the prospectus or the rules of the Automated Clearing House. When AIP or Telephone Purchase transactions are presented, sufficient collected funds must be in my account to pay them. I agree that my bank s treatment and rights to respect each entry shall be the same as if it were signed personally by me. I agree that if any such entries are dishonored with good or sufficient cause, my bank shall be under no liability whatsoever. I further agree that any such authorization, unless previously terminated by my bank in writing, is to remain in effect until the Funds transfer agent receives and has had a reasonable amount of time to act upon a written notice of revocation. By signing this application, I certify that: I have received and read the prospectus for the Fund(s) in which I am investing, and I agree to the terms of the prospectus. It is my responsibility to read the prospectus of any Fund into which I exchange. I have received and read the custodian's Disclosure Statement for IRAs. Neither the Fund nor its transfer agent will be liable for any loss or expense for acting upon written or telephone instructions reasonably believed to be genuine and in accordance with the procedures described in the prospectus. I certify under penalties of perjury that (1) the Social Security Number or Tax Identification Number given on this application is correct and (2) I am not subject to backup withholding because the Internal Revenue Service (a) has not notified me that I am, as a result of failure to report all interest or dividends, or (b) has notified me that I am no longer subject to backup withholding. The certifications in this paragraph are required from all nonexempt persons to prevent backup withholding of a percentage of all taxable distributions and proceeds of share sales, exchanges, or redemptions under the federal income tax law. Check here if you are subject to backup withholding. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. I hereby agree to indemnify and hold ICON Funds and its agents harmless for acting upon instructions, either oral or in writing, pursuant to this form. SIGNATURE of owner DATE Your application and investment will be returned if the application is not complete and signed. P.O. Box Boston, MA Overnight Express Mail: ICON Funds 30 Dan Road Canton, MA Final Reminders Before you mail, have you: Completed all required information? Full Name in Section 1? Social Security or Tax ID Number in Section 1? Birth Date in Section 1? Permanent Street Address in Section 1? Enclosed additional documentation, if applicable? Enclosed your check made payable to ICON Funds? Included a voided bank check, if applicable? Signed your application in Section 15? Retained a photocopy of this application for your records? PAGE 6 of 6