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Vanguard Direct Rollover IRAAdoption AgreementFor institutional plan participant use onlyThis form is for a participant or a beneficiary of a participant who wishes to roll over Vanguardmutual fund assets from an employer-sponsored retirement plan, administered by Vanguard, to aVanguard IRA . Do not use this form to roll over brokerage assets, non-Vanguard mutual funds, or companystock. You must contact Vanguard Brokerage Services (VBS ), a division of Vanguard MarketingCorporation, at 800-992-8327 to obtain and complete a separate form. Questions?Call 800-523-1188.If you need other forms or want tocomplete this form online, visit ourwebsite at:Please complete, print, and sign or print the form and fill out using capital lettersand black ink.www.vanguard.com/serviceforms1. Account owner information(In the case of a rollover by a beneficiary of a deceased participant, provide the name of individual or trust beneficiary.) Provide your full,legal name.Name of individual (first, middle initial, last) or Name of TrustName of trustee, if applicableDate of birth (mm/dd/yyyy)or Date of trust agreement (mm/dd/yyyy)Daytime phone (area code, number, extension)Evening phone (area code, number, extension)E-mail addressIf you have applied for anSSN or other taxpayeridentification number buthave not received it,enter the date on whichyou applied.Social Security number (SSN) or other taxpayer identification number Important: If an account owner is a trust, the trustees must also complete and submit with this form a VanguardTrustee Certification Form (available at vanguard.com/forms).CitizenshipU.S. Resident alienYou must completethis entire section. Tax residency Nonresident alien*U.S. Other*Country of citizenship if not U.S.Country of tax residence if not U.S.Name of employer who sponsors the retirement planEmployer's retirement plan numberMailing addressStreet or P.O. BoxCity, State, ZipCountry if not U.S.Street address (P.O. Box or rural route is not acceptable; address can be military APO or FPO.)This is required if it isdifferent from themailing address or ifthe mailing address is aP.O. Box.Street City, State, ZipCountry if not U.S.*For Individuals. If you're a nonresident alien, you must complete an IRA Form W-8 electronically to certify your tax status, and to claim treatybenefits if applicable. We'll mail you instructions for completing the electronic Form W-8 once your account has been established.For trusts. If the country of establishment or tax residence is other than the U.S., you'll be required to complete either an official IRS Form W-9on paper to certify the trust's tax status as U.S. or a Form W-8 electronically to certify the trust's tax status as foreign, and to claim treaty benefitsif applicable. We'll mail you instructions once your account has been established.(09/20/2016) 2016The Vanguard Group, Inc.All rights reserved.Connect with Vanguard vanguard.com 800-523-1188T33355 0920161 of 9
2. Custodian Information Complete this section only if you are opening this IRA for a minor.Name (first, middle initial, last) Provide the full,legal name.Date of birth (mm/dd/yyyy)E-mail address (optional)Daytime phone (area code, number, extension)If you have applied for anSSN or other taxpayeridentification number buthave not received it,enter the date on whichyou applied.Social Security number (SSN) or other taxpayer identification number CitizenshipU.S. Resident alienYou must completethis entire section.Evening phone (area code, number, extension) Tax residency Nonresident alienCountry of citizenship if not U.S.U.S. OtherCountry of tax residence if not U.S.Mailing addressCheck if the following addresses are the same as the addresses on the previouspage. If they are, you do not have to repeat them.Street or P.O. BoxCity, State, ZipCountry if not U.S.Street address (P.O. Box or rural route is not acceptable; address can be military APO or FPO.)This is required if it isdifferent from themailing address or ifthe mailing address is aP.O. Box.Street City, State, ZipCountry if not U.S.3. Rollover to a traditional IRAComplete this section if you are rolling non-Roth (i.e. pre-tax and traditional after-tax) plan assets to a traditional IRA.Roth assets cannot be rolled over to a traditional IRA.Rollover instructionsYou can roll overassets to your currentfunds or new funds. An existing traditional/rollover IRAAn existing SEP or SIMPLE IRA* Vanguard IRA account numberA new rollover IRAIf you are a nonspousebeneficiary, you mustselect this option. A new inherited traditional IRA.**Name of deceased employer-sponsored plan participant*You cannot use this form to open a new SEP IRA or SIMPLE IRA. You can only roll over to a SIMPLEIRA if it has been at least 2 years since the first contribution was made to your SIMPLE IRA.**You must take required minimum distributions from the inherited IRA. Please read thespecial tax notice regarding plan payments for further details about this requirement.(09/20/2016)T33355 0920162 of 9
