Application-CESA by lanyuehua

VIEWS: 4 PAGES: 24

									                                                                                                                       Coverdell Education Savings Account

8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148

Client Services: 888-855-9856
1             Account Owner Information
     Mr.                Ms.         Designated Beneficiary Name: (Account Owner)
Address:                                                                                                 City:                                  State:                               Zip:


Phone:                                                         Cell:                                                                     Fax:


Social Security #:                                             Date of Birth:                                                            Email:


Statement Options:                        Email Quarterly              Go Green!                                   Mail Annually                                             Both


2             Responsible Party Information (Parent or Guardian)

     Mr.                Ms.               Mrs.        Name:
Street Address:                                                                                          City:                                   State:                              Zip:


Mailing Address: (If different than above)                                                               City:                                   State:                              Zip:


Phone:                                                         Cell:                                                                     Fax:

Social Security #:                                             Date of Birth:                                                            Email:

Please share with us who you were referred by:


                         Type of Photo I.D.:                                                                           Identification #:


                                     PLEASE ATTACH A LEGIBLE PHOTOCOPY OF THE ABOVE REFERENCED PHOTO IDENTIFICATION
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 your name, address, date of birth, social
security number or tax identification number and other information that will allow us to identify you. This information will be verified to ensure the identity of all persons
opening an account. In certain instances, Provident Trust Group (“PTG”) is required to collect documents to fulfill its legal obligation. Documents provided in connection
with your application will be used solely to establish and verify a customer’s identity, and PTG shall have no obligation with respect to the terms of any such document.

5             Agent Authorization (Optional)
Agent Name:                                                                                                Company Name:

Address:                                                                                                   City:                                  State:                         Zip:

Phone:                                                                         Fax:                                                    Email:

Agent Signature:                                                                                                                                                 Date:


                                         I AUTHORIZE PROVIDENT TRUST GROUP TO GIVE MY AGENT THE FOLLOWING AUTHORITY:
      Account Information Only
              This authorization is limited to communication regarding account(s) status and transactional information only.
      Full Authority for ALL assets
              This authorization includes the ability to buy, sell, and/or re-invest any asset within my account upon written direction from my Agent.
      Authority Limited to the following asset ONLY:
              This authority includes the ability to buy, sell, and/or re-invest only the asset listed above upon written direction from my Agent.
Provident Trust Group does not issue any monetary distributions directly to Agents. Provident Trust Group reserves the right to contact the Account Owner to confirm the sale or purchase of an asset. Provident Trust
Group has the right to rely on any presentations and/or warranties made by my Agent in connection with the sale or purchase of an asset on behalf of my Account, including but not limited to, representation with regard
to prohibited transactions and asset suitability requirements. As the Account Owner, I realize I have the right to revoke my Agent’s authority at any time, but must do so in writing.

                                                                                                                                                                                                           CESA_PTG
4         Beneficiary Information

The following individual(s) or entity(ies) shall be my primary and/or contingent beneficiary(ies) of this ESA. If neither primary nor contingent is
indicated, the individual or entity will be deemed to be a primary beneficiary. If more than one primary beneficiary is designated and no
distribution percentages are indicated, the beneficiaries will be deemed to own equal share percentages. Multiple contingent beneficiaries with no
share percentages indicated will also be deemed to share equally.


If any primary or contingent beneficiary dies before I do, his or her interest and the interest of his or her heirs shall terminate completely, and the
percentage share of any remaining beneficiary(ies) shall be increased on a pro rata basis. If no primary beneficiary(ies) survives me, the contingent
beneficiary(ies) shall acquire the designated share of the ESA.



       Beneficiary Name & Address               Date of Birth          Social Security Number      Relationship     Share %      Type of Beneficiary
                                                  MM-DD-YY                     123-12-1234

1.
                                                                                                                                    Primary

                                                                                                                                    Contingent

2.
                                                                                                                                    Primary

                                                                                                                                    Contingent

3.
                                                                                                                                    Primary

                                                                                                                                    Contingent




             Spousal Consent Agreement (ONLY REQUIRED IF SPOUSE IS NOT LISTED AS PRIMARY BENEFICIARY)

This section should be reviewed if either the trust or the residence of the ESA holder is located in a community or marital property state and the
ESA holder is married. Due to the important tax consequences of giving up one’s community property interest, individual signing this section
should consult with a competent tax or legal advisor.



                                                                Current Marital Status

     I Am Not Married – I understand that if I become married in the future, I must complete a new ESA Designation of Beneficiary Form.

     I Am Married – I understand that if I choose to designate a primary beneficiary other than my spouse, my spouse must sign below.



I am the spouse of the above-named ESA holder. 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 ESA, I have been advised to see a tax professional. I
hereby give the ESA holder any interest I have in the funds or property deposited in this ESA and consent to the beneficiary designation(s) indicated
above. I assume full responsibility for any adverse consequences that may result. No tax or legal advice was given to me by the Custodian or
Administrator.

Spouse’s Signature:                                   Spouse’s Name: (Please Type or Print)                           Date:
   3           ESA Funding Information
    How will you be funding this account?

         Option 1: Transfer from Prior Custodian              Option 2: 60-Day Rollover of Qualified Funds                     Option 3: One-Time Contribution Check

                     Please complete the                                 Please complete the                           Contribution Year:
                     Transfer/Rollover Form                              Rollover Certification Form
                                                                                                                       Contribution Amount:


        Also, please sign me up for Automatic Ongoing Contributions!
        If you select this option, please fill out the Automatic Ongoing Contribution Form.



   4           Fee Payments

    Set Up Fee Options:                    Credit Card         Check Enclosed     (Check Instructions At Bottom)                    Debit Cash from Incoming Funding

    Annual Maintenance Fees:               Credit Card         Debit Cash from my ESA                     Invoice                   ACH                Fill out the ACH Form

    Credit Card Information (Required for ALL Accounts)
    Name of Cardholder: (Please Print or Type)
                                                                                                                    Card Type:               Visa                MasterCard

    Billing Address:                                                                 City:                            State:                    Zip:


    Credit Card #:                                                           Expiration Date:                            Verification Code:*

                                                                             MM                 YYYY                     *3 digit number on back of card

    Provident Trust Group requires that all Account Owners maintain a valid credit card on file to maintain their account. The Account Owner gives Provident Trust
    Group the right to charge the Account Owner’s card or debit cash from their account if their preferred method of payment fails. If ACH is chosen to pay for annual
    fees, the Account Owner gives Provident Trust Group the right to debit his/her checking account for the annual fee. Account Owner reserves the right to terminate
    the deduction at any time but must do so in writing. Provident Trust Group is not liable for Account Owner’s failure to notify Provident Trust Group of alternative
    payment.



    6          Account Owner Agreement and Authorization
    Important: Please read before signing.
    I understand the eligibility requirements for the type of ESA deposit I am making and I state that I do qualify to make the deposit. I have received a
    copy of the Application, the ESA Custodial Account Agreement, Disclosure Statement, Money Market Account Disclosure, and the Fee Schedule &
    Disclosure. I understand that the terms and conditions which apply to this ESA are contained in this Application and the Plan Agreement. I agree to
    be bound by those terms and conditions. Within seven (7) days from the date I open this ESA I may revoke it without penalty by mailing or
    delivering a written notice to the Custodian.

    I assume complete responsibility for 1) determining that I am eligible for an ESA each year I make a contribution, 2) ensuring that all contributions I
    make are within the limits set forth by the tax laws, and 3) the tax consequences of any contribution (including rollover contributions) and
    distributions.
    Account Owner Name: (Please Type or Print)

    Account Owner Signature:                                                                                                     Date:

SIGN HERE
                                                                                                                                                                v1.03-01.17.12


                  Please Note: If you are submitting a check, please complete the Check Submission Form.
                                                                                            Check Submission Form
P.O. Box 4330, Ontario, CA 91761-8830

Client Services: 888-855-9856
Account Owner Information
Name:                                                              Date:


Amount:                                                            Check #:



This check is being sent to make a(n):
                         Option 1: IRA Account Contribution    Tax Year:

                         Option 2: IRA Account Establishment & First Year Annual Fee Payment
                         Option 3: Rollover into an IRA
                         Option 4: Deposit into Cash Account




                                        Provident utilizes a secure lockbox for all checks.
              Please remit the above portion with your check and mail to the following lockbox address:

                         Regular Mail (USPS)                               Overnight Mail

                         Provident Trust Group                             Provident Trust Group
                         P.O. Box 4330                                     Attn: Lockbox Department
                         Ontario, CA 91761-8830                            3833 Ebony St.
                                                                           Ontario, CA 91761

Make sure that you:
  Make the check payable to “Provident Trust Group FBO: Your Name IRA”
  Notate your Account Number (if available), tax year (if applicable) or the last four digits of your SSN in the “Memo” section.


                          Example




                                                                                                     Example
                                                                                                                         Incoming Transfer/Rollover Form  
 
8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148 
                                                                                                                                                        Account # (Provident Use Only)
Client Services: 888‐855‐9856 
                




    1 
            Funds Coming From 
    Company Name:                                                                                                                  Phone:

    Address:                                                                              City:                                    State:                             Zip:

    Account Owner’s Name:                                                                              Account/Contract #:

    SSN: 
                                                                                                       Account Type at                                  Account Type at 
                                                                                                       Resigning Custodian:                             Receiving Custodian: 
    Can this transfer request be faxed?         Yes             No                                           Employer Sponsored Plan 
                                                                                                                                                         


                                                                                                                                                              Traditional IRA 
                                                                                                               Type: ______________                           Roth IRA 
    If so:              Fax #: _______________________________                                               Traditional IRA                                  SEP IRA 
                                                                                                             Roth IRA                                         Simple IRA 
    Please process these instructions: 
                                                                                                             SEP IRA                                          Individual(k) 
     
                                                                                                             Simple IRA                                       Coverdell ESA 
          IMMEDIATELY 
                                                                                                             Coverdell ESA                                    Other:_______________   
             
                                                                                                             Other:_______________                       
          ON THIS DATE ____________________                                                             


     
     
     
     
     
     


2 
         Funding Options 
                                                                                                                               

          Transfer                                 Direct Rollover                           Rollover                               Convert my Traditional IRA from my 
                                                                                       
                                                                                                                                   prior Custodian to a Roth IRA to be held 
                                                                                       
                                                                                                                                   at Provident Trust Group 
    Transfer: Describes the movement of cash and/or assets directly between IRA Trustees without distribution to an individual.  As such, no tax forms are generated by either Trustee. 
     


    Direct Rollover: Describes the movement of cash and/or assets that takes place directly between the Trustee of a business retirement plan (such as a profit sharing, money purchase, defined 
    benefit, etc).  Or the administrator of a 403(a) or (b) annuity, and the Trustee of an IRA.  By directly rolling an eligible rollover distribution to Provident Trust Group, LLC, LLC IRA (as opposed 
    to receiving an outright distribution as described below under “Rollover”), an individual can avoid the mandatory 20% Federal Tax withholding imposed on such distributions. 
     


    Rollover: Describes a cash and/or asset contribution to an IRA by an individual within sixty (60) days of receipt of the eligible rollover distribution.  To make a rollover, an individual must 
    have received an eligible distribution directly from the Trustee of a business retirement plan or IRA (such as a profit sharing money purchase, defined benefit, etc).  The individual may roll 
    over all or any part of the actual amount received and, if the distribution was from a business retirement plan or 403(a) or (b) annuity (thus subject to the mandatory 20% Federal Income Tax 
    withholding), he/she may roll up to 100% of the distribution by making up the 20% difference that was previously withheld. 
     

                   Please provide a copy of your most recent account statement with the current (resigning) Custodian for your assets with this form.
                                                                  

    This will be a                                               This will be a  
    Complete Transfer/Rollover:                                  Partial Transfer/Rollover: 
                                                                  
         Liquidate all assets and transfer                              Cash $__________________________ 
                                                                  
    cash balance to IRA                                          AND/OR 
                                                                  

    OR                                                           Individual Asset Instructions: 
                                                                     Liquidate     Re‐Register                     Asset Description                        # of Shares           Approx. Value
         Re‐register all assets and transfer                                                                                                                                               
    cash balance to IRA                                                                                                                                                                    
                                                                                                                                                                                           
                                                                  
3     Delivery Instructions


    Regular Mail                                              Overnight Mail                                               Wiring Instructions

                                                                                                                     Citizens Business Bank
Provident Trust Group, LLC                             Provident Trust Group, LLC                                    16830 Ventura Blvd., Ste 310
8880 W. Sunset Rd., Ste 250                            8880 W. Sunset Rd., Ste 250                                   Encino, CA 91436
Las Vegas, NV 89148                                    Las Vegas, NV 89148
                                                                                                                     ABA # 122234149
Make check payable to:                                 Make check payable to:                                        Acct # 046032314
Provident Trust Group, LLC                             Provident Trust Group, LLC                                        Please reference “Provident Trust Group” and the
FBO: (Client Name) IRA                                 FBO: (Client Name) IRA                                              Account Owner’s Name and Account Number.




4     Limited Power of Attorney
I, the undersigned, do hereby grant a limited power of attorney to Provident Trust Group and its agents to request information regarding my account and the status
of this rollover or transfer from the custodian listed above. The power of attorney shall commence and be in full force as of the date listed below and shall remain in
full force and effect thereafter until the completion of the rollover or transfer of the assets listed in Section 2.

      Account Authorization
I am aware that I am responsible for the payment of Federal Income Tax on the taxable portion of this surrender and that I may be subject to tax
penalties under Estimated Tax Payment rules if my payment of estimated tax and withholdings, if any, are not adequate. I am also aware of any
surrender/withdrawal penalties which may apply, and I authorize the transaction described above.

