Citibank Traditional IRA Kit

Enclosed please find your requested Individual Retirement Account (IRA) documents for you to complete and

return. Unless you have already converted to simplified banking, by returning the enclosed documents for the

below-listed actions, you will initiate Early Access to convert any eligible deposit and investment accounts you

currently own to simplified banking.

• Opening a new Traditional or Roth IRA.

• Opening a new Certificate of Deposit (CD) account or Insured Money Market Account (IMMA) within an

existing IRA.

If you choose not to proceed at this time, you can convert later by initiating Early Access or you will be converted

by Citibank pursuant to a separate notice in 2024.

Please note: Uniform Transfers to Minors Act (UTMA) / Uniform Gifts to Minors Act (UGMA) accounts, and

Special Title accounts, and their beneficial owners, are ineligible for Early Access.

About simplified banking:

• Citibank’s simplified banking will transform the way you bank. We are enhancing the customer experience,

which includes changing how you receive benefits and features, automatically linking eligible accounts you

own, simplifying our checking products and providing you with different opportunities to waive Monthly

Service Fees.

As part of these changes, we are eliminating Account Packages.

If you meet the qualifying

Balance Ranges, you will enjoy the benefits of the Citi Priority, Citigold® and Citigold® Private Client

Relationship Tiers.

Please note that IRAs do not have Monthly Services Fees and will be unaffected by this particular change.

IRA account customers with no other deposit accounts are in the Citibank Account Package.

• You can convert to simplified banking before your conversion date by initiating Early Access. Before you

choose Early Access or engage in activities that will initiate Early Access, learn more about how simplified

banking will impact you and your accounts by speaking to a banker or by viewing your simplified banking

snapshot and Early Access at citi.com/earlyaccess. Please note, once you convert to simplified banking, your

accounts cannot return to an Account Package.

Here’s how conversion works:

• Customers in the Citibank Account Package will immediately join Relationship Tiers if they have at least

$30,000 in combined average monthly balances (CAMB) in the month prior to conversion.

• Customers with accounts in the Citi Priority, Citigold and Citigold Private Client Account Packages on their

conversion date will remain in Relationship Tiers by the same name unless they meet a higher CAMB Balance

Range in the month prior to conversion.

• Customers may be converted to a Legacy Relationship as defined in the Citi Consumer Deposit Account

Agreement (“CMA”). You will be notified after conversion if a Legacy Relationship applies to your accounts.”

For more information

The Client Manual — Consumer Accounts and Marketplace Addendum (“CMMA”) applies to existing non-

retirement Citibank accounts that have not been converted to simplified banking. The Consumer Deposit

Account Agreement (“CMA”) applies to accounts in simplified banking. Terms, conditions and fees for accounts,

products, programs and services are subject to change. Agreements are subject to change without notice unless

required by law and amendments will be made available to you. You can obtain copies of the current CMA and

CMMA online at citi.com/accountagreementsandnotices and copies of the CMA in Citibank branches.

If you have any questions, please do not hesitate to contact your local branch or call 1-800-321-CITI (For TTY:

We accept 711 or other Relay Service).

07/23 Page 1 of 1

Citibank Traditional IRA Kit

Document Sections:

What You Need to Know

Traditional IRA Application

> Plan Owner Information

> Traditional IRA Application

Traditional IRA Plan Documents

> Traditional IRA Plan Documents, please visit: citi.com/TraditionalIRAplan

> Addendum to the Citibank Retirement Plan Documents and Coverdell Education

Savings Account — Cost of Living Adjustment (COLA) Information,

please visit: citi.com/AddendumCOLAInformation

> Consumer Deposit Account Agreement, please visit:

citi.com/ConsumerDepositAccountAgreement

Privacy Notice

> Please visit: citi.com/ConsumerPrivacyNotice

CUSTOMER INITIALS

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herein are service marks of Citigroup Inc. or its affiliates, used and registered throughout the world.

What You Need to Know

Please review the information below before you complete this form.