3. Rollover to a traditional IRA (continued)Investment instructionsA. Vanguard funds to invest your rollover inThis section must be completed to direct your Vanguard mutual fund and/or investment contract assets. Indicate whichVanguard funds you want to invest in and the percentage you wish to allocate to each fund. For fund names and numbers go tovanguard.com/us/funds. Be sure the funds you choose are currently open to new investors.Roll over my assets into the same Vanguard funds I currently have in my employer's plan. Please note: Investmentcontracts and collective trusts are not available for IRAs. Vanguard Federal Money Market Fund will be substituted for yourinvestment contract fund(s), collective trusts, company stock, and non-Vanguard mutual funds unless otherwise specifiedbelow. Vanguard will substitute the Investor share class of the corresponding fund unless otherwise specified below.You can rollover into yourcurrent funds ornew funds.Roll over my assets into the Vanguard funds listed below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address. B. Non-Vanguard funds(Complete this section only if you own non-Vanguard mutual funds. If you wish to retain your non-Vanguardfunds, please contact Vanguard Brokerage Services at 800-992-8327 for further instructions.)Sell my non-Vanguard mutual funds and invest the proceeds in a Vanguard Brokerage IRA money market settlementaccount.Please note: If you want to purchase non-Vanguard mutual funds, individual stocks, bonds, or options, youmust contact Vanguard Brokerage Services at 800-992-8327.Sell my non-Vanguard mutual funds and purchase shares of the Vanguard funds indicated below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address.(09/20/2016) T33355 0920163 of 9
3. Rollover to a traditional IRA (continued)C. Rollover of company stock(Complete this section only if you own company stock. If you wish to retain your stock in your IRA, please contact VanguardBrokerage Services at 800-992-8327 for further instructions.)I wish to retain my stock. I understand that I must contact Vanguard Brokerage Services for a separate application.Residual company stock fund shares will be sold and invested as indicated below.Sell my company stock fund shares and purchase shares of the Vanguard funds indicated below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address. D. Vanguard Brokerage Option (VBO )Choose this option if you are rolling over a plan with non-Vanguard mutual fund assets including individual securities that youwould like to rollover directly to a Brokerage Rollover IRA.Please contact Vanguard Brokerage Services at 800-992-8327 for further direction and a separate application.4. Rollover to a Roth IRAComplete this section if you are rolling over Roth and/or non-Roth plan assets (i.e. pre-tax, after-tax assets) to a Roth IRA.In general, a rollover from a non-Roth employer-sponsor plan to a Roth IRA is taxable in the year of the rollover. Please contact Vanguard or your taxadvisor for more details.You can roll overassets to your currentfunds or new funds. An existing Roth IRA Vanguard IRA account numberA new Roth IRAIf you are a nonspousebeneficiary, you mustselect this option. A new inherited Roth IRA.**Name of deceased employer-sponsored plan participant**You must take required minimum distributions from the inherited IRA. Please read thespecial tax notice regarding plan payments for further details about this requirement.(09/20/2016)T33355 0920164 of 9
