TruIRA ENROLLMENT FORM

TruIRA ENROLLMENT FORM
Participant Account Information

PLEASE DON'T USE ALL CAPS
Legal Name

First NameLast Name
Mailing Address (NO PO Box)

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (No PO Box)
City
County
State
Zip Code
Phone Number
Email
Date of Birth
SSN
(Needed to acquire both a TIN & EIN for the TruIRA)
Married
Citizenship Status
Type of TruIRA:
Amount to Rollover:
Primary Beneficiaries Information
Primary Beneficiary #1 Name:
(Individual, Trust, Charity)
Primary Beneficiary #1 Share %:
(Share Percent Allocated must total 100%)
Primary Beneficiary #1 Relationship
(Spouse, son, daughter, trust)
Primary Beneficiary #1 Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Primary Beneficiary #2 Name:
(Individual, Trust, Charity)
Primary Beneficiary #2 Share %:
(Share Percent Allocated must total 100%)
Primary Beneficiary #2 Relationship
(Spouse, son, daughter, trust)
Primary Beneficiary #2 Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Add Additional Beneficiaries?
Primary Beneficiary #3 Name:
(Individual, Trust, Charity)
Primary Beneficiary #3 Share %:
(Share Percent Allocated must total 100%)
Primary Beneficiary #3 Relationship
(Spouse, son, daughter, trust)
Primary Beneficiary #3 Phone:
(Spouse, son, daughter, trust)
Primary Beneficiary #4 Name:
(Individual, Trust, Charity)
Primary Beneficiary #4 Share %:
(Share Percent Allocated must total 100%)
Primary Beneficiary #4 Relationship
(Spouse, son, daughter, trust)
Primary Beneficiary #4 Phone:
(Spouse, son, daughter, trust)
Disclosure and Authorization Statement
As Trustee, I agree that the TruIRA must be operated in compliance and shall not engage in any transaction that would be considered a "prohibited transaction" as defined in Section 4975 of the Code and the Regulations thereunder.
I acknowledge that Ascension Business Group, LLC provides document preparation and consulting services ONLY solely for the purpose of assisting in the drafting and organization of this Trust Agreement. I further understand and agree that Ascension Business Group has not provided, and does not provide, legal advice or legal representation. I also agree that Ascension Business Group consultants are not financial advisors, and that they do not recommend or endorse any investments. I agree to seek out appropriately licensed professionals (financial, real estate, legal, tax) when making investments.
I hereby certify that all information provided above is true, correct, and complete to the best of my knowledge. I acknowledge that I am solely responsible for filing any and all tax returns or related filings associated with the TruIRA. I authorize Ascension Business Group, LLC, beginning in the second year from the date below, to charge a $399 annual Custodial Maintenance Fee to the payment method on file. This fee is assessed once per year to maintain the TruIRA in good standing with the custodian. I understand and agree that the custodial fee is mandatory, non-refundable, and required for continued account maintenance and compliance.
Limited Power of Attorney
I hereby appoint Ascension Business Group, LLC as my authorized agent and attorney-in-fact to act on my behalf, in my name and place, to the same extent as I could personally act if present, to the extent permitted by applicable law. This authorization specifically includes the authority to obtain a new Tax Identification Number (EIN) for my TruIRA Trust and/or related retirement account structure.This Power of Attorney shall remain in effect for a period of thirty (30) days from the date of execution and shall automatically terminate upon the expiration of such period or upon my written revocation, whichever occurs first.I, for myself and for my heirs, executors, legal representatives, and assigns, hereby agree to indemnify and hold harmless any third party from and against any and all claims, liabilities, losses, or damages that may arise by reason of such third party relying in good faith upon the provisions of this Power of Attorney.
Date

MonthDayYear
Should be Empty:

TruIRA ENROLLMENT FORM

Participant Account Information

Primary Beneficiaries Information

Disclosure and Authorization Statement

Limited Power of Attorney