IMPORTANT INFORMATION ABOUT OPENING A NEW ACCOUNT AT CITIBANK: To help the United States Government fight

terrorism and money laundering, Federal law requires us to obtain, verify and record information that identifies each person

that opens an account.

What this means for you: When you open an account, we will ask for your name, a street address, date of birth, and an

identification number, such as a social security number, that Federal law requires us to obtain. We may also ask to see your

driver’s license or other identifying documents that will allow us to identify you. We appreciate your cooperation.

Please ensure you supply the following along with your completed application:

• Copy of valid government-issued photo ID (examples include: U.S. Drivers license, U.S. state-issued identity card, U.S. passport,

non-U.S. passport).

• Proof of residential address dated within 60 days of the date of this application (such as a utility bill, telephone bill – landline only,

cell phone is not acceptable).

• IRS Form W-9

if you are a US Person or IRS Form W-8BEN

if you are a non-US Person

• Please complete all sections marked as “Must Complete” to avoid delays with your application.

• To fund the plan, either attach a check made payable to Citibank, N.A. or provide instructions to debit your Citibank checking

or savings account.

When requesting a trustee-to-trustee transfer or direct rollover of funds from another institution please remember to:

• Attach a completed Citibank Transfer and Direct Rollover form

• Attach your distribution confirmation statement or your most recent account statement

• If a direct rollover, please include a check payable to Citibank N.A. as successor custodian

When requesting a conversion or recharacterization of a contribution from an existing Citibank Traditional IRA or SEP-IRA,

please remember to:

• Attach a completed Citibank IRA and Roth IRA Withdrawal and Tax Withholding Election Form.

• A Roth IRA conversion cannot be undone or recharacterized.

Return completed form(s) to a Citibank branch or mail form(s) to:

Retirement Plan Services

P.O. Box 769001

San Antonio, TX 78245-9951

For overnight delivery, send to:

Retirement Plan Services

100 Citibank Drive

San Antonio, TX 78245

If you have any questions

Call Retirement Plan Services at 1-800-695-5911.* For TTY: we accept 711 or other Relay Service. Representatives are available to

assist you Monday through Friday 8:00 a.m. – 10:00 p.m. Eastern Time, and Saturday 9:00 a.m. – 5:30 p.m. Eastern Time.

*To ensure quality service, calls are recorded

IRS Form W-9 can be found online by visiting: https://www.irs.gov/pub/irs-pdf/fw9.pdf IRS Form W-8BEN can be found online by visiting https://www.irs.gov/pub/irs-pdf/

fw8ben.pdf

06/23 RPS507 Traditional

Page 1 of 12

PART A

Citibank IRA Application

Plan Owner Information

You must complete Sections 1-3 to avoid delays with your application process.

Please type ”N/A” when not applicable.

1. Owner Information (Must Complete)

First Name:

______________________________ Middle: _________________________________ Last Name: ___________________________________

Date of Birth (mm/dd/yyyy): _______________________________________________________

Identification

Identification Type:

_____________________________________ ID Number: ____________________________________State: _____________________

Issue Date: __________________________ Expiration Date: ________________________________

Residential Address (If less than one year in address, please provide Prior Residential Address below)

Housing Status:  Own  Rent  Co-Op/Condo  Parents  Other

Street Address:

_________________________________________________________________________________ Apt. Number: _____________________

City: _____________________________________State: _____________________________ Zip: ________________ Country: ________________________

Address since:___________________________

Prior Residential Address

Start Date: ______________________________End Date: _________________________

Street Address: _________________________________________________________________________________ Apt. Number: _____________________

City: _____________________________________State: _____________________________ Country: _________________________ Zip: _______________

Mailing Address (If different from Residential Address above)

Street Address:

_________________________________________________________________________________ Apt. Number: _____________________

City: _____________________________________State: _____________________________ Zip: ________________ Country: ________________________

Phone Number (Please at least one)

Home: ___________________________________ Business: _______________________________ Mobile: ________________________________________

By providing a phone number, you agree that we or our service providers can contact you at that number by text message, artificial

voice, pre-recorded or autodialed calls. Your phone plan charges may apply.

Email Address (Please provide at least one)

Primary:________________________________________________Secondary: _____________________________________________

 I prefer not to provide or do not have an email address.

Security Questions

Mother’s Maiden Name: ________________________________ First School Attended: __________________________________

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06/23 RPS507 Traditional

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PART A

2. Tax Reporting and Senior Public Figure (SPF) Information (Must Complete)

Tax Reporting Information

 I am a U.S. Person. My Social Security Number is:

________________________________

 I am a resident alien. My Social Security Number is: ______________________________ and my Country of Citizenship is: ________________

 I am a Non-U.S. Person (a nonresident alien). My Foreign Tax Identification Number (FTIN) is: ______________________________________

 My status as a U.S. Person or non-U.S. Person has changed (I may be required to submit an updated U.S. Tax Certification

Form W-9

or Form W-8BEN

)

My country of tax reporting is__________________________________(If U.S. Citizen or resident alien, please complete Form W-9

Important: Non-US Persons are generally subject to a 30% withholding tax on the amount of their withdrawal. A reduced rate may

apply if you have provided a Form W-8BEN

with a valid treaty claim with a country that provides for a lower withholding rate.

Senior Public Figure (SPF) Information

The definition of senior public figure encompasses both foreign and domestic senior public figures.

A senior public figure is a current or former:

• senior official in the executive, legislative, administrative, military or judicial branches of a government, whether elected or

appointed, or paid or not; or

• senior official of a major political party; or

• senior executive of a government-owned or government-funded corporation, institution or charity.



Yes, I am a senior public figure

 No, I am not a senior public figure

If Yes, what is your senior public figure office title? _________________________________________________________________________________

If Yes, how long in this position?  Up to 1 Year  1–5 years  5–10 years  10–20 years  20+ years

In addition, the definition of a senior public figure (SPF) includes the “close associates” and “immediate family members” of a senior

public figure. A close associate is a person who is widely and publicly known to have a close association with a senior public figure.

The immediate family members of a senior public figure include, for example, spouses, domestic partners, parents, siblings, children,

step-children, the spouses of children, and a spouse’s parents and siblings.

 Yes, I am a close associate or related to a senior public figure

 No, I am not a close associate or related to a senior public figure

If Yes, what is your relationship to the senior public figure?

____________________________________________________________________________

Footnotes:

IRS Form W-9 can be found online by visiting: https://www.irs.gov/pub/irs-pdf/fw9.pdf

IRS Form W-8BEN can be found online by visiting: https://www.irs.gov/pub/irs-pdf/fw8ben.pdf

Branch employees please submit the appropriate addendum.

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06/23 RPS507 Traditional

Page 3 of 12

PART A

3. Financial Information (Must Complete)

SOURCE OF WEALTH

1. Occupation

> What is your current occupation status?



Full Time  Part Time  Business Owner  Home maker

 Self Employed  Retired  Student  Not Employed

If Employment

Employer Name

_______________________________________________________________________________________________________________________

Street Address _________________________________________________________________________________ Apt. Number ______________________

City _____________________________________State ______________________________ Country _________________________ Zip ________________

Start Date ______________ End Date ___________________

Employer Country ____________________________________

Occupation Category __________________________________ Occupation Subcategory ________________________________________

Industry Classification ________________________________

Is this a primary contributor to Source of Wealth?  Yes  No If Yes, Include in Section 2.

If Business Ownership

Business Name

_______________________________________________________________________________________________________________________

Country of Primary Business Operations (May provide up to three)

1. _________________________________________ 2. ____________________________________ 3. __________________________________________

Country of Incorporation ________________________________

Industry Classification ___________________________________

Is this a primary contributor to Source of Wealth?  Yes  No If Yes, Include in Section 2

If Self-Employed

Country of Primary Business Operations (May provide up to three)

1. _________________________________________ 2. ____________________________________ 3. __________________________________________

Industry Classification ___________________________________

Occupation Category ____________________________________ Occupation Subcategory ________________________________________

Is this a primary contributor to Source of Wealth?  Yes  No If Yes, Include in Section 2

2. Source of Wealth

> Identify Client’s significant Source of Wealth which contributed 25% or more to their total net worth

 Employment (Section 2A  Investments excluding Retirement Accounts (Section 2F

 Bus

iness Ownership (Section 2B  Personal Real Estate (Section 2G

 Self-Empl

oyment (Section 2C  Trust Fund (Section 2H

 Inh

eritance/Gift/Payout (Section 2D  Government Support (Section 2I

 Sp

ousal/Parental/Partner Support (Section 2E  Loans/Grants/Scholarships (Section 2J

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06/23 RPS507 Traditional

Page 4 of 12

PART A

2A. Employment

Employer Name

_______________________________________________________________________________________________________________________

Employer Country _______________________________________ Country of Employer’s Headquarters ____________________________

Occupation Category ____________________________________ Occupation Subcategory ________________________________________

Industry Classification ___________________________________

Annual Compensation (USD) ____________________________

Is the client receiving any Pension/Retirement Payments?  Yes  No If Yes, Annual Amount (USD) _____________________________

2B. Business Ownership

Business Name

________________________________________________________________________________________________________________________

Country of Primary Business Operations (May provide up to three)

1. _________________________________________ 2. ____________________________________ 3. __________________________________________

Country of Incorporation ________________________________

Annual Personal Income from Business (USD) ____________

Industry Classification ___________________________________

2C. Self-Employment

Country of Primary Business Operations (May provide up to three)

1. _________________________________________ 2. ____________________________________ 3. __________________________________________

Industry Classification ___________________________________

Occupation Category ____________________________________ Occupation Sub-Category ______________________________________

Annual Personal Income from Self-Employment (USD) _______________

2D. Inheritance/Gift/Payout

Name of Payor or Entity

_______________________________________________________________________________________________________________

Relationship to Client _____________________________________________

Value of Payment (USD) ___________________________________________

Country ___________________________________________________________

2E. Spouse/Parental/Partner Support

First Name

________________________________________________________ Last Name ____________________________________________________

Date of Birth

________________________________ Relationship to Client __________________________Percentage of Contribution ______________

Provider of Funds Country _________________________________________ Provider of Funds Country of Citizenship ______________________

> What is the Source of Wealth of the person who is providing you the funds?

 Business Ownership

Business Name _____________________________________________________________________________________________________________________

 Employment

Employer Name _____________________________________________________________________________________________________________________

 Self-Employment

Industry Classification _____________________________________________________________

 Government Support

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06/23 RPS507 Traditional

Page 5 of 12

PART A

 Inheritance/Gift/Payout

Name of Payor or Entity ____________________________________________________________ Relationship to Client _____________________

 Investments

Does client still own investments?  Yes  No

If yes, provide the following:

Current Value of the Investments (USD) __________________________________________

If no, provide the following:

Value of the Investment at the time of sale (USD) _________________________________

 Personal Real Estate

Has the client sold any Real Estate that generated capital gain?  Yes  No

If yes, provide the following:

Value of the Personal Real Estate at the time of sale (USD) ________________________

Does the client own Personal Real Estate that generates rental income?  Yes  No

If yes, provide the following:

Annual net rental income (USD) _________________

 Trust Fund

Name of Grantor/Settler or Entity ___________________________________________________ Relationship to Client ________________________

 Loans/Grants/Scholarships

Name of Payor or Entity ____________________________________________________________ Relationship to Client ________________________

2F. Investments Excluding Retirement Accounts

Start Year of Investments

______________________________________

Does the client still own the Investment?  Yes  No

If Yes, Current value of investments (USD) _________________________

If No, Value of the investment at the time of sale (USD) ____________

2G. Personal Real Estate

Original Year of Real Estate Purchase

__________________________________

> Has the client sold any real estate that generated a capital gain?  Yes  No If Yes, provide the following:

Value at the time of sale (USD) _______________________________________

> Does the client own Personal Real Estate that generates rental income?  Yes  No If Yes, provide the following:

Annual net rental income (USD) _____________________________________

2H. Trust Fund

Only First and Last Name OR Entity Name is required.

Total amount of payout over the life of the Trust

_______________________

> Grantor/Settlor Details

Name of Grantor/Settlor or Entity __________________________________________________________________________________________________

Grantor Relationship to Client ___________________________________

Country ___________________________

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06/23 RPS507 Traditional

Page 6 of 12

PART A

2I. Government Support

Yearly Income from Government Support (USD)

_______________________

Country of Government Agency _______________________________________

2J. Loans/Grants/Scholarship

Name of Payor or Entity Name

_________________________________________________________________________________________________________

Relationship to Client

_____________________________________________

Country of Grantor ________________________________________________

Value of Loan/Grant/Scholarship (USD) ____________________________

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06/23 RPS507 Traditional

Page 7 of 12

PART A

Citibank Traditional IRA Application

• To open a new Traditional IRA account, use this form. You may open only one IRA per application.

– Your IRA will have a unique Plan Number which will be used as your IRA reference number for this and all future IRA transactions

• To open a new Roth IRA, please use the Citibank Roth IRA Application.

• Non-spouse beneficiary(ies) please use the Beneficiary IRA application

• To open a SEP-IRA to receive SEP contributions, please use the SEP-IRA Employee application. Please use the SEP Employer

application with SEP Adoption Agreement to establish a SEP plan.

• For contributions to an existing Citibank IRA, please use the Citibank IRA Contribution Form.

– You may also use the last page of your most recent Year-End Summary Statement, or call Retirement Plan Services at

1-800-695-59

11. For TTY: we accept 711 or other Relay Service. To ensure quality service, calls are recorded.

You must complete Sections 1-6 to avoid delays with your application process.

Please type ”N/A” when not applicable.

1. Plan Type (Must Complete)

 Traditional IRA  Rollover IRA

2. Contribution Type and Total Amount of Your Contribution (Must Complete)

Contributions made in a tax year are treated as a contribution for that tax year unless the client (participant) affirmatively and

timely requests that the contribution be treated as a prior year contribution.



Regular Contribution – Current Year: Year: 20 ____ Current Tax Year $ ____________________

 Regular Contribution – Prior Year: Year: 20 Prior Tax Year $ _______________________

 Trustee-to-Trustee Transfer Contribution (please see footnote #1 for more details)

Contribution Amount $_________________________



Yes, Citibank, N.A. is to initiate a trustee-to-trustee transfer or direct rollover from another institution on my behalf.

 No, Citibank, N.A. is not to initiate a trustee-to-trustee transfer or direct rollover from another institution on my behalf.

If“Yes”, attach a Citibank IRA Transfer and Direct Rollover Form and a recent account statement from the other institution.

If“No,” please continue to Section 3

 Rollover Contribution Distribution (please see footnote #2 for more details)

Please Note: Under current law, you may make only one rollover from an IRA to another (or the same) IRA in any 12-month period,

regardless of the number of IRAs you own. If you have completed an IRA-to-IRA rollover in the preceding 12 months you may not

complete another nontaxable rollover at this time. Rollovers from employer plans, and direct trustee-to-trustee transfers are not

subject to this limitation. For additional information, see https://www.irs.gov/retirement-plans/ira-one-rollover-per-year-rule

 Direct Rollover  Late Direct Rollover  60 Day Rollover  Late 60 Day Rollover

Plan type from which the distribution was made:

 Traditional IRA  Roth IRA  401K  ESOP  Profit Sharing Plan  Other: ______________________________

Distribution Amount $ ________________________

Original Distribution and Rollover Contribution Amount $ _____________________________________

Original date that funds were distributed __________________________________

Date funds were received __________________________________________________

Footnotes:

A Trustee-to-Trustee Transfer contribution occurs when retirement assets are transferred directly from one financial institution to another financial

institution to like qualified plans.