4. Rollover to a Roth IRA (continued)Investment instructionsA. Vanguard funds to invest your rollover inThis section must be completed to direct your Vanguard mutual fund and/or investment contract assets. Indicate whichVanguard funds you want to invest in and the percentage you wish to allocate to each fund. For fund names and numbers go tovanguard.com/us/funds. Be sure the funds you choose are currently open to new investors.Roll over my assets into the same Vanguard funds I currently have in my employer's plan. Please note: Investmentcontracts and collective trusts are not available for IRAs. Vanguard Federal Money Market Fund will be substituted for yourinvestment contract fund(s), collective trusts, company stock, and non-Vanguard mutual funds unless otherwise specifiedbelow. Vanguard will substitute the Investor share class of the corresponding fund unless otherwise specified below.You can rollover into yourcurrent funds ornew funds.Roll over my assets into the Vanguard funds listed below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address. B. Non-Vanguard funds(Complete this section only if you own non-Vanguard mutual funds. If you wish to retain your non-Vanguardfunds, please contact Vanguard Brokerage Services at 800-992-8327 for further instructions.)Sell my non-Vanguard mutual funds and invest the proceeds in a Vanguard Brokerage IRA money market settlementaccount.Please note: If you want to purchase non-Vanguard mutual funds, individual stocks, bonds, or options, youmust contact Vanguard Brokerage Services at 800-992-8327.Sell my non-Vanguard mutual funds and purchase shares of the Vanguard funds indicated below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address.(09/20/2016) T33355 0920165 of 9
4. Rollover to a Roth IRA (continued)C. Rollover of company stock(Complete this section only if you own company stock. If you wish to retain your stock in your IRA, please contact VanguardBrokerage Services at 800-992-8327 for further instructions.)I wish to retain my stock. I understand that I must contact Vanguard Brokerage Services for a separate application.Residual company stock fund shares will be sold and invested as indicated below.Sell my company stock fund shares and purchase shares of the Vanguard funds indicated below.Note: Please provide your fund allocation in whole percentages. Partial percentages will be rounded to the nearestwhole percent to allow your total allocation to equal 100%.When indicating howmuch to invest, be sureyou are meeting the fund'sminimum investment (formost funds, it is 3,000).If you need more space,provide the information ona separate sheet.Fund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsFund nameFund number% of assetsNote that we charge a 20 annual account service fee for each Vanguard fund with a balanceof less than 10,000 in an account. This fee does not apply if you sign up for account accesson Vanguard.com and choose electronic delivery of account statements, confirmations, fundreports, and prospectuses. This fee does not apply to members of our enhanced services,which require a minimum of 100,000 in total household assets held at Vanguard by you andyour immediate family members residing at the same address. D. Vanguard Brokerage Option (VBO )Choose this option if you are rolling over a plan with non-Vanguard mutual fund assets including individual securities that youwould like to rollover directly to a Brokerage Rollover IRA.Please contact Vanguard Brokerage Services at 800-992-8327 for further direction and a separate application.5. BeneficiariesComplete this section only if you're rolling over some or all of the assets to a new traditional IRA and/or Roth IRA and youdon't have existing IRAs of the same type. If you're rolling over the assets to an existing Vanguard IRA, we'll apply yourexisting beneficiary designations. If the account owner is a trust, skip to Section 6.Check the type(s) of Vanguard IRA to which the following beneficiary designations should apply.If you are establishingmore than one type ofIRA and want to makedifferent beneficiarydesignations for each,photocopy this section.All of my traditional IRAsAll of my inherited traditional IRAsAll of my Roth IRAsAll of my inherited Roth IRAsMy existing SEP/SIMPLE IRAPrimary beneficiaries(Check all that apply.)Those you designate as your primary beneficiaries will be first to inherit your IRA assets upon your death. Indicate the percentages ofyour assets to be distributed to the designated primary beneficiaries upon your death. The total must equal 100%.My spouseIf you select "To the person I am married to at the time of my death," your assets will be distributed to whomever is yourspouse at that time.To the person named here.Name (first, middle initial, last)Birth date (mm/dd/yyyy)%Check only one option;do not check both boxes. orTo the person I am married to at the time of my death.(09/20/2016)%T33355 0920166 of 9