Account Owner Name: (Please Type or Print)                    Account Owner Signature:                                                     Date:

                                                  SIGN HERE

                                                                                                                 Authorized Officer to Place Stamp Here
                                                                                                           Notary or Medallion Signature Guarantee
              Please check with your current custodian to
              determine whether they will require a Notary
              Stamp or a Medallion Signature Guarantee to
              transfer or rollover your account. A signature
              guarantee can be obtained from your bank. If
              your current custodian does not require a notary
              or signature guarantee, please just sign above                                     A Medallion Signature Guarantee program is approved by the Securities Transfer
                                                                                                 Association that enables participating financial institutions to guarantee signatures. The
              and return this form to Provident Trust Group.                                     Medallion programs ensure that the individual signing the certificate or stock power is in
                                                                                                 fact the registered owner as it appears on the stock certificate or stock power.




Provident Trust Group Acknowledgement of Acceptance:
The authorized signature certifies acceptance of the assignment and surrender or     By: _____________________________________________
transfer of funds as instructed in this request. After deducting any sums as are              Provident Trust Group, LLC – Custodian
permitted under the plan, please complete this transaction and send funds with
a copy of this form to: Provident Trust Group

                                                                                     Date: ___________________________________________




Page 2 of 2                                                                                                                                                             v1.02-12.29.10
                                                                                                                                                      Direction of Investment  
 

    8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148 

    Client Services: 888‐855‐9856                                                                   

     In  order  to  process  your  investment  in  a  timely  manner,  please  ensure  that  you  have  completed  all  of  the  following  form  fields. 
     Failure to complete the following form fields properly may cause delays in the processing of your investment.  
      
                                                                                              Account Owner Information 
     ACCOUNT OWNER NAME                                                                                                                                   ACCOUNT # 

     ADDRESS                                                                                                    CITY                                      STATE                    ZIP 

      PHONE                                                                   FAX                                          EMAIL 


                                                                                                  Direction of Investment 
     Type of Asset:  Please check one and describe (e.g. address, LLC name, type of note and what for) below. 
      

         Real Estate                           CD                                               Promissory Note or Mortgage               Life Settlement              
         LLC, LP or C‐Corp                Money Market                        F.  Other ________________________________________________ 
     Please Describe your investment:_______________________________________________________________________________ 
     __________________________________________________________________________________________________________ 

                                    Please review and submit the applicable documents for your self‐directed investment: 
     Promissory Note or Mortgage – Copy of the Promissory Note or Mortgage and Security Interest (i.e. Deed of Trust, Deed of 
     Mortgage, and Security Agreement) 
     Limited Partnerships – Copy of Tax ID, Certificate of Limited Partnership, and Limited Partnership Agreement signed by Partners 
     Limited Liability Company – Copy of Tax ID, Articles of Organization, and Operating Agreement signed by Members. 
     Private Stock/C‐Corporation – Copy of Tax ID, Articles of Incorporation, and By‐Laws.  All original stock certificates must be 
     physically held by Provident Trust Group, LLC. 
     S‐Corporation – AN IRA IS NOT A QUALIFIED SHAREHOLDER FOR AN S‐CORPORATION. 
     Private Placement Memoranda (“PPM”) – Copy of PPM, Operating Agreement, and Subscription Agreement 
     Land Trust – Copy of the signed Trust Agreement and any related documentation associated with the investment. 
     Real Estate ‐ All documents associated with purchase of real estate (i.e. Purchase Agreement, Preliminary Title Report, Deed, Lease 
     Agreements, etc) 
     Life Settlements‐ Copy of Promissory Note and Life Insurance Policy  
                                                    IMPORTANT:  Your IRA is considered the legal owner of this investment. 
                                                           As such, all documents must reflect this ownership. 
                                                            The correct vesting for all investment documents should be as follows: 
                                                                “PROVIDENT TRUST GROUP, LLC FBO Your Name IRA” 
                                                      Failure to title the asset correctly may cause delay and/or tax consequences. 

                                Please list the Documents you require Provident Trust Group to sign on behalf of your IRA: 
     (You may not sign personally for any investment made by your IRA) 
        
     1.________________________________________ 2.______________________________________ 3.___________________________________ 
      
     4. _______________________________________  5. _____________________________________  6. ___________________________________ 
      
       If more lines are necessary, please attach a separate sheet marked as “Addendum A.”     

      
     Mail documents to:    ______________________________________________            Fax documents to: _________________________________ 
                                                ______________________________________________            Attention to:  _____________________________________ 
                                                ______________________________________________                                                                                                   


                                                                                                       Processing Options 
                                    Normal Processing (Free)                                                   Same‐Day Service ($50.00)      
                             Note:  For same‐day service, all documents must be remitted to custodian or administrator by 10:00a.m. PST. 
                    If you are sending your Same‐Day Service by overnight delivery, please be sure to notify Provident Trust Group prior to arrival. 
                                                  Cleared funds must be available in account for Same‐Day Service. 

                                                                           Funding Information 

        Amount of funds required   $____________________                                                       Percentage Ownership of Asset  _________  % 

                                                                          Payment Instructions 
        CHECK 
                                  Regular Mail (Free)                                                                   Overnight Mail ($35.00) 
Make Check Payable to:  __________________________________   Address:___________________________________________ 
City: ________________________________________________    State: ___________________  Zip Code: ___________________ 

    WIRING INSTRUCTIONS ($35.00) 
 
Bank Name: __________________________________________    Account Name: _______________________________________ 
Account #: ____________________________________________  ABA (Routing) #: ______________________________________    
Address:  _____________________________________________  City:___________________  State:_________  Zip:___________ 
                                    Contact Phone #: _______________________________________________ 

                                                                   Account Owner Authorization 
   
   
  My IRA account is self‐directed and I, alone, am responsible for the selection, due diligence, management, review and retention of all investments in my account.  I 
  agree that the Custodian and Administrator are not a “fiduciary” for my account, as the term is defined in the Internal Revenue Code, ERISA or any other applicable 
  federal, state or local laws.  I hereby direct the Custodian and Administrator, in a passive capacity, to enact this transaction for my account, in accordance with my 
  adoption agreement. 
 
 
Account Owner Name: __________________________________________ 
                                          Please type or print name 
 
 
Account Owner Signature:  
                                                      __________________________________________________      Date: __________________________________ 
                          SIGN HERE 
 
Custodian Signature: _________________________________________________________      Date: __________________________________ 
     
                                                                                                                                                               11.30.09

                                                                                             
   
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                             
                                                                                           Direction of Investment Disclosure

1.   ACCOUNTHOLDER WARRANTIES. As an accountholder of a self‐directed                    assets or investment purchased by me. Custodian and Administrator
     retirement account, I represent and warrant to Custodian and                        shall not be responsible to take any action should there be any default
     Administrator the following:                                                        or any other obligation with regard to this investment.
           i.    I warrant that I have properly titled any asset held by my        6.    It is not the responsibility of Custodian and Administrator to review or
                 retirement account;                                                     consider the prudence, merits, viability or suitability of any investment
          ii.    I warrant that any individuals and or entities associated with          made by me or to determine whether the investment is acceptable
                 this investment does not constitute a “disqualified person”             under ERISA, the Internal Revenue Code or any other applicable law. I
                 as defined by 4975(e)(2);                                               understand that certain transactions are prohibited in individual
         iii.    I warrant that I am not receiving any personal benefit from             retirement accounts and qualified retirement plans under Section 4975
                 the investments made by retirement account (e.g. using                  of the Internal Revenue Code. I further understand that the
                 your rental property as a vacation home);                               determination of a prohibited transaction depends on the facts and
         iv.     I acknowledge that if my retirement account invests in an               circumstances that surround the particular transaction.
                 asset that does not provide an automated update in regards        7.    Custodian and Administrator will make no determination as to whether
                 to its fair market value (FMV), I must provide that value to            my investment is prohibited. I further understand that should my IRA
                 Provident Trust Group each year as requested;                           engage in a prohibited transaction, my account will incur a taxable
          v.     I acknowledge that an investment in my retirement account               distribution as well as possible penalties.
                 may create Unrelated Business Taxable Income (UBTI), and I        8.    I represent to Custodian and Administrator that I have consulted with
                 should consult my tax advisor on the tax consequences of                my own legal, tax and accounting advisors to insure that my investment
                 my investment;                                                          does not constitute a prohibited transaction and that my investment
         vi.     I warrant that my retirement account has invested in an                 complies with all applicable federal and state laws, regulations and
                 asset that complies with all applicable federal and/or state            requirements including without limitation that the offering entity or
                 requirements;                                                           individual is not a disqualified person under IRC 4975 (e) (2).
        vii.     I warrant that I have provided all documentation associated       9.    In the event any investment for my retirement account produces
                 with my investment to Provident Trust Group, LLC;                       taxable income (unrelated or debt financed) pursuant to IRC 511‐514. I
       viii.     I acknowledge that I have read the disclosures provided with            agree to prepare or have prepared for me, the required 990T tax form
                 the Direction of Investment and accept and all risk that may            along with a direction of investment authorizing the Custodian and
                 be associated with the asset I have chosen; and                         Administrator to pay taxes from my account. Forms need to be
         ix.     I understand that neither Custodian nor Administrator                   submitted to the Custodian and/or Administrator for filing five (5) days
                 insures the investments made by retirement account.                     prior to the date on which they are due.
2.   Neither Custodian or Administrator nor any employee or agent of               10.   Custodian and Administrator do not provide legal or tax services or
     Custodian or Administrator has selected nor recommended any                         advice with respect to my investment; and the undersigned releases
     investment for me; and neither Custodian, Administrator nor any                     and indemnifies, and agrees to hold harmless and defend Custodian
     employee or agent of Custodian or Administrator has acted as a broker               and Administrator in the event that my investment or sale of assets
     dealer or salesperson in completing any purchase or sale of an                      pursuant to the Direction of Investment violates any federal or state
     investment or a security from me, except where Custodian and/or                     law or regulation or otherwise results in a disqualification, penalty, fine
     Administrator may purchase or sell a publicly‐held security, privately-             or tax imposed upon the IRA, Custodian, Administrator or the
     held security, or any other asset which may or may not be deemed to                 undersigned.
     be a security on my behalf, at my own direction through its affiliate that    11.   Custodian and Administrator shall be fully protected in acting upon any
     may receive a commission for such a transaction.                                    instrument, certificate, or paper believed to be genuine and to be
3.   Custodian and Administrator are neither an agent nor a representative               signed or presented by the proper person or persons whether or not by
     of any investment program or other entity in which or with which I may              facsimile or other copy, and, and Custodian and Administrator shall be
     invest, and any salesperson, promoter, financial advisor, broker or                 under no duty to make any investigation or inquiry as to any statement
     other part involved in the purchase or sale of my investment shall be               contained in any such writing, but may accept the same as conclusive
     considered my own agent and representative and not the agent or                     evidence of the truth and accuracy of the statements therein
     representative of Custodian and Administrator. Custodian and                        contained.
     Administrator have no duty or responsibility to investigate or make           12.   The undersigned represents to Custodian and Administrator that if any
     recommendations as to my choice of agent. Custodian and                             investment is a “security” under applicable federal or state securities
     Administrator shall not be responsible for or bound by any                          laws, such investment has been registered or is exempt from
     representations, warranties, statements or commitments made by such                 registration under federal and state securities laws and the
     party.                                                                              undersigned releases and waives all claims against Custodian and
4.   Custodian and Administrator are acting solely as a passive custodian                Administrator for its role in carrying out the instructions of the
     and administrator to hold IRA assets and in no other capacity; an                   undersigned with respect to such investment. The undersigned
     affiliate may receive a commission in connection with the unsolicited               acknowledges that the foregoing representation is being relied upon by
     purchase or sale of a publicly‐traded security, privately-held security, or         Custodian and Administrator in accepting the undersigned’s Direction
     any other asset which may or may not be deemed to be a security.                    of Investment and agrees to indemnify Custodian and Administrator
     Custodian and Administrator have no responsibility to question or in                with respect to all costs, expenses (including attorney’s fees). Fines,
     any way evaluate any investment directions given by me or any                       penalties, liabilities, damages, actions, judgments and claims arising out
     appointed financial representative. I further understand that Custodian             of such investment and/or breach of the foregoing representation.
     and Administrator do not compensate nor receive compensation from             13.   The undersigned authorizes and directs Custodian and Administrator to
     the undersigned chosen representative.                                              execute and deliver, on behalf of the undersigned’s IRA, any and all
5.   Custodian and Administrator shall be under no obligation or duty to                 documents delivered to Custodian and Administrator in connection
     investigate, analyze, monitor, verify title to or otherwise evaluate any            with my investment and Custodian and Administrator shall have no
     investment contemplated herein, or to obtain or maintain insurance                  responsibility to verify or determine that any such documents are
     coverage (whether liability, property or otherwise) with respect to any