The rollover must occur within 60 days of the date you received the funds. Please include a copy of your distribution confirmation statement if you are

establishing a plan with funds you previously withdrew from an IRA, Roth IRA, Qualified Plan, or SEP-IRA. For more information please review https://

www.irs.gov/retirement-plans/accepting-late-rollover-contributions

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06/23 RPS507 Traditional

Page 8 of 12

PART A

 Recharacterization Contribution (please see footnote #3 for more details)



From a Traditional IRA  From a Roth IRA  From a SEP-IRA

Amount $ ______________________________________

 Conversion Contribution (To a Roth IRA only, please see footnote #4 for more details)

Amount $ ______________________________________

3. Source of Funds for This Account (Must Complete)



Cash on hand  Sale of property  Check Deposit

 Transfer from existing Citibank account  Business ownership  Investments



Wages/Pensions/Social Security  Inheritance  Other ___________________________

4. Product Type (Must Complete)

Refer to your Citibank IRA Plan Documents. Citibank can hold contribution funds uninvested or deposit funds in a Citibank Insured Money

Market (“IMMA”) account if you do not provide clear written directions by the time Citibank receives the funds or in order to process

certain transactions including requests from you, a beneficiary, a local state or federal governmental entity or other authorized party.

Certificates of Deposit (“CD”) and IMMA accounts will receive the interest rate in effect when Citibank receives the funds. Please refer

to the IRA account Product section of the IRA Account Supplement for details. For current Annual Percentage Yields and interest rates

for CD and IMMA accounts in a Citibank IRA, visit citi.com, speak to a banker in a Citibank branch, or call Retirement Plan Services.

Contribution amounts you list here cannot exceed the total contribution amount indicated in Section 2 and Section 5.

 Certificate(s) of Deposit (“CD”)

Term _______________________ Term ________________________ Term ________________________

Amount $ __________________ Amount $ ___________________ Amount $ ___________________

(minimum deposit $250) (minimum deposit $250) (minimum deposit $250)

 Insured Money Market (“IMMA”) account

Amount $ ____________________________________

(no minimum)

5. Contribution Method (Must Complete)

a.  Check attached (Check must be made payable to Citibank, N.A. or for trustee-to-trustee transfers/direct rollovers Citibank,

N.A. as successor custodian)

b.  Debit from a Citibank checking or savings account:

 One time debit

Please deduct $ _________________________from my Citibank checking or savings account # _____________________________

 Monthly debit (contributions are for the current year only and will be credited to an IRA plan)

Please deduct $ _________________________from my Citibank checking or savings account # _____________________________

on the ___________________________ day of each month, beginning with the month of ________________________ .

Footnotes:

If you are recharacterizing a contribution from an existing Citibank Traditional IRA, Roth IRA, or SEP-IRA, please also attach a completed Citibank IRA

and Roth IRA Withdrawal and Tax Withholding Election Form. A Roth IRA conversion made on or after January 1, 2018, cannot be re-characterized.

For details, see “Recharacterizations” in Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs) https://www.irs.gov/forms-

pubs/about-publication-590-a

If you are converting a contribution from an existing Citibank Traditional IRA or SEP-IRA, please also attach a completed Citibank IRA or Roth IRA

Withdrawal and Tax Withholding Election Form.

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06/23 RPS507 Traditional

Page 9 of 12

PART A

6. Beneficiary Designation

Naming a Beneficiary

• You may designate up to ten (10) primary beneficiaries and ten (10) contingent beneficiaries per plan (Please attach a separate form

with the additional beneficiaries and/or contingent if more than six).

• If you do not designate a beneficiary, your estate will be your beneficiary.

• The beneficiaries designated here will be the beneficiaries of the entire IRA you are currently opening. You cannot designate a

beneficiary for a particular deposit product type within an IRA, Roth IRA, or SEP-IRA. The name of the person designated will

govern, not the relationship.

• If you designate more than one primary beneficiary, the proceeds will be distributed equally among the designated beneficiaries

unless you indicate the share percentage for each. Any contingent beneficiary you name will receive proceeds only if all your primary

beneficiaries are deceased. If you designate more than one contingent beneficiary, the proceeds will be distributed equally among

the survivors unless you indicate the share percentage for each.

Primary Beneficiary(ies)

Name

_______________________________________________________________________________________________________________________________

Address _____________________________________________________________________________________________________________________________