5. Beneficiaries (continued)Primary beneficiaries (continued)(Check all that apply.)Those you designate as your primary beneficiaries will be first to inherit your IRA assets upon your death. Indicate the percentages ofyour assets to be distributed to the designated primary beneficiaries upon your death. The total must equal 100%.My descendantsTo my descendants who survive me, per stirpes.If you want your assetsdivided into unequalamounts, list the namesof the individuals below.Your assets will be divided equally among your children. If a child is deceased, the entireportion due to that child will be divided equally among his or her children (if any).% Equally to my grandchildren who survive me.%Individuals Name of individual (first, middle initial, last)If you want to name morethan two primarybeneficiaries, please liston a separate piece ofpaper and attach it tothis form.Birth date (mm/dd/yyyy)% Birth date (mm/dd/yyyy)Name of individual (first, middle initial, last)%TrustsTo an existing trust created under an agreement.Name of trustDate of trust (mm/dd/yyyy)%This applies to existingtrusts only; you cannotcreate a trust withthis form.To a trust created under my last will.Name of trust or section of will%OtherOrganization or charity (Provide name)%If you choose this box,indicate the percentageand skip to Section 6.My estate%If the percentages do nottotal 100%, Vanguard willallocate equal percentagestotaling 100%.Total100%Secondary beneficiariesThose you designate as your secondary beneficiaries will inherit your assets only if there are no surviving primary beneficiaries upon yourdeath. Indicate the percentages of your assets to be distributed to the designated secondary beneficiaries upon your death. The total mustequal 100%.My spouseIf you select "To the person I am married to at the time of my death," your assets will be distributed towhomever is your spouse at that time.To the person named here.Name (first, middle initial, last)Check only oneoption; do not checkboth boxes.(09/20/2016)Birth date (mm/dd/yyyy) To the person I am married to at the time of my death. T33355 0920167 of 9
5. Beneficiaries (continued)Secondary beneficiaries (continued)(Check all that apply.)Those you designate as your secondary beneficiaries will inherit your assets only if there are no surviving primary beneficiaries upon yourdeath. Indicate the percentages of your assets to be distributed to the designated secondary beneficiaries upon your death. The total mustequal 100%.My descendants To my descendants who survive me, per stirpes.If you want your assetsdivided into unequalamounts, list the namesof the individuals below.Your assets will be divided equally among your children. If a child is deceased, the entireportion due to that child will be divided equally among his or her children (if any). % Equally to my grandchildren who survive me.%Individuals Name of individual (first, middle initial, last)If you want to name morethan two secondarybeneficiaries, please liston a separate piece ofpaper and attach it tothis form.Birth date (mm/dd/yyyy)% Birth date (mm/dd/yyyy)Name of individual (first, middle initial, last)%TrustsTo an existing trust created under an agreement.Name of trustThis applies to existingtrusts only; you cannotcreate a trust withthis form.Date of trust (mm/dd/yyyy)% To a trust created under my last will.Name of trust or section of will%OtherOrganization or charity (Provide name)%If you choose this box,indicate the percentageand skip to Section 6.My estate%If the percentages do nottotal 100%, Vanguard willallocate equal percentagestotaling 100%.(09/20/2016)Total100%T33355 0920168 of 9
6. Signature of account ownerRead carefully before signing.Important information about opening a new account.Vanguard is required by federal law to obtain from each person who opens an account certainpersonal information (including name, street address, and date of birth among other information)that will be used to verify identity. If you do not provide us with this information, we will not beable to open the account. If we are unable to verify your identity, Vanguard reserves the right toclose your account or take other steps we deem reasonable.I hereby adopt or reaffirm my prior adoption of the Vanguard Traditional and Roth IRA CustodialAccount Agreement that is incorporated herein by reference and that I acknowledge having receivedand read. I also acknowledge having received and read the Vanguard Traditional and Roth IRADisclosure Statement and a prospectus for each Vanguard fund I elected under this agreement.I understand that if I have elected to have assets rolled over into an existing Vanguard IRA and have notcompleted Section 5, the beneficiary designations on my existing Vanguard IRA will remain in effect.If I am a U.S. citizen, a U.S. