Embarcadero Funds | 8000 Town Centre Drive, Suite 400 | Broadview Heights, OH 44147 | 800-228-2121
FUNDS Roth IRA · Transfer of Assets
Instructions for completing this form are provided on the reverse.
PART I C I PA N T I N F O R M AT I O N
Name Account Number
Street Address (PO Box is not sufficient)
Phone number (evening) Phone number (day)
Date of Birth SSN or TIN
US Citizen Resident Alien: Country of Origin Non-Resident Alien: Country of Origin
CUR R E N T P L A N I N F O R M AT I O N
• Please check with your current Custodian for the correct address and whether a Medallion Signature Guarantee is required to avoid delays.
• Attach a copy of a current statement if possible.
Name of current custodian or agent
For Certificate of Deposits: Immediately At Maturity Date
TRAN S F E R AU T H O R I Z AT I O N
Please transfer the following investments to Mutual Shareholder Services, LLC as Custodian for Embarcadero Funds Roth IRA.
1. Fund Name or Type of Investment to be transferred Account number
Liquidate entire account Transfer in kind Partial $ or shares
2. Fund Name or Type of Investment to be transferred Account number
Liquidate entire account Transfer in kind Partial $ or shares
I authorize the Transfer of Assets as noted above to my Embarcadero Funds Roth IRA and Embarcadero Funds and Mutual Shareholder Services, LLC to process this
request on my behalf. I understand it is my responsibility to assure the prompt Transfer of Assets by the current Custodian. I have read and understand all information
in the instructions and hereby provide the applicable certification.
Signature of IRA Partcipant (required) Date
Medallion Signature Guarantee Stamp and Signature
(if required by your current Custodian or transfer agent)
TO BE COMPLETED BY M U T UA L S H A R E H O L D E R S E R V I C E S , L L C
Issue check payable to: Mutual Shareholder Services, LLC as Custodian for Embarcadero Funds Roth IRA.
Embarcadero Funds FBO Account number SSN
EMB A RC A D E RO F U N D S ROT H I R A ACCO U N T INFORMATION
I am opening a new Roth IRA and have attached the required application. New accounts must meet the fund minimum.
Deposit the proceeds into my existing Roth IRA. Account Number:
EMB A RC A D E RO F U N D I N V E ST M E N T E L E C T I O N
For NEW accounts, the initial investment must be at least $2,000 (express as a dollar amount or as a percentage). ALL DIVIDENDS AND CAPITAL
GAINS WILL BE REINVESTED.
Embarcadero Small Cap Growth Fund (XX) $ or %
Embarcadero All Cap Growth Fund (XX) $ or %
Embarcadero Alternative Strategies Fund (XX) $ or %
TELE P H O N E E XCH A N G E P R I V I L E G E S
I do not want the ability to exchange shares by telephone on this account
TERM S A N D CO N D I T I O N S
I, the Participant, acknowledge that I have received and read the current Prospectus for each Fund, which I have designated for investment. I understand that all
dividends and distributions from the Fund shares held in my Account will be reinvested in shares of the Fund from which received.
Each subsequent contribution will be invested based on the written instructions received with the contribution. In the event that this is a rollover contribution, the
undersigned hereby irrevocably elects, pursuant to the requirements of Section 1.402(a)(5)-1T of the IRS regulations, to treat this contribution as a rollover contribu-
tion. The Custodian, upon written instructions from you, may exchange any Embarcadero Fund shares for any other Embarcadero Fund shares in accordance with the
then current prospectus.
Custodial Fees: $15 annual maintenance fee per year. The participant may prepay the annual maintenance fee. If the fee is not prepaid, the Custodian will deduct
the fee from the Account at year-end or at the time the Account is closed. The Custodian reserves the right to change the custodial fee, but will give at least 30 days
written notice to the Participant of any fee changes. The Custodian will keep those records, identify and file returns and provide other information concerning your
Account as required of Custodians by the Internal Revenue Code (IRC) and any Regulations issued or forms adopted by the Treasury Department of the United States.
I hereby establish an Individual Retirement Account (“IRA”) under the terms and conditions contained in the accompanying Custodial Account Agreement, which is
incorporated herein by reference. The combined instrument is hereinafter referred to as the “Agreement”. I acknowledge receipt of a copy of the Custodial Account
Agreement, this Application and Adoption Agreement, and the Disclosure Statement with respect to this IRA.
I direct that all benefits upon my death be paid as indicated on the beneficiary designation. If I named a beneficiary that is a Trust, I understand I must provide certain
information concerning such Trust to the Custodian.
I understand and agree that this IRA becomes effective upon written acceptance by the Custodian, Mutual Shareholder Services, LLC, which written acceptance shall
consist of a confirmation of transaction statement issued by the Custodian.
I (the Participant) certify under penalties of perjury that I am a US person (including a US resident alien) and that my Social Security Number is true, correct and
complete and that this number is my Taxpayer Identification Number. (If you are a foreign person, use the appropriate Form W-8.)
To help the U.S. government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record
information that identifies persons opening accounts. To comply, we require your name, address, date of birth and government-issued identification number (gener-
ally, a Social Security Number) and other information that may help us identify you. We may ask for copies of related documentation and we may consult third-party
databases to help verify your identity.
Partcipant’s Signature Date
IRA Custodian: Mutual Shareholder Services, LLC, 8000 Town Centre Drive, Suite 400, Broadview Heights, OH 44147. Distributor: Mutual Shareholder Services, LLC
for Embarcadero Funds. Shares of Embarcadero Funds are offered by the Distributor, Mutual Shareholder Services, LLC. The Distributor is not a bank, and shares of
the Funds are not deposits or obligations of, or guaranteed or endorsed by, any bank nor are they federally insured or otherwise supported by the FDIC, the Federal
Reserve Board or any other agency.
FOR D E A L E R U S E O N LY
Broker/Dealer Name and Number Representative Name and Number
Branch Location and Number Representative Phone Number