Page 1 of 2
      complete, accurate or constitute necessary to comply with this                     or estimates of value. These values are only for guidance or reporting
      Direction.                                                                         purposes and should not be deemed an accurate representation of true
14.   Custodian and Administrator shall only be responsible to comply with               fair market value of the asset. Where no readily available market
      those investment directions given by the undersigned to purchase,                  information exists, assets may be designated “not available”.
      retain and/or sell assets attainable by Custodian and Administrator          20.   Any suit filed against Custodian and Administrator arising out of or in
      “over‐the counter” on a recognizable change or otherwise, including,               connection with its role as Custodian and Administrator of the
      without limitation, bank deposits, real property, promissory notes and             undersigned’s IRA shall only be initiated in the courts of Clark County,
      other indebtedness, mortgages, viaticals, securities, interests in                 Nevada; and the undersigned agrees to submit to such jurisdiction.
      partnerships and limited liability companies, accounts receivable,           21.   The undersigned agrees to reimburse or advance to Custodian and
      security interests, etc.; provided in each case that the investment may            Administrator, on demand, all legal fees, expenses, costs, fines and
      be obtained by Custodian and Administrator and is compatible with its              penalties incurred or to be incurred in connection with the defense,
      administrative and operational requirements and framework, as                      contest or prosecution of any claim made, threatened or asserted
      determined by the Custodian and Administrator, in its sole discretion.             pertaining to the undersigned’s investment through Custodian and
15.   The undersigned agrees that any documents sent to the undersigned by               Administrator, including, without limitation, claims asserted by the
      Custodian or Administrator in connection with my investment shall be               undersigned, any state or federal regulatory authority or self regulatory
      deemed approved by the undersigned, unless written notice to the                   organization.
      contrary is received by the Custodian and/or Administrator within five       22.   The undersigned releases and indemnifies, holds harmless and defends
      (5) days after delivery of such documents by Custodian or                          Custodian and Administrator from any and all claims, damages, liability,
      Administrator.                                                                     actions, costs, expenses (including, without limitation, attorney’s fees)
16.   Custodian and Administrator shall have no duty or responsibility to                and responsibility for any loss resulting to the IRA, the undersigned or
      disburse any payment for any investment without any express                        to any beneficiary or incurred by Custodian and Administrator, in
      direction. I agree to furnish Custodian and/or Administrator with                  connection with or by reason of any sale or investment made or other
      payment instructions utilizing Custodian’s/Administrator’s Direction of            action taken (or omitted to be taken) pursuant to and/or in connection
      Investment form or such other form approved by Custodian or                        with this Direction of Investment or resulting therefrom. Under no
      Administrator. Custodian and Administrator also have the right not to              circumstances shall Custodian and/or administrator be subject to or
      affect any transaction/investment in which it deems to be beyond the               liable for any consequential, incidental, indirect, special, exemplary or
      scope of its administrative capabilities or expertise.                             similar damages, including without limitation, damages or costs
17.   Custodian and Administrator shall use reasonable efforts to acquire or             incurred as a result of loss of time, loss of savings, loss of data, loss of
      sell investments in accordance with the directions of the undersigned              revenues and/or profits, whether foreseeable or unforeseeable, that
      within a reasonable period of time after the Custodian and                         may arise out of or in connection with this agreement or Custodian or
      Administrator have received an investment direction and Custodian and              Administrator complying with your directions, regardless if such
      Administrator shall make reasonable efforts to notify the undersigned if           damages are based in contract, tort, warranty, negligence, strict
      Custodian and Administrator are unable or unwilling to comply with an              liability, products liability or otherwise.
      investment direction. Custodian and Administrator shall, subject to the      23.   The undersigned acknowledges, understands and agrees that this
      foregoing, remit funds as directed, but has no responsibility to verify or         Direction of Investment and any other Direction of Investment of the
      asset that such funds have been invested to purchase or acquire the                undersigned is subject to all of the terms, conditions, representations,
      asset selected by me.                                                              warranties and agreements contained in this Direction of Investment
18.   The undersigned consents to the fee schedule of Custodian and                      Disclosures, the undersigned’s Custodial Agreement and Disclosure
      Administrator as in effect, as may be modified from time to time.                  Information and any other documents or disclosures provided to you by
19.   The undersigned understands that valuations of illiquid assets (assets             Custodian and/or Administrator.
      that are not traded on a public exchange) are generally reported at
      cost, or values provided to us by issuers, program sponsors, IRA owners




Page 2 of 2                                                                                                                                           v1.02-01.18.12
                                                                                                                                                             Fee Schedule

8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148

Client Services: 888-855-9856
Plan Type                                                                                Establishment Fee                                        Annual Fee
Traditional & Roth IRA                                                                           $50.00                                             $395.00
SEP & SIMPLE IRA                                                                                 $50.00                                             $445.00
Additional Participant                                                                           $50.00                                             $145.00

Individual (k)                                                                                   $150.00                                            $445.00
Additional Participant                                                                           $50.00                                             $155.00

Health Savings Account (HSA)                                                                     $50.00                                             $135.00

Coverdell Education Savings Account (ESA)                                                        $50.00                                             $155.00
                                                                                                                                                                  1
Inherited IRA                                                                                    $50.00                                             $395.00
1
Full Distribution (No Account Setup)                                                                                                                $200.00

Qualified Plan Self-Directed Account                                                             $75.00                                             $295.00


Miscellaneous Fees
Recurring Check Fee                                                                                                                                 $10.00
Recurring ACH/Cashier’s Check Fee                                                                                                                   $15.00
Wire Transfer                                                                                                                                       $35.00
Incoming Transfer Processing under $1000                                                                                                            $50.00
International Wire Transfer                                                                                                                         $50.00
Dishonored Check/Returned Wire/Rejected Credit Card                                                                                                 $35.00
Premium Payment Processing Fee                                                                                                                      $10.00
Notary Fee                                                                                                                                          $10.00
Medallion Fee                                                                                                                                       $25.00
Additional Paper Statement (per Request)                                                                                                            $10.00
Overnight Mail                                                                                                                                      $35.00
Safekeeping Fee (per document charged annually)                                                                                                     $25.00
Re-Registration of Assets (including Required Minimum Distributions)                                                                                $95.00
                                                                                                                                                           2
Traditional IRA to Roth IRA Conversion                                                                                                              $95.00
        2
          Fee includes conversion of first asset, each additional asset is subject to an additional $25.00 fee per asset
                                                                                                                                                              3
Re-Characterization of Roth IRA                                                                                                                     $95.00
      3
        Fee includes re-characterization of first asset, each additional asset is subject to an additional $25.00 fee per asset
Real Estate Purchase                                                                                                                                $100.00
              4
Rush Services                                                                                                                                       $50.00 (per item)
Account Research                                                                                                                                    $75.00 (per hour)
                        5
Form 5500 Preparation                                                                                                                               $325.00
                5
Loan Setup Fee                                                                                                                                      $225.00
                  5
Loan Default Fee                                                                                                                                    $150.00
                   5
Plan Amendment                                                                                                                                      $150.00
Asset Distribution via Check                                                                                                                        $35.00
Asset Distribution via Wire                                                                                                                         $50.00
Termination of Account                                                                                                                              $250.00
5
    Applies to Individual (k) Plans only.
4
 Rush Services – All documents must be remitted by Provident Trust Group by 10A.M. PST. If documents are sent via Overnight Mail, please notify Provident Trust Group prior to arrival.
Cleared funds must be available in the account for the same day service for investments.
NOTE: There may be certain fees and charges connected with the investment instruments you may have selected for your IRA. These fees may include but are not limited to: sales
commissions, distribution fees, annual maintenance fees, investment management fees, set-up fees, and surrender or termination fees. Refer to the plan document for a more detailed
description of what fees or restrictions may apply.

Page 1 of 2                                                                                                                                                           v1.04-02.24.11
                                                              FEE DISCLOSURE INFORMATION
Payment of Fees & Collection Procedures
Fees for all new accounts must accompany the Account Application at the time when the account is established (unless specified otherwise on the Account
Application). All items subject to collection or to any right of rescission may be held until collection or expiration of any applicable rescission period. After account
establishment, fees are billed annually and will be deducted automatically from available cash or charged to your credit card (Visa or MasterCard), if authorized.
Credit card charges may be billed under the name of Provident Trust Group, LLC or Provident Trust Group. Rejected credit card charges are subject to a $35
reprocessing fee. Regardless of whether or not the fee has been collected, an invoice will be generated detailing the fees that the IRA incurred for the previous year.
All fees are due and payable 30 days from the date of invoicing.

Forfeiture of Discounted Fee Structure
If you have been given the privilege of a discounted fee structure and payment has not been received within sixty (60) days from the due date reflected on your
invoice, your discounted fee will be forfeited and your fee will be permanently adjusted to our standard fee on the sixty-first (61st) day from the due date reflected on
your original invoice.

Liquidation of Assets for Non-Payment of Fees & Late Fees
If payment is not received within forty-five (45) days from the due date reflected on your invoice, a $25 Late Fee per year plus an additional $5 late fee for each
additional month that you remain past due will be assessed to your account and a Past Due Notice will be mailed to you (i.e. if your account is one (1) year past due,
the total late fees on the account will be $80).
Additionally we may liquidate assets from the account, without notice, for any outstanding fee which has not been paid. We may, at our discretion, liquidate
sufficient assets to cover outstanding fees plus one year’s estimated fees, including termination fees. Upon receipt funds will be first applied to outstanding fees.
Remaining balances, if any, will be placed into your account. Accounts with past due fees, unfunded accounts and accounts with zero value will continue to incur
administration and maintenance fees until such time as you notify Provident Trust Group in writing of your intent to close the account or that you wish that Provident
Trust Group resign as custodian. Should fees not be collected we have the option to cease performing any functions, including, but not limited to, processing
investment transactions until such time as all fees charged against the account are fully paid, and we may begin the process of closing your account and will distribute
all assets to you. This distribution will be reported to the IRS on form 1099-R and may subject you to possible taxes and penalties. In the event of nonpayment we
may employ a collection agency to recover any unpaid fees or expenses. You will be liable for all past due fees, re-registration fees, late fees, collection fees and
account termination fees.

Right to make adjustments to the Fee Schedule
Provident Trust Group reserves the right to make any adjustments in its fees for trust or agency services when such adjustments are warranted by changes in
governing laws, regulations, operating technology or economic conditions. Provident Trust Group has the right to effect changes to the fee schedule upon thirty (30)
days written notice to the participant at the address shown on the records of Provident Trust Group with the exception of extraordinary services which may be
changed by Provident Trust Group at any time without notice.

Earnings
A minimum cash balance of $250 must be maintained in your Custodial Account at all times provided there is a current Credit Card on file. If no Credit Card is on file,
a minimum cash balance of $500 must be maintained in your Custodial Account at all times. An administrative fee is charged for handling the cash reserve account.
Refer to the IRA Owner Agreement and Disclosure Statement for more information about fees. The method for computing and allocating annual earnings (interest,
dividends, etc.) on your investments will vary with the nature and issuer of the investment chosen. Please refer to the prospectus or contract of the investment(s) of
your choice for the method(s) used for computing and allocating annual earnings. Custodian shall be under no obligation to forward any proxies, financial statements
or other literature received by it in connection with or relating to Custodial Property held under this agreement. Custodian shall be under no obligation to take any
action with regard to proxies, stock dividends, warrants, rights to subscribe, plans of reorganization or recapitalization, or plans for exchange of securities or assets.

Definition of Miscellaneous Fees
Our right to compensation and reimbursement shall constitute a first prior lien against your account. Although under certain circumstances investment companies or
financial advisors may offer to pay your fees, you are (personally) responsible for payment of all fees. Establishment and Annual Fees are due at the time the account
is established. Transactional fees are charged each time you either purchase, sell, or otherwise dispose of an asset in your account. Transactions are normally
processed within 5 business days from the date we have in our possession sufficient funds and all of the properly executed investment paperwork. We make no
representations or warranties with respect to the timing of our processing of your transaction if the investment paperwork is incomplete or in the event your account
does not have sufficient funds. Transaction fees are not charged for receipt of income or contributions, nor are they charged for deposits to the Service 1st Bank of
Nevada money market account. Special Services Fees are charged at the time services are provided. Distribution fees are charged each time you request funds or
assets to be distributed from your account. Additional fees may apply for distribution of non-cash assets (such as Asset Re-Registrations). Termination fees are
charged at the time of processing. In order to avoid delays in processing your request, please ensure you have sufficient cash in your account to pay your outstanding
fees, including termination and re-registration fees. If cash is not available, an invoice will be mailed. Any fee charged by a third party to re-register assets will be
billed directly to an account holder’s account or credit card. Provident Trust Group reserves the right to assess an additional fee for extraordinary services.

Retirement Plan Custodial or Plan Agreement and Disclosure Information
Additional fee disclosures are made in your retirement plan custodial or plan agreement and disclosure shall also apply to your account. Please keep a copy of the
custodial agreement and disclosure information for your records.




Page 2 of 2                                                                                                                                                 v1.04-02.24.11
                                                  Client Services: 888-855-9856




              Custodial Agreement and Disclosure Information
                          Coverdell ESA Account




                                            Custodial Agreement … … … … … … 2


                                            Disclosure Statement … … … … … … 6




Page 1 of 7                                                                      v1.01-11.30.09
                                          COVERDELL ESA CUSTODIAL ACCOUNT AGREEMENT
Form 5305-EA Under Section 530 of the Internal Revenue Code                                                                                             FORM (REV. MARCH 2002)
The Depositor whose name appears on the Application is establishing a Coverdell            2. The Custodian agrees to submit to the Internal Revenue Service (IRS) and
Education Savings Account under Section 530 for the benefit of the Designated                 Responsible Individual the reports prescribed by the IRS.
Beneficiary whose name appears on the Application exclusively to pay for the
qualified elementary, secondary, and higher education expenses, within the meaning         ARTICLE VIII
of Section 530(b)(2), of such Designated Beneficiary.                                      Notwithstanding any other articles which may be added or incorporated, the
                                                                                           provisions of Articles I through III will be controlling. Any additional articles
The Depositor has assigned the custodial account the sum indicated on the Application.     inconsistent with Section 530 and the related regulations will be invalid.
The Depositor and the Custodian make the following agreement:                              ARTICLE IX
ARTICLE I                                                                                  This agreement will be amended as necessary to comply with the provisions of the
The Custodian may accept additional cash contributions provided the Designated             Code and the related regulations. Other amendments may be made with the consent
Beneficiary has not attained the age of 18 as of the date such contributions are           of the Depositor and the Custodian whose signatures appear on the Application.
made. Contributions by an individual contributor may be made for the tax year of           ARTICLE X
the Designated Beneficiary by the due date of the beneficiary’s tax return for that        10.01 Definitions: In this part of this Agreement (Article VIII), the words “you” and
year (excluding extensions). Total contributions that are not rollover contributions             “your” mean the Depositor, the words “we,” “us” and “our” mean the
described in section 530(d)(5) are limited to $2,000 for the tax year. In the case of an
                                                                                                 Custodian, “Code” means the Internal Revenue Code, and “Regulations”
individual contributor, the $2,000 limitation for any year is phased out between
                                                                                                 means the Treasury Regulations.
modified adjusted gross income (AGI) of $95,000 and $110,000. For married
individuals filing jointly, the phase-out occurs between modified AGI of $190,000 and      10.02 Notices and Change of Address: Any required notice regarding this Coverdell
$220,000. Modified AGI is defined in section 530(c)(2).                                          ESA will be considered effective when we send it to the intended recipient at
ARTICLE II                                                                                       the last address which we have in our records. Any notice to be given to us
                                                                                                 will be considered effective when we actually receive it. You, or the intended
No part of the custodial account funds may be invested in life insurance contracts,
                                                                                                 recipient, must notify us of any change of address.
nor may the assets of the custodial account be commingled with other property
except in a common trust fund or a common investment fund (within the meaning of           10.03 Representations and Responsibilities:
Section 530(b)(1)(D)).                                                                           (a) In General. You represent and warrant to us that any information you have
                                                                                                     given or will give us with respect to this Agreement is complete and
ARTICLE III                                                                                          accurate. Further, you agree that any directions you give us, or action you
1. Any balance to the credit of the Designated Beneficiary on the date on which he                   take will be proper under this Agreement, and that we are entitled to rely
   or she attains age 30 shall be distributed to him or her within 30 days of such date.             upon any such information or directions. If we fail to receive directions from
                                                                                                     you regarding any transaction, or if we receive ambiguous directions
2. Any balance to the credit of the Designated Beneficiary shall be distributed                      regarding any transaction, or we, in good faith, believe that any transaction
   within 30 days of his or her death unless the designated death beneficiary is a                   requested is in dispute, we reserve the right to take no action until further
   Family Member of the Designated Beneficiary and is under the age of 30 on the                     clarification acceptable to us is received from you or the appropriate
   date of death. In such case, that Family Member shall become the Designated                       government or judicial authority. We shall not be responsible for losses of
   Beneficiary as of the date of death.                                                              any kind that may result from your directions to us or your actions or
                                                                                                     failures to act, and you agree to reimburse and indemnify us for any loss we
ARTICLE IV                                                                                           may incur as a result of such directions, actions or failures to act. We shall
The Depositor shall have the power to direct the Custodian regarding the investment                  not be responsible for any penalties, taxes, judgments or expenses you incur
                                                                                                     in connection with your Coverdell ESA. We have no duty to determine
of the amount listed on the Application assigned to the custodial account (including                 whether your contributions or distributions comply with the Code,
earnings thereon) in the investment choices offered by the Custodian. The                            Regulations, rulings or this Agreement. We may permit you to appoint,
Responsible Individual, however, shall have the power to redirect the Custodian                      through written notice acceptable to us, an authorized agent to act on your
regarding the investment of such amounts, as well as the power to direct the                         behalf with respect to this Agreement (e.g., attorney-in-fact, executor,
Custodian regarding the investment of all additional contributions (including                        administrator, and investment manager); however, we have no duty to
earnings thereon) to the custodial account. In the event that the Responsible                        determine the validity of such appointment or any instrument appointing
Individual does not direct the Custodian regarding the investment of additional                      such authorized agent. We shall not be responsible for losses of any kind
                                                                                                     that may result from directions, actions or failures to act by your authorized
contributions (including earnings thereon), the initial investment direction of the                  agent, and you agree to reimburse and indemnify us for any loss we may
Depositor also will govern all additional contributions made to the custodial account                incur as a result of such directions, actions or failures to act by your
until such time as the Responsible Individual otherwise directs the Custodian. Unless                authorized agent. Except as otherwise indicated herein, you will have sixty
otherwise provided in this agreement, the Responsible Individual also shall have the                 (60) days after you receive any documents, statements or other information
power to direct the Custodian regarding the administration, management, and                          from us to notify us in writing of any errors or inaccuracies reflected in these
distribution of the account.                                                                         documents, statements or other information. If you do not notify us within
                                                                                                     60 days, the documents, statements or other information shall be deemed
ARTICLE V                                                                                            correct and accurate, and we shall have no further liability or obligation for
                                                                                                     such documents, statements, other information or the transactions
The Responsible Individual named by the Depositor shall be a parent or guardian of                   described therein.
the Designated Beneficiary. The custodial account shall have only one Responsible
Individual at any time. If the Responsible Individual becomes incapacitated or dies                  By performing services under this Agreement we are acting as your agent.
while the Designated Beneficiary is a minor under state law, the successor                           You acknowledge and agree that nothing in this Agreement shall be
                                                                                                     construed as conferring fiduciary status upon us. We shall not be required
Responsible Individual shall be the person named to succeed in that capacity by the                  to perform any additional services unless specifically agreed to under the
preceding Responsible Individual in a witnessed writing or, if no successor is so                    terms and conditions of this Agreement, or as required under the Code and
named, the successor Responsible Individual shall be the Designated Beneficiary’s                    the Regulations promulgated hereunder with respect to Coverdell ESAs. We
other parent or successor guardian. Unless otherwise directed by checking the                        may employ agents and organizations, including but not limited to Provident
option on the Application, at the time that the Designated Beneficiary attains the age               Trust Group, LLC, for the purpose of performing administrative or other
of majority under state law, the Designated Beneficiary becomes the Responsible                      custodial-related services with respect to your Coverdell ESA for which we
Individual. If a Family Member under the age of majority under state law becomes                     otherwise have responsibility under this Agreement, and the limitations on
                                                                                                     our duties to you under this Agreement or otherwise shall also apply with
the Designated Beneficiary by reason of being a named death beneficiary, the                         respect to each agent or organization so employed. You represent to us that
Responsible Individual shall be such Designated Beneficiary’s parent or guardian.                    any loss sustained in your Coverdell ESA will not affect your retirement
                                                                                                     income standard; and if a mandatory distribution arises, you will have the
ARTICLE VI                                                                                           ability through your Coverdell ESA and/or other retirement accounts to
(See the Application and Section 10.04 of this agreement for information regarding                   meet any mandatory distribution requirements. You agree to release and
the Responsible Individual’s ability to change the Designated Beneficiary named by                   indemnify, hold harmless and defend us from any and all claims, damages,
the Depositor.)                                                                                      liability, actions, costs, expenses (including, without limitation, attorneys’
                                                                                                     fees) and responsibility for any loss, resulting to the Coverdell ESA, to you
ARTICLE VII                                                                                          or to any beneficiary or incurred by or asserted against us, in connection
                                                                                                     with or by reason of any sale or investment made or other action taken (or
1. The Depositor agrees to provide the Custodian with all information necessary to                   omitted to be taken) pursuant to and/or in connection with any investment
   prepare any reports required by Section 530(h).                                                   transaction directed by you or your investment advisor or resulting from
Page 2 of 7
            serving as the custodian hereunder, including, without limitation, claims,                 determine necessary or appropriate to protect your Coverdell ESA assets
            damages, liability, actions and losses asserted by you. You agree to                       and to direct us in writing as to the payment of any premiums therefore.
            reimburse or advance to us, on demand, all legal fees, expenses, costs, fines,             Furthermore it is your responsibility to determine that payment has been
            penalties and obligations incurred or to be incurred in connection with the                made upon your written request by verifying same with your Coverdell
            defense, contest, prosecution or satisfaction of any claim made, threatened                ESA statements. We will not be responsible for notification or payments
            or asserted pertaining to any investment or action you or your investment                  of any insurance premiums, real estate taxes, utilities, or other charges
            advisor directed through the custodian, including, without limitation, claims              with respect to any investment held in your Coverdell ESA, unless you
            asserted by you, any state or federal regulatory authority or self regulatory              specifically direct us to pay the same in writing and sufficient funds are
            organization. To the extent written instructions or notices are required                   available to pay same from your Coverdell ESA. Furthermore, it is your
            under this Agreement; we may accept or provide such information in any                     responsibility to determine that payment has been made from the
            other form permitted by the Code or applicable regulations.                                custodial account. You must utilize an appropriate payment directive
                                                                                                       form available from us within a sufficient period of time for such direction
      (b)   Prohibited Transactions. You understand that certain transactions are                      to be accomplished in accordance with the custodian’s normal business
            prohibited in Coverdell ESAs plans under Section 4975 of the Internal
            Revenue Code. You further understand that the determination of a                           practices (without regard to whether we have undertaken efforts to
                                                                                                       comply with such directive). Service Fees: We have the right to charge an
            prohibited transaction depends on the facts and circumstances that                         annual service fee or other designated fees (e.g., a transfer, rollover or
            surround the particular transaction. We will make no determination as to
            whether any Coverdell ESA investment is prohibited. You further                            termination fee) for maintaining your Coverdell ESA. In addition, we have
                                                                                                       the right to be reimbursed for all expenses, including legal expenses, we
            understand that should your Coverdell ESA engage in a prohibited                           incur in connection with the administration of your Coverdell ESA. We
            transaction, you will incur a taxable distribution as well as possible
            penalties. You represent to us that you have consulted or will consult with                may charge you separately for any fees or expenses, or we may deduct
                                                                                                       the amount of the fees or expenses from the assets in your Coverdell ESA
            your own tax or legal professional to ensure that none of your Coverdell                   at our discretion. We reserve the right to charge any additional fee upon
            ESA investments will constitute a prohibited transaction and that your
            Coverdell ESA investments will comply with all applicable federal and                      30 days notice to you that the fee will be effective. Fees such as sub
                                                                                                       accounting and other fees or commissions may be paid to us or our
            state laws, regulations and requirements.                                                  affiliates by third parties for assistance in performing certain transactions
      (c)   Unrelated Business Income Tax (UBIT). Since your Coverdell ESA is a tax-                   with respect to this Coverdell ESA.
            exempt organization under federal tax law, if your Coverdell ESA earns
            income from an investment which utilizes debt-financing or which is                    (h) All invoices are due and payable upon receipt. If such charge cannot be
                                                                                                       consummated, we shall submit an invoice to you for all outstanding fees
            derived from a business regarded as not related to the exempt purpose of                   and expenses plus any applicable invoice costs and late charges and /or
            your Coverdell ESA, it may be subject to the so-called “unrelated business
            income tax” if it is in excess of permitted deductions. For example,                       we may liquidate sufficient investments in the custodial account in
                                                                                                       accordance with Section 10.12 of this Article to pay such fees and
            income from a Coverdell ESA investment in a partnership generally will                     expenses. Any brokerage commissions attributable to the assets in your
            result in unrelated business taxable income. In the event that your
            direction of investment of Coverdell ESA assets results in taxable income                  Coverdell ESA will be charged to your Coverdell ESA. You cannot
                                                                                                       reimburse your Coverdell ESA for those commissions. Fees are generally
            (unrelated or debt-financed) pursuant to Sections 511-514 of the Internal                  based upon the fair market value of the assets held in the Coverdell ESA;
            Revenue Code in excess of the $1,000 exclusion (as that amount may be
            adjusted)for any taxable year, you agree to prepare or have prepared the                   provided that where such assets are nonmarketable investments or do
                                                                                                       not have a readily available market value, the fees shall be based upon
            applicable IRS form, an application for employer identification number (if                 cost or the estimated fair market value of such assets, whichever is
            not previously obtained), and any other documents that may be required,
            and to submit them to us, for filing with the Internal Revenue Service, at                 greater. If an entity in which Coverdell ESA assets are invested is subject
                                                                                                       to bankruptcy, reorganization, receivership or similar proceedings, the fee
            least five days prior to the date on which the return is due for such                      based upon such asset will not be less than $150.00. Publicly traded
            taxable year, along with an appropriate payment directive authorizing the
            custodian to execute the forms on behalf of your Coverdell ESA and to                      securities shall be valued at their fair market value. If cost is not reflective
                                                                                                       of fair market value with respect to the assets held in your Coverdell ESA,
            pay the applicable unrelated business income tax from your Coverdell                       you may provide us with a qualified independent valuation of such assets
            ESA.                                                                                       for purposes of determining an appropriate fee; and we will give
      (d)   Listed Transactions and Reportable Transactions. You understand that                       consideration to such independent valuation. Our determination shall be
            certain transactions are or may be identified by the Internal Revenue                      binding and conclusive for purposes of Coverdell ESA fees based upon
            Service as abusive tax shelter schemes or transactions. You further                        value.
            understand that the determination of a listed or reportable transaction may
            depend upon the facts and circumstances that surround the particular                   (i) Interest Earned Within Pooled Trust Account. We perform sub-
                                                                                                       accounting, record-keeping, administrative and/or other services related
            transaction. We will make no determination as to whether any Coverdell                     to the Coverdell ESA. For the provision of the services, Provident Trust
            ESA investment constitutes a listed or reportable transaction. You represent
            to us that you have consulted or will consult with your own tax or legal                   Group retains all benefit for the interest earned within the pooled Trust
                                                                                                       Account and will charge fees as disclosed in the Financial Disclosure. Any
            professional to ensure that any listed or reportable transactions engaged in               interest paid to you from the pooled trust account will be at the
            by your Coverdell ESA are identified. You further represent and
            acknowledge to us that with respect to any listed or reportable transaction                discretion of Provident Trust Group. Once you have directed your funds
                                                                                                       into an interest bearing investment, the benefit of the interest earned on
            you are considered the entity manager who approved or caused your
            Coverdell ESA to be a party to the transaction and that you are responsible                those investments will be retained by you.
            for: reporting each such transaction to the Internal Revenue Service, using      10.04 Investment of Amounts in the Coverdell ESA:
            the applicable IRS form; paying any applicable excise taxes, using the                 (a) In General. You have exclusive responsibility for and control over the
            applicable IRS form; disclosing to the Coverdell ESA custodian that such                   investment of the assets of your Coverdell ESA. All transactions shall be
            transaction was a prohibited tax shelter transaction: and directing us as to               subject to any and all restrictions or limitations, direct or indirect, which are
            any necessary corrective action to be taken by your Coverdell ESA.                         imposed by our charter, articles of incorporation, or bylaws; any and all
      (e)   Passive Custodian Provides No Investment Advice. We do not provide                         applicable federal and state laws and regulations; the rules, regulations,
            legal or tax services or advice with respect to your Coverdell ESA                         customs and usages of any exchange, market or clearing house where the
            investments; and you release and indemnify and agree to hold harmless                      transaction is executed; our internal policies, standards and practices; and
            and defend us in the event that any investment or sale of your Coverdell                   this agreement. After your death, your beneficiary(ies) shall have the right
            ESA assets pursuant to a Direction of Investment form violates any federal                 to direct the investment of your Coverdell ESA assets, subject to the same
            or state law or regulation or otherwise results in a disqualification,                     conditions that applied to you during your lifetime under this Agreement
            penalty, fine or tax imposed upon you, your Coverdell ESA, or us.                          (including, without limitation, Section 10.03 of this article). We will not
                                                                                                       exercise the voting rights and other shareholder rights with respect to
      (f)   Investment Conforms to All Applicable Securities Laws. You represent to                    investments in your Coverdell ESA unless you provide timely written
            us that if any investment by your Coverdell ESA is a security under                        directions acceptable to us according to our then current policies and
            applicable federal or state securities laws, such investment has been                      procedures. You will select the type of investment for your Coverdell ESA
            registered or is exempt from registration under federal and state                          assets, provided, however, that your selection of investments shall be
            securities laws; and you release and waive all claims against us for our                   limited to those types of investments that we are authorized by our charter,
            role in carrying out your instructions with respect to such investment. You                articles of incorporation, or bylaws to offer and comport with our internal
            acknowledge that the foregoing representation is being relied upon by us                   policies, practices, and standards and are deemed administratively feasible
            in accepting your investment directions and you agree to indemnify us                      by us. We may, in our sole discretion, make available to you, additional
            with respect to all costs, expenses (including attorneys’ fees), fines,                    investment offerings, which shall be limited to publicly traded securities,
            penalties, liabilities, damages, actions, judgments and claims arising out                 mutual funds, money market instruments and other investments that are
            of such investment and/or a breach of the foregoing representation,                        obtainable by us and that we are capable of holding in the ordinary course
            including, without limitation, claims asserted by you.                                     of our business.
      (g)   Custodian Not Responsible for Insurance. We will not bear or assume any                (b) Custodian Acting in Passive Capacity Only. We are acting solely as a
            responsibility to notify you, secure or maintain fire, casualty, liability or              passive custodian to hold Coverdell ESA assets and we have no discretion
            other insurance coverage on any personal or real property held by your                     to direct any investment in your Coverdell ESA. Accordingly, we are not a
            Coverdell ESA or which serves as collateral under any mortgage or other                    fiduciary (as said term is defined in the Internal Revenue Code, ERISA, or
            security instrument held by your Coverdell ESA with respect to any                         any other applicable federal, state or local laws) with respect to your
            promissory note or other evidence of indebtedness. It is incumbent upon                    Coverdell ESA account. However, through our affiliate, we may receive a
            you as the Coverdell ESA owner to arrange for such insurance as you
Page 3 of 7
           commission in connection with the unsolicited purchase or sale of a                      name a successor beneficiary(ies) for the inherited Coverdell ESA. This
           publicly-traded security.                                                                designation can only be made on a form provided by or acceptable to us, and it
                                                                                                    will only be effective when it is filed with us during the original Coverdell ESA
           It is not our responsibility to review the prudence, merits, viability or                beneficiary’s(ies’) lifetime. Unless otherwise specified, each beneficiary
           suitability of any investment directed by you or your investment advisors
           or to determine whether the investment is acceptable under ERISA, the                    designation form that the original Coverdell ESA beneficiary(ies) files with us will
                                                                                                    cancel all previous ones. The consent of a successor beneficiary(ies) shall not be
           Internal Revenue Code or any other applicable law. We do not offer any                   required for the original Coverdell ESA beneficiary(ies) to revoke a successor
           investment advice, nor do we endorse any investment, investment
           product or investment strategy; and we do not endorse any investment                     beneficiary(ies) designation. If the original Coverdell ESA beneficiary(ies) does
                                                                                                    not designate a successor beneficiary(ies), his or her estate will be the successor
           advisor, representative, broker, or other party selected by you. We have                 beneficiary. In no event shall the successor beneficiary(ies) be able to extend
           no responsibility to question any investment directions given by you or by
                                                                                                    the distribution period beyond that required for the original Coverdell ESA
           any investment advisor or representative appointed by you.                               beneficiary.
           It is your responsibility to perform proper due diligence with regard to           10.06 Required Minimum Distributions: Your required minimum distribution is
           any such representative, investment advisor, broker or other party. We                   calculated using the uniform lifetime table in Regulations section 1.401(a)(9)-
           will follow the directions of any such investment advisor, representative,
           broker or other party selected by you provided you furnish us with                       9. However, if your spouse is your sole designated beneficiary and is more
                                                                                                    than 10 years younger than you, your required minimum distribution is
           written authorization and documentation acceptable to us, and the                        calculated each year using the joint and last survivor table in Regulations
           custodian will be entitled to all the same protections and indemnities in
           our reliance upon and execution of the directives of such investment                     section 1.401(a)(9)-9.
           advisor or other party as if such directives were given by you. We shall be              If you fail to request your required minimum distribution by your required
           under no obligation or duty to investigate, analyze, monitor, verify title               beginning date, we can, at our complete and sole discretion, do any one of
           to, or otherwise evaluate or perform due diligence for any investment                    the following:
           directed by you or your investment advisor, representative or agent; nor
           shall we be responsible to notify you or take any action should there be                      •   make no distribution until you give us a proper withdrawal request;
           any default with regard to any investment. Any review performed by us                         •   distribute your entire Coverdell ESA to you in a single sum payment; or
           with respect to an investment shall be solely for our own purposes of                         •   determine your required minimum distribution from your Coverdell
           determining compliance with our internal policies, practices and                                  ESA with us each year based on your life expectancy, calculated using
           standards, as we determine from time to time and the administrative
           feasibility of the investment and neither such review nor its acceptance                          the uniform lifetime table in Regulations section 1.401(a)(9)-9, and
           should be construed in any way as an endorsement of any investment,                               pay those distributions to you until you direct otherwise. We will not
           investment company or investment strategy. We also have the right not                             be liable for any penalties or taxes related to your failure to take a
           to affect any transaction/investment which we deem to be beyond the                               required minimum distribution or to your receipt of an amount in
           scope of our administrative responsibilities, capabilities or expertise or                        excess of the required minimum distribution.
           that we determine in our sole discretion does not comport with our
           internal policies, practices or standards. We have no duty or obligation to        10.07 Termination of Agreement, Resignation, or Removal of Custodian: Either party
           notify you with respect to any information, knowledge, irregularities or                 may terminate this Agreement at any time by giving written notice to the
           our concerns relating to your investment or your investment advisor,                     other. We can resign as Custodian at any time effective 30 days after we mail
           broker, agent, promoter or representative, except as to civil pleadings or               written notice of our resignation to you. Upon receipt of that notice, you
           court orders received by us. We shall use reasonable efforts to acquire or               must make arrangements to transfer your Coverdell ESA to another financial
           sell investments in accordance with your directions within a reasonable                  organization. If you do not complete a transfer of your Coverdell ESA within
           period of time after we have received an investment direction and we                     30 days from the date we mail the notice to you, we have the right to transfer
           shall make reasonable efforts to notify you if we are unable or unwilling                your Coverdell ESA assets to a successor Coverdell ESA custodian or trustee
           to comply with an investment direction. Subject to the foregoing, we shall               that we choose in our sole discretion, or we may pay or distribute your
           remit funds as directed, but have no responsibility to verify or assure that             Coverdell ESA assets to you in a single sum or assignment. If we transfer your
           such funds have been invested to purchase or acquire the asset selected                  Coverdell ESA, the existing Coverdell ESA documents will govern your
                                                                                                    Coverdell ESA relationship with the new custodian or trustee unless the
           by you.                                                                                  successor custodian/trustee notifies you in writing of any changes and/or
      (c) Investment Documentation. In directing us with respect to any                             requires new Coverdell ESA documents to be signed by you. We shall not be
           investment, you must utilize our Direction of Investment form or such                    liable for any actions or failures to act on the part of any successor custodian
           other form acceptable to us. We shall be fully protected in acting upon                  or trustee, nor for any tax consequences you may incur that result from the
           any instrument, certificate, paper or transmission believed to be genuine                transfer or distribution of your assets pursuant to this section. If this
           and to be signed or presented by the proper person or persons whether                    Agreement is terminated, we may charge to your Coverdell ESA a reasonable
           or not by facsimile or other form acceptable to the custodian, and the                   amount of money that we believe is necessary to cover any associated costs,
           custodian shall be under no duty to make any investigation or inquiry as                 including but not limited to, one or more of the following:
           to any statement contained in any such communication, but may accept
           the same as conclusive evidence of the truth and accuracy of the                              •  any fees, expenses or taxes chargeable against your Coverdell ESA;
           statements therein contained. You authorize and direct us to execute and                      •  any penalties or surrender charges associated with the early
           deliver, on behalf of your Coverdell ESA, any and all documents delivered                        withdrawal of any savings instrument or other investment in your
           to us in connection with your Coverdell ESA investments; and we shall                            Coverdell ESA after your Coverdell ESA Account with us is closed, if
           have no responsibility to verify or determine that any such documents are                        there are additional assets remaining in or subsequently credited to
           complete, accurate or constitute the documents necessary to comply                               your Coverdell ESA account, we will endeavor to distribute or transfer
           with your investment direction. You authorize and direct us to correct
           errors in investment titling without notice to you and to correct other                          such assets in accordance with your prior direction, but after
           minor clerical errors with telephone or email consent from you upon                              offsetting any applicable administrative expenses and custodial fees
           verification of your identity.                                                                   (per our then operative fee schedule). If we are required to comply
                                                                                                            with Regulations section 1.408–2(e), and we fail to do so, or we are
      (d) Deposit Investments. The deposit investments available through us may                             not keeping the records, making the returns or sending the
           include savings, share, and/or money market accounts, and various
           certificates of deposit (CDs).                                                                   statements as are required by forms or Regulations, the IRS may,
                                                                                                            after notifying you, require you to substitute another trustee or
      (e) Un-Invested Cash Funds. You direct us to sweep available free credit                              custodian.
           balances automatically into an FDIC insured bank account until such time as
           further direction is received from you or your designated representative(s).             We may establish a policy requiring distribution of the entire balance of your
           You also authorize us to transfer any such funds to a different FDIC insured             Coverdell ESA to you in cash or property if the balance of your Coverdell ESA
           bank account without any further approval from you.                                      drops below the minimum balance required under the applicable investment
                                                                                                    or policy established.
10.05 Beneficiary(ies): If you die before you receive all of the amounts in your
       Coverdell ESA, payments from your Coverdell ESA will be made to your                   10.08 Successor Custodian: If our organization changes its name, reorganizes,
       beneficiary(ies). You may designate one or more persons or entities as                       merges with another organization (or comes under the control of any federal
       beneficiary of your Coverdell ESA. This designation can only be made on a form               or state agency), or if our entire organization (or any portion which includes
       provided by or acceptable to us, and it will only be effective when it is filed with         your Coverdell ESA) is bought by another organization, that organization (or
       us during your lifetime. Unless otherwise specified, each beneficiary designation            agency) shall automatically become the trustee or custodian of your
       you file with us will cancel all previous ones. The consent of a beneficiary(ies)            Coverdell ESA, but only if it is the type of organization authorized to serve as
       shall not be required for you to revoke a beneficiary designation. If you have               a Coverdell ESA trustee or custodian.
       designated both primary and contingent beneficiaries and no primary                    10.09 Amendments: We have the right to amend this Agreement at any time. Any
       beneficiary(ies) survives you, the contingent beneficiary(ies) shall acquire the             amendment we make to comply with the Code and related Regulations does
       designated share of your Coverdell ESA. If you do not designate a beneficiary, or            not require your consent. You will be deemed to have consented to any other
       if all of your primary and contingent beneficiary(ies) predecease you, your                  amendment unless, within 30 days from the date we mail the amendment,
       estate will be the beneficiary. A spouse beneficiary shall have all rights as                you notify us in writing that you do not consent.
       granted under the Code or applicable Regulations to treat your Coverdell ESA as
       his or her own. We may allow, if permitted by state law, an original Coverdell         10.10 Withdrawals or Transfers: All requests for withdrawal or transfer shall be in
       ESA beneficiary(ies) (the beneficiary(ies) who is entitled to receive                        writing on a form provided by or acceptable to us. The method of distribution
       distribution(s) from an inherited Coverdell ESA at the time of your death) to                must be specified in writing. The tax identification number of the recipient

Page 4 of 7
        must be provided to us before we are obligated to make a distribution.             Depositor and the Custodian. This account must be created in the United States for
        Withdrawals shall be subject to all applicable tax and other laws and              the exclusive purpose of paying the qualified elementary, secondary, and higher
        regulations, including possible early withdrawal penalties or surrender            education expenses of the Designated Beneficiary.
        charges and withholding requirements.
10.11   Transfers from Other Plans: We can receive amounts transferred to this             If the model account is a trust account, see Form 5305-E, Coverdell Education Savings
        Coverdell ESA from the custodian or trustee of another Coverdell ESA. In           Trust Account.
        addition, we can accept direct rollovers of eligible rollover distributions from
        employer-sponsored retirement plans as permitted by the Code. We reserve           Do not file Form 5305-EA with the IRS. Instead, the Depositor must keep the
        the right not to accept any transfer or direct rollover.                           completed form in its records.
10.12   Liquidation of Assets: We have the right to liquidate assets in your Coverdell     DEFINITIONS
        ESA if necessary to make distributions or to pay fees, expenses, indemnities,
        taxes, federal tax levies, penalties or surrender charges properly chargeable      Custodian: The Custodian must be a bank or savings and loan association, as defined
        against your Coverdell ESA. If you fail to direct us as to which assets to         in Section 408(n), or any person who has the approval of the IRS to act as Custodian.
        liquidate, we will decide, in our complete and sole discretion, and you agree      Any person who may serve as a Custodian of a Traditional IRA may serve as the
        not to hold us liable for any adverse consequences that result from our            Custodian of a Coverdell ESA.
        decision.
                                                                                           Depositor: The Depositor is the person who establishes the custodial account.
10.13   Restrictions on the Fund: Neither you nor any beneficiary may sell, transfer or
        pledge any interest in your Coverdell ESA in any manner whatsoever, except         Designated Beneficiary: The Designated Beneficiary is the individual on whose behalf
        as provided by law or this Agreement. The assets in your Coverdell ESA shall       the custodial account has been established.
        not be responsible for the debts, contracts or torts of any person entitled to
        distributions under this Agreement.                                                Family Member: Family Members of the Designated Beneficiary include his or her
10.14   What Law Applies: This Agreement is subject to all applicable federal laws         spouse, child, grandchild, sibling, parent, niece or nephew, son-in-law, daughter-in-
        and regulations and shall be governed by and construed under the applicable        law, father-in-law, mother-in-law, brother-in-law or sister-in-law, and the spouse of
        laws of the State of Nevada. If any part of this Agreement is held to be illegal   any such individual. A first cousin, but not his or her spouse, is also a “family
        or invalid, the remaining parts shall not be affected. Neither your nor our        member.”
        failure to enforce at any time or for any period of time any of the provisions
        of this Agreement shall be construed as a waiver of such provisions, or your       Responsible Individual: The Responsible Individual, generally, is a parent or guardian
        right or our right thereafter to enforce each and every such provision. Any        of the Designated Beneficiary. However, under certain circumstances, the
        suit filed against custodian arising out of or in connection with this             Responsible Individual may be the Designated Beneficiary.
        Agreement shall only be instituted in the county courts of Clark County,
        Nevada where custodian maintains its principal office and you agree to             IDENTIFICATION NUMBERS
        submit to such jurisdiction both in connection with any such suit you may file     The Depositor’s and Designated Beneficiary’s social security numbers will serve as
        and in connection with any suit which we may file against you.                     their identification numbers. If the Depositor is a nonresident alien and does not
10.15   Valuations Policy: In valuing the assets of the custodial account for              have an identification number, write “Foreign” in the block where the number is
        recordkeeping and reporting purposes we shall use reasonable, good faith           requested. The Designated Beneficiary’s social security number is the identification
        efforts to ascertain the fair market value of each asset through utilization of    number of his or her Coverdell ESA. If the Designated Beneficiary is a nonresident
        various outside sources available to us and consideration of various relevant      alien, the Designated Beneficiary’s individual taxpayer identification number is the
        factors generally recognized as appropriate to the application of customary        identification number of his or her Coverdell ESA. An employer identification number
        valuation techniques. However where assets are illiquid or their value is not
        readily ascertainable on either an established exchange or generally               (EIN) is required only for a Coverdell ESA for which a return is filed to report
        recognized market, the valuation is by necessity not a true market value and       unrelated business income. An EIN is required for a common fund created for
        is merely an estimate of value in a broad range of values and its accuracy         Coverdell ESAs.
        should not be relied upon by you for any other purposes. The precision with
        which a value is assigned is a factor of the nature of the asset and the cost
        effectiveness of pursuing a more comprehensive appraisal. In certain cases                                        SPECIFIC INSTRUCTIONS
        where fair market value is not readily ascertainable and we do not have a
        recent qualified independent appraisal we may follow an internal protocol for      Note: The age limitation restricting contributions, distributions, rollover
        assigning value based on the cost of the asset or we may rely upon a current       contributions, and change of beneficiary are waived for a designated beneficiary with
        independent appraisal obtained by you. We neither provide a guarantee of           special needs.
        value nor the appropriateness of the appraisal techniques applied in
        developing an estimate of value and we assume no responsibility for the            Article X: Article X and any that follow may incorporate additional provisions that are
        accuracy of the valuations presented with respect to assets whose value is         agreed to by the Depositor and Custodian to complete the agreement. They may
        not readily ascertainable on either an established exchange or a generally         include, for example, provisions relating to: definitions, investment powers, voting
        recognized market.                                                                 rights, exculpatory provisions, amendment and termination, removal of the
                                                                                           Custodian, Custodian’s fees, state law requirements, treatment of excess
                                     INSTRUCTIONS                                          contributions, and prohibited transactions with the Depositor, Designated
                                                                                           Beneficiary, or Responsible Individual, etc. Attach additional pages as necessary.
(Section references are to the Internal Revenue Code unless otherwise noted.)
                                                                                           Optional Provisions in Article V and Article VI: Form 5305-EA may be reproduced in a
PURPOSE OF FORM                                                                            manner that provides only those optional provisions offered by the Custodian.
Form 5305-EA is a model custodial account agreement that meets the requirements
of Section 530(b)(1) and has been pre-approved by the IRS. A Coverdell Education
Savings Account (ESA) is established after the form is fully executed by both the




Page 5 of 7
                                                                   DISCLOSURE STATEMENT
REQUIREMENTS OF A COVERDELL ESA                                                             Unless otherwise indicated on the Application, the Responsible Individual may
A. CASH CONTRIBUTIONS – A Coverdell ESA contribution must be in cash.                       not change the Designated Beneficiary. If the Depositor has indicated on the
                                                                                            Application that the Responsible Individual may change the Designated
B. MAXIMUM CONTRIBUTION – The total amount that may be contributed to any                   Beneficiary, the Responsible Individual may change the Designated Beneficiary
   and all Coverdell ESAs on behalf of a Designated Beneficiary is $2,000 per year,         to another member of the Designated Beneficiary’s family. The Responsible
   excluding rollover and transfer contributions.                                           Individual shall perform the following duties.
    Contributions may not be made to a Coverdell ESA after the Designated                   1. receive a copy of the plan agreement and disclosure statement.
    Beneficiary’s 18th birthday, except in the case of a special needs beneficiary.
                                                                                            2. direct the Custodian regarding the investment of contributions, including
    The Coverdell ESA contribution that may be made by a Depositor is further                  the ability to redirect the investment of the initial contribution.
    limited if the Depositor’s modified adjusted gross income (MAGI) exceeds
                                                                                            3. direct the Custodian regarding the administration, management and
    $190,000 and he or she is a married individual filing jointly ($95,000 for single
                                                                                               distribution of the account, unless the plan agreement indicates otherwise.
    taxpayers). Married individuals filing jointly with MAGI exceeding $220,000
    may not fund a Coverdell ESA. Single individuals with MAGI exceeding                    4. name a successor responsible individual if the need arises.
    $110,000 may not fund a Coverdell ESA. The MAGI limits apply only to
                                                                                            5. notify the Custodian of any address change for the individuals identified
    Depositors that are individuals.
                                                                                               on the plan agreement.
    If the Depositor is married filing jointly with MAGI between $190,000 and
                                                                                            6. remove excess contributions made to the Coverdell ESA.
    $220,000, the maximum Coverdell ESA contribution is determined as follows:
    (1) subtract the Depositor’s MAGI from $220,000, (2) divide the difference by       INCOME TAX CONSEQUENCES OF ESTABLISHING A COVERDELL ESA
    $30,000, and (3) multiply the result in step (2) by $2,000. For example, if the
    Depositor’s MAGI is $205,000, the maximum Coverdell ESA contribution that           A. CONTRIBUTIONS NOT DEDUCTED – No deduction is allowed for Coverdell ESA
    may be made by such Depositor is $1,000. This amount is determined as                  contributions, including transfer and rollover contributions.
    follows: [($220,000 minus $205,000) divided by $30,000] multiplied by $2,000.       B. TAX-DEFERRED EARNINGS – The investment earnings of the Coverdell ESA are
    If the Depositor is a single tax filer with MAGI between $95,000 and $110,000,         not subject to federal income tax as they accumulate in the Coverdell ESA. In
    the maximum Coverdell ESA contribution is determined as follows: (1) subtract          addition, distributions of the Coverdell ESA earnings will be free from federal
    the Depositor’s MAGI from $110,000, (2) divide the difference by $15,000, and          income tax if the distributions are taken to pay for qualified education
    (3) multiply the result in step (2) by $2,000. For example, if the Depositor’s         expenses, as discussed below.
    MAGI is $98,000, the maximum Coverdell ESA contribution that may be made            C. TAXATION OF DISTRIBUTIONS – The taxation of distributions from the
    by such Depositor is $1,600. This amount is determined as follows: [($110,000          Coverdell ESA depends on whether or not the distributions are used for
    minus $98,000) divided by $15,000] multiplied by $2,000.                               qualified education expenses.
    The Coverdell ESA contribution that may be made by a Depositor is not limited           1. Qualified Education Expenses – The Designated Beneficiary may take tax-
    by contributions made by the Depositor to Traditional or Roth IRAs. In                     free distributions from a Coverdell ESA to pay for elementary, secondary or
    addition, there is no earned income requirement to be eligible to contribute to            post-secondary education expenses at an eligible educational institution.
    a Coverdell ESA. There is no requirement that the Depositor be related to the              Such expenses include tuition, fees, books, supplies, special needs services,
    Designated Beneficiary in order to make contributions. In addition, the                    room and board, uniforms, transportation, academic tutoring and
    Designated Beneficiary may contribute to his or her own Coverdell ESA.                     supplementary items or services (including extended day programs). Also
C. ELIGIBLE CUSTODIANS – The Custodian of the Coverdell ESA must be a bank,                    qualifying are expenses for the purchase of computer technology or
   savings and loan association, credit union, or person approved by the                       equipment, Internet access and related services, if such technology,
   Secretary of the Treasury.                                                                  equipment or services are to be used by the Designated Beneficiary or
                                                                                               Designated Beneficiary’s family during any of the years the Designated
D. COMMINGLING ASSETS – The assets of the Coverdell ESA cannot be                              Beneficiary is in school. Qualified expenses may also include amounts
   commingled with other property except in a common trust fund or common                      contributed to a qualified tuition program.
   investment fund.
                                                                                            2. Nonqualifying Distributions – If a Designated Beneficiary withdraws
E. LIFE INSURANCE – No portion of the Coverdell ESA may be invested in life                    amounts from a Coverdell ESA which exceed the qualified education
   insurance contracts.                                                                        expenses for the same year, or the distributions are not used for qualified
                                                                                               education expenses, a portion of the distributions will be taxable. The
F. COLLECTIBLES – The assets of the Coverdell ESA may not be invested in                       amount in excess of the qualified education expenses is taxable pro rata,
   collectibles (within the meaning of Internal Revenue Code (IRC) Sec. 408(m)). A             based on the earnings and the basis in the account.
   collectible is defined as any work of art, rug or antique, metal or gem, stamp
   or coin, alcoholic beverage, or other tangible personal property specified by                In most cases of a nonqualified distribution, the taxable portion of a
   the Internal Revenue Service (IRS). However, specially minted United States                  Coverdell ESA distribution is also subject to an additional 10 percent tax.
   gold and silver bullion coins and certain state-issued coins are permissible                 There are several exceptions to the 10 percent tax including distributions
   investments. Beginning January 1, 1998, platinum coins and certain gold,                     made payable
   silver, platinum or palladium bullion (as described in IRC Sec. 408(m)(3)) are
                                                                                                a. to a designated death beneficiary of the Coverdell ESA or to the estate
   also permitted as Coverdell ESA investments.
                                                                                                   of the Designated Beneficiary following the death of the Designated
G. REQUIRED DISTRIBUTIONS – Except in the case of a special needs beneficiary, the                 Beneficiary;
   assets of the Coverdell ESA are required to be distributed to the Designated                 b. to the Designated Beneficiary if the Designated Beneficiary is disabled;
   Beneficiary within 30 days of the Designated Beneficiary’s attainment of age 30.
   The Designated Beneficiary will be subject to both income tax and an additional              c.   to the Designated Beneficiary if the Designated Beneficiary received a
   10 percent tax on the portion of the distribution that represents earnings, if the                qualified scholarship, an educational assistance allowance or an
   Designated Beneficiary does not have any qualified education expenses in that                     excludable payment exception, but only to the extent the distribution is
   year.                                                                                             not more than the amount of the scholarship, allowance or excludable
                                                                                                     payment, and
    Any balance remaining in the Coverdell ESA upon the death of the Designated
    Beneficiary shall be distributed within 30 days of the Designated Beneficiary’s             d. to the Designated Beneficiary as a removal of excess along with the net
    death, unless a death beneficiary is named and the death beneficiary is a                      income attributable.
    qualified family member under age 30. If the death beneficiary is a qualified
                                                                                            3. Hope or Lifetime Learning Credits – A Designated Beneficiary may claim
    family member under age 30, that individual will become the Designated
                                                                                               the Hope Credit or the Lifetime Learning Credit on his or her federal
    Beneficiary as of the date of death.
                                                                                               income tax return in the same taxable year that a tax-free distribution
H. RESPONSIBLE INDIVIDUAL – The Responsible Individual is generally the parent                 from a Coverdell ESA is claimed, as long as the distribution(s) does not
   or guardian of the Designated Beneficiary. However, the financial organization              cover the same expenses claimed for the Hope Credit or Lifetime Learning
   may establish a policy that permits someone other than the Designated                       Credit.
   Beneficiary’s parent or legal guardian to serve as the Responsible Individual.
 Page 6 of 7
D. ROLLOVERS – Coverdell ESA amounts may be rolled over to another Coverdell                the Coverdell ESA will lose its tax-exempt status and the Designated
   ESA of the same Designated Beneficiary or that of a qualified family member,             Beneficiary must generally include the value of the earnings in his or her
   provided that all of the applicable rollover rules are followed. Rollover is a           account in his or her gross income for the year.
   term used to describe a tax-free movement of cash to a Coverdell ESA from
   another Coverdell ESA. The rollover rules are generally summarized below.            B. PLEDGING – If the Responsible Individual pledges any portion of the Coverdell
   These transactions are often complex. If you have any questions regarding a             ESA as collateral for a loan, the amount so pledged will be treated as a
   rollover, please see a competent tax advisor.                                           distribution and may be included in the Designated Beneficiary’s gross income
                                                                                           for that year to the extent that it represents earnings.
    1. Coverdell ESA to Coverdell ESA Rollovers – Funds distributed from a
       Coverdell ESA may be rolled over to another Coverdell ESA of the same            C. ESTATE AND GIFT TAX – Transfers of Coverdell ESA assets to a death
       Designated Beneficiary or that of a qualifying family member if the                 designated beneficiary made during the Designated Beneficiary’s life and at his
       requirements of IRC Sec. 530(d)(5) are met. A proper Coverdell ESA to               or her request or because of the Designated Beneficiary’s failure to instruct
       Coverdell ESA rollover is completed if all or part of a distribution is rolled      otherwise, may be subject to federal gift tax under IRC Sec. 2501 if made after
       over not later than 60 days after the distribution is received. The                 October 22, 1986.
       Responsible Individual may not have completed another rollover from the          D. INCOME TAX TREATMENT – Any withdrawal from the Coverdell ESA is not
       distributing Coverdell ESA during the 12 months preceding the date the              subject to federal income tax withholding.
       distribution was received. Further, the Responsible Individual may roll the
       same dollars or assets only once every 12 months.                                FEDERAL TAX PENALTIES
                                                                                        A. EXCESS CONTRIBUTION PENALTY – An excise tax of 6 percent is imposed upon
    2. Qualified Family Member – A Coverdell ESA may be rolled to another
                                                                                           any excess contribution made to a Coverdell ESA. This tax will apply each year
       Coverdell ESA of the same Designated Beneficiary or to a Coverdell ESA
                                                                                           in which an excess remains in the Coverdell ESA. An excess contribution is any
       maintained for the benefit of a qualified family member of the Designated
                                                                                           contribution amount which exceeds the contribution limit, excluding rollover
       Beneficiary, who is under the age of 30. The age 30 limitation does not
                                                                                           and direct transfer amounts. The contribution limit is $2,000 per Designated
       apply to qualified family members who are special needs beneficiaries.
                                                                                           Beneficiary per year. The contribution limit may be further limited by the
       Qualified family members of the Designated Beneficiary include the
                                                                                           Depositor’s MAGI as discussed previously. The excess contribution should be
       Designated Beneficiary’s child, grandchild, or stepchild, brother, sister,
                                                                                           removed by the Responsible Individual and made payable to the Designated
       stepbrother, or stepsister, nephew or niece, parents, stepparents, or
                                                                                           Beneficiary.
       grandparents, uncle or aunt, spouses of all the family members listed
       above, cousin, and Designated Beneficiary’s spouse.                              B. PENALTY REPORTING – The Designated Beneficiary must file form 5329 with
                                                                                           the Internal Revenue Service to report and remit any penalties for excise
    3. Rollover of Military Death Benefits – If you receive or have received a
                                                                                           taxes.
       military death gratuity or a payment from the Servicemembers’ Group Life
       Insurance (SGLI) program, you may be able to roll over the proceeds to           OTHER
       your Coverdell ESA. The rollover contribution amount is limited to the sum       A. IRS PLAN APPROVAL – The agreement used to establish this Coverdell ESA has
       of the death benefits or SGLI payment received, less any such amount that           been approved by the IRS. The IRS approval is a determination only as to form.
       was rolled over to a Roth IRA. Proceeds must be rolled over within one              It is not an endorsement of the plan in operation or of the investments
       year of receipt of the gratuity or SGLI payment for deaths occurring on or          offered.
       after June 17, 2008. For deaths occurring between October 7, 2001 and
       June 17, 2008, proceeds may be rolled over no later than one year from           B. ADDITIONAL INFORMATION – You may obtain further information on
       June 17, 2008. Any amount that is rolled over under this provision is               Coverdell ESAs from your District Office of the IRS. In particular, you may wish
       considered nontaxable basis in the Coverdell ESA.                                   to obtain IRS Publication 970, Tax Benefits For Higher Education, by calling
                                                                                           1-800-TAX-FORM, or by visiting www.irs.gov on the Internet.
E. CARRYBACK CONTRIBUTIONS – A contribution is deemed to have been made
   on the last day of the preceding taxable year if it is made by the deadline for      C. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW
   filing the Depositor’s income tax return (not including extensions), and the            ACCOUNT – To help the government fight the funding of terrorism and money
   Depositor designates that contribution as a contribution for the preceding              laundering activities, Federal law requires all financial organizations to obtain,
   taxable year. For example, if the Depositor is a calendar year filer and makes a        verify, and record information that identifies each person who opens an
   Coverdell ESA contribution on or before April 15, the contribution is                   account. What this means for you: When you open an account, you are
   considered to have been made for the previous tax year if the Depositor                 required to provide your name, residential address, date of birth, and
   designates it as such.                                                                  identification number. We may require other information that will allow us to
                                                                                           identify you.
LIMITATIONS AND RESTRICTIONS
A. PROHIBITED TRANSACTIONS – If the Responsible Individual engages in a
   prohibited transaction with the Coverdell ESA as described in IRC Sec. 4975,




Page 7 of 7
                                                                                                        Money Market Account Disclosure

8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148

Client Services: 888-855-9856

                                        MONEY MARKET ACCOUNTS & TERMS ARE SUBJECT TO CHANGE WITHOUT NOTICE
                                                   PLEASE CALL (888) 855-9856 TO OBTAIN CURRENT RATE INFORMATION.
                                                      The information provided in this disclosure is accurate as of 09/2010.
 Your money market balance is federally insured to at least $250,000 and backed by the full faith and credit of the United States Government.

 This disclosure supplements your Account Disclosure and other applicable disclosures. Please keep all these documents together for your records.
 TERMS AND CONDITIONS
 The following terms and conditions governing your Money Market Account constitute a mutually protective service agreement between you and Provident
 Trust Group (the “Trust Company”). The Disclosure Statement brochure is incorporated by reference.
 Opening this account is conditioned on maintaining an account with the Trust Company.
 RATES ON MONEY MARKET ACCOUNTS
 The Money Market rate is variable and is set at the discretion of the Board of Directors at the end of each month. Changes to the Money Market rate will
 not be communicated to the client after the account opening but the client may inquire about the set rate at any time by calling or emailing the Trust
 Company.
 FEES
 The Money Market account will be subject to all fees set forth on your fee disclosure enclosed with your account.
 ANNUAL PERCENTAGE YIELD (APY)
 Annual Percentage Yield (APY), is a percentage rate that measures the total amount of dividends paid on an account based on the dividend rate and the
 frequency of compounding for a twelve-month period. The APY calculation is based on an assumed term of 365 days. If you withdraw dividends before this
 period, it may reduce your earnings.
 DIVIDEND INFORMATION
 Dividends begin to accrue on the business day you make a deposit but do not accrue on the date of withdrawal for the amount of the withdrawal.
 Dividends are paid on a monthly basis on the first day of each month following the dividend period. For example, the beginning date of the first dividend
 period of the calendar year is January 1, and the ending date of the dividend period January 31. The dividends would be posted following the end of the
 dividend period, which for this example would be February 1. This dividend and the resulting Annual Percentage Yield Earned (APY Earned) in this example
 would appear on the February statement. All other dividend periods follow this pattern of dates. If you close your account before dividends are posted, we
 may credit any accrued dividends at the time you close your account. Dividends are compounded monthly on a 365/365 basis, using the daily balance
 method. The dividend rate is divided by 365 days to determine the daily periodic rate. The daily periodic rate is then applied to the entire account balance
 each day. At the Trust Company’s discretion, we may change the dividend rate and applicable Annual Percentage Yield (APY) on your account at any time
 without prior notice. We advise members to periodically inquire by calling 1-888-855-9856 about current rates.
 TRANSACTION LIMITATIONS
 During any month, you may not make more than six withdrawals or transfers to another Trust Company account of yours or to a third party by means of
 check, draft or similar order, a preauthorized or automatic transfer or telephonic order or instruction. If you exceed the transfer limitations set forth above
 in any month, your account will be subject to an excessive transaction fee of $15 per month. If there are continuous excessive transactions in violation of
 the limits stated above, the Trust Company is required to close your money market account and move the balance to another type of account that allows
 for more transactions without penalty. Money market accounts do not have overdraft protection nor can the money market account be used as an
 overdraft protection source for your checking account.
 STATEMENT CYCLES
 Active accounts receive yearly paper statements or on-demand electronic statements to enable you to reconcile your records. Accounts Statements are
 mailed at the convenience of the Trust Company, usually near the beginning of the year. Electronic statements are usually posted by the second business
 day of the month. If you would like a statement prior to the time one is normally furnished, you can request a printout of your account history. The charge
 for this special printout service is listed on the Schedule of Fees.
 CHANGE IN TERMS
 The Trust Company reserves the right to change the terms and conditions of your account at any time, including the fee schedule. A notice of any changes
 that would affect your account will be mailed to you 30 business days in advance of the effective date of change.




 Page 1 of 1                                                                                                                                       v1.01-09.30.10
                                                                                                         Privacy Disclosure

Client Services: 888-855-9856


Provident Trust Group, LLC, your Administrator, is committed to providing each client competitive products and services to
meet their retirement fund needs. We are equally committed to protecting the privacy of our clients. Under federal law, we
are required to give you this privacy notice. It describes our company’s privacy policy and practices concerning the personal
information we collect and disclose about our clients. It also includes information about the parties who receive personal and
sometimes nonpublic information from us as we conduct the business of the administrator.

If after reading this notice you have questions, please contact us at (702) 434-0023.

Information We Collect About You
We collect nonpublic personal information about you from the following sources:
          Information we receive from you on applications and other forms.
          Information about your transactions with us.
          Information obtained when verifying the information you provide on an application or other forms..

We may disclose all of the information we collect, as described above, as permitted by law.

Disclosure of Information to Parties That Provide Services to Us
In order for us to conduct the business of the administrator, we may disclose all of the information we collect, as described
above, to companies that perform marketing or other services on our behalf or to other financial institutions with whom we
have joint marketing agreements so that we may provide clients competitive products and services. We may also disclose
nonpublic personal information about you under circumstances as permitted or required by law. These disclosures typically
include information to process transactions on your behalf, conduct the operations of our administrator, and follow your
instructions as you authorize, or protect the security of our financial records.

To protect our clients’ privacy, we only work with companies that agree to maintain strong confidentiality protections and limit
the use of information we provide. We do not permit these companies to sell the information we provide to other third
parties.

Disclosure of Information about Former Clients
If you terminate your account with Provident Trust Group, LLC, we will not share information we have collected about you,
except as may be permitted or required by law.

How We Protect Your Information
We restrict access to nonpublic personal information about you to those employees who need to know that information to
provide products or services to you. We maintain physical, electronic, or procedural safeguards that comply with federal
regulations to guard your nonpublic personal information.

What Clients Can Do to Help
Provident Trust Group, LLC is committed to protecting the privacy of its clients. Clients can help by following these simple
guidelines:
           Protect your account numbers, PINs (personal identification numbers) or passwords.
           Use caution when disclosing your account numbers, social security numbers, etc. to other persons. If someone
              calls you explaining the call is on behalf of the administrator and asks for your account number, you should
              beware. Official administrator staff will have access to your information and will not need to ask for it.
           Keep your information with us current. If your address or phone number changes, please let us know. It is
              important that we have current information on how to reach you. If we detect potentially fraudulent or
              unauthorized activity or use of an account, we will attempt to contact you immediately.
           Let us know if you have questions. Please do not hesitate to call us - we are here to serve you!




Page 1 of 1                                                                                                          v1.01-11.30.09
                                                                                                                                          IRA Rollover Certification
   P.O. Box 4330, Ontario, CA 91761-8830

   Client Services: 888-855-9856
   1               Account Owner Information
      Name:                                                                                                                     Account #:


      Address:                                                                        City:                                     State:                          Zip:


      Social Security #:                                            Date of Birth:                                              Phone:


  2                Option 1: Traditional IRA or SIMPLE IRA Rollover
      To be an eligible rollover, all questions must be answered “No” or “N/A.”
      Amount:                                      Check #: (If Available)
                                                                                                     This rollover should be placed in a:               Traditional IRA           SIMPLE IRA
      $
    A.      TIMELINES
                                                                                                                                                                         Yes           No
            Have more than 60 days elapsed since you received the distribution from the distributing IRA?
    B.      RMD ROLLOVER RESTRICTION
                                                                                                                                                                         Yes           No
            Does the rollover contribution contain any amounts which constitute a required minimum distribution?
    C.      TWELVE MONTH RESTRICTION
            Did you receive any other distributions from the distributing IRA during the preceding 12 months which you rolled over?                                      Yes           No
            Have the assets involved in this transaction been previously rolled over from one IRA to another IRA within the past 12 months?                              Yes           No
    D.      SIMPLE IRA ROLLOVER RESTRICTIONS
            If a SIMPLE IRA is being rolled over to a Traditional IRA, did you first begin participating in a SIMPLE IRA plan sponsored by your                          Yes           No      N/A
            employer less than two years ago?

  3                Option 2: Employer-Sponsored Retirement Plan to Traditional IRA Rollover
      A.     ELIGIBLE PERSON: Your status in the plan from which you received the funds or property intended for rollover is as follows: (Select One)
                Plan Participant     Surviving Spouse Beneficiary        Non-spouse Beneficiary of Plan Participant         Alternate Payee of Qualified Domestic Relations Order
      B.     ELIGIBLE PLAN: You received the distribution you are rolling over from the following type of plan: ( Select One)

                       Qualified Retirement Plan (IRC Sec. 401(a))                                   Annuity Plan (IRC Sec. 403(a))
                       Tax-Sheltered Annuity Plan (IRC Sec. 403(b))                                  Deferred Compensation Plan (IRC Sec. 457(b)) maintained by a governmental employer

      C.     ELIGIBLE ROLLOVER DEPOSIT (To be an eligible rollover, all questions must be answered “No”)
                                                                                                                                                                                 Yes           No
             Does the rollover contribution contain any amounts which constitute a required minimum distribution?
             Is the distribution which is being rolled over part of a series of substantially equal periodic payments?                                                           Yes           No
             Does the rollover contribution contain any amounts which are eligible for the death benefit exclusion (i.e. death before August 21, 1996)?                          Yes           No
             Does the rollover contribution include any nontaxable amounts attributable to the purchase of life insurance under the distributing plan (i.e.,
                                                                                                                                                                                 Yes           No
             P.S. 58 costs)?
             Does the rollover contribution include any funds or property other than the funds or property you received from the distributing plan (and/or
                                                                                                                                                                                 Yes           No
             proceeds from the sale of distributed property)?
             Does the rollover contribution include any amounts which constitute a distribution due to hardship?                                                                 Yes           No

             Does the rollover contribution include any Roth 401(k) or Roth 403(b) plan elective deferrals?                                                                      Yes           No
      D.     TIMELINES
                                                                                                                                                                                 Yes           No
             Have more than 60 days elapsed since you received the distribution from the distributing plan?

   4               Account Owner Authorization
      I have read and understand the rollover rules and conditions on both pages of this form and I have met the requirements for making an IRA rollover. Due to the important tax consequences
      of rolling over funds or property to an IRA, I have been advised to see a tax professional. All information provided by me is true and correct and may be relied on by the Trustee or Custodian.
      I assume full responsibility for this rollover transaction and will not hold the Trustee or Custodian liable for any adverse consequences that may result. I herby irrevocably designate this
      contribution as a rollover contribution.

      Account Owner Name: (Please Type or Print)

      Account Owner Signature:                                                                                                           Date:
SIGN HERE

                                                                                                                                                                                       v1.02-01.04.12
                                           Mail Rollover Checks To: P.O. Box 4330, Ontario, CA 91761-8830
   Page 1 of 2
                                                     Rules and Conditions Applicable To Rollovers
GENERAL INFORMATION                                                                          ELIGIBLE PLAN
A rollover is a way to move money or property from one eligible retirement plan              A distribution will not be eligible to be rolled over unless that distribution is made from
(e.g., IRA or Qualified Retirement Plan (QRP)) to another eligible retirement plan.          an eligible retirement plan. An eligible retirement plan is a plan that is qualified under
The Internal Revenue Code (IRC) limits how many distributions may be rolled over,            IRC Section 401(a), 403(a), 403(b), or 457(b). Eligible retirement plans include defined
how quickly rollovers must be completed and how the Trustee or Custodian must                benefit plans, profit sharing plans, money purchase pension plans, 401(k) plans, tax-
report the transaction. By properly completing this form you are certifying to the           sheltered annuities, eligible 457(b) deferred compensation plans, and employee stock
Trustee or Custodian that you have satisfied the rules and conditions applicable to a        ownership plans.
rollover and that you are making an irrevocable election to treat the transaction as         ELIGIBLE ROLLOVER DEPOSIT
a rollover.                                                                                  Only certain types of eligible retirement plan distributions, called “eligible rollover
TRADITIONAL IRA OR SIMPLE IRA ROLLOVER REQUIREMENTS (Option One)                             distributions,” may be deposited into an IRA. Eligible rollover distributions include most
TIMELINESS                                                                                   distributions from eligible plans except the following:
The funds you receive from the distributing IRA must generally be deposited into             Required Minimum Distributions – Distributions which represent required minimum
another IRA within 60 days after you receive them. However, this period is 120 days          distributions paid during a participant’s first distribution calendar year or later may not
for certain rollovers relating to first-time home purchases. When counting the 60 (or        be rolled over.
120) days include weekends and holidays. Receipt generally means the day you                 Substantially Equal Periodic Payments – For purposes of determining an eligible
actually have the funds in hand. For example, the 60 days would begin on the day             rollover distribution, substantially equal periodic payments are defined as a series of
following the day you pick up the check from the Trustee or Custodian or when you            substantially equal distributions made not less frequently than annually and calculated
receive the check in the mail.                                                               1) over the life (or life expectancy) of the individual or the joint lives (or life
The IRS has the authority to grant extensions to the 60 (or 120) day rule in cases           expectancies) of the individual and the individual’s beneficiary or, 2) for a specified
where a hardship occurs (e.g. casualty, disaster, etc.). Generally, in order to receive      period of 10 years or more.
this relief you must apply for a Private Letter Ruling accompanied by the applicable         Death Benefit Exclusion Amounts – If you are a surviving spouse beneficiary and your
user fee. An automatic waiver (no application to the IRS) is available if all the            spouse died before August 21, 1996, a portion of your distribution may qualify for the
following are true: (1) the financial institution receives the funds prior to the            Death Benefit Exclusion Allowance. You may not roll over any portion of your
expiration of the 60-day rollover period, (2) you follow all procedures required for         distribution which qualifies for the Death Benefit Exclusion Allowance.
depositing the funds into an eligible IRA within the 60-day period, (3) the funds are        P.S. 58 Costs – If you received distribution of a life insurance policy from a plan, the
not deposited due to financial institution error, (4) the funds are deposited into an        amounts attributable to the cost of life insurance purchased by the plan which have
IRA within one year from the beginning of the 60-day rollover period, and (5) if the         been previously taxed to the participant may not be rolled over.
financial institution had deposited the funds as instructed, it would have been a            Property Distributions – If property other than cash is distributed, only the same
valid rollover.                                                                              property or the proceeds from its sale may be rolled over. If you receive property but
RMD ROLLOVER RESTRICTION                                                                     wish to roll over cash, you must actually sell the property and roll over the proceeds.
If this rollover is being made during or after the year for which you are required to        Hardship Distributions – Distributions taken on account of financial hardship are not
begin receiving distributions, you cannot roll over any distribution to the extent that it   eligible to be rolled over.
is a required minimum distribution from the distributing plan. If the deceased IRA           Roth 401(k) or 403(b) Amounts – Distributions of elective deferrals from a Roth 401(k)
holder died after his or her required beginning date and you are the spouse                  or 403(b) plan are not eligible to be rolled over to a Traditional IRA.
beneficiary of a deceased IRA holder and you are rolling this IRA into your own IRA,         TIMELINESS
you must make sure that the deceased’s required minimum distribution for the year of         If the check is payable to you, the funds you receive from the distributing plan must be
death is removed from his or her IRA assets prior to the completion of the rollover.         deposited in an IRA within 60 days after you receive them. When counting the 60 days
TWELVE MONTH RESTRICTION                                                                     include weekends and holidays. Receipt generally means the day you actually have the
You are entitled to one distribution per year per IRA which may be rolled over.              funds in hand.
Twelve (12) months must pass after receipt of one distribution which you roll over           The IRS has the authority to grant extensions to the 60 day rule in cases where a
before you may take another distribution from the same IRA to roll over. An IRA is           hardship occurs (e.g. casualty, disaster, etc.). Generally, in order to receive this relief
created by executing a plan agreement, not by depositing a contribution into a               you must apply for a Private Letter Ruling accompanied by the applicable user fee. An
separate investment within an existing IRA.                                                  automatic waiver (no application to the IRS) is available if all the following are true: (1)
You are entitled to roll over the same assets only once in a twelve (12) month               the financial institution receives the funds prior to the expiration of the 60-day rollover
period. Twelve (12) months must elapse between the time you receive a                        period, (2) you follow all procedures required for depositing the funds into an eligible
distribution of the assets to be rolled over until you receive another distribution of       IRA within the 60-day period, (3) the funds are not deposited due to financial institution
those same assets for rollover purposes.                                                     error, (4) the funds are deposited into an IRA within one year from the beginning of the
SIMPLE IRA ROLLOVER RESTRICTIONS                                                             60-day rollover period, and (5) if the financial institution had deposited the funds as
You may roll funds from one SIMPLE IRA to another SIMPLE IRA if the timeliness and           instructed, it would have been a valid rollover.
12 month restriction discussed above have been met. In addition, a SIMPLE IRA may            CAUTION ABOUT COMMINGLING FUNDS
be rolled over to a Traditional IRA provided two years have passed since you first           If you are rolling over funds from certain eligible retirement plans, you may be eligible
participated in a SIMPLE IRA plan sponsored by your employer.                                to take advantage of favorable tax treatment if the IRA is maintained as a conduit IRA
EMPLOYER-SPONSORED RETIREMENT PLAN TO TRADITIONAL IRA ROLLOVER                               and the funds are subsequently rolled back over to another eligible retirement plan. See
REQUIREMENTS (Option Two)                                                                    your tax professional for additional information.
ELIGIBLE PERSON
Only an eligible person may roll funds from a QRP, 403(a) Plan, 403(b) Plan, or
eligible 457(b) Deferred Compensation Plan into an IRA. You will only be an eligible
person if you were or are a participant in the distributing plan, the surviving spouse
beneficiary of a deceased participant, or the alternate payee identified in a
Qualified Domestic Relations Order (QDRO). A QDRO is a domestic relations order
issued in a divorce proceeding which meets certain conditions and grants to an
alternate payee (e.g., exspouse) the right to receive all or a portion of a
participant’s benefits under a QRP. If the alternate payee is a spouse or former
spouse, the alternate payee can roll over all or a portion of the amount received to
an IRA. A nonspouse beneficiary may only roll over to an inherited IRA. A rollover to
an inherited IRA must be done as a direct rollover from an eligible retirement plan.




Page 2 of 2
                                                                                   ACH & Automatic Ongoing Contribution Authorization

8880 W. Sunset Rd., Ste 250, Las Vegas, NV 89148

Client Services: 888-855-9856
        Account Owner Information
                        Account #:                          Account Owner Name:

                        Address:                                                                  City:                                State:                 Zip:

                        Phone:                                                                    Email:

        Account Owner’s Bank Information
                        Bank Name:                                                                                                     Phone:

                        Name on Account:

                        Address:                                                                  City:                                State:                 Zip:

                        Routing Number: (9 Digits)                                                Bank Account #:

                                                         Business Checking                          Personal Checking                           Savings
         Transaction Information
                                                                                 th
                        All automatic payments will be initiated on the 12 of the month from the bank account listed above. Please allow 2-3 business days
                        for processing. The contribution may be prorated if elected during the middle of the time period.
                        NOTE: The annual contribution limit for a Traditional or Roth IRA in 2010 is $5,000 or $6,000 if you are over 50. If you have a SIMPLE or SEP IRA, please
                        note the limits prior to making your contribution.
                        One time debit:                                                           I would like to make the following contributions to my IRA:
                                              Annual Fee
                                              Contribution                                            Once            Monthly             Quarterly             Annually
                                              CANCEL ACH SERVICE
                        Amount of Debit: $________________.____                                               Amount of Debit: $________________.____
        Authorization
                           This authorization must be written and signed by the Account Owner.
                           The Account Owner must receive a copy of the authorization
                           Provident retains the original authorization for at least 2 years following the revocation of the authorization. Provident must be able to produce a
                            copy of the authorization on demand from the Originating Depository Financial Institution, or from the Account Owner.
                           The authorization must be readily identifiable as an ACH authorization (either Debit or Credit) and must clearly and conspicuously state its terms.
                           The authorization must state the manner in which the authorization may be revoked.
                        The authorization must specify that the receiver may revoke the authorization only by notifying the originator in the manner specified on the
                        authorization form.
                        I hereby authorize Provident Trust Group, LLC, through Service 1st Bank of Nevada, to electronically draft via the Automated Clearing House (ACH) system
                        the amounts indicated above from the account identified above. This authorization is to remain in full force and effect until Provident Trust Group has
                        received written notification from the Account Owner of its termination in such time and in such manner as to afford Provident that the Bank Named
                        above a reasonable opportunity to act on it. The Undersigned hereby certifies that they are duly authorized to execute this form on behalf of the above
                        listed account holder. I acknowledge that I am subject to a $35 reject fee if items are returned for insufficient funds.
                        Account Owner Signature:                                                          Date:


            SIGN HERE
                                                                                                                                                                      v1.02-10.01.10




                                                                                                    Attach your voided check or deposit slip HERE

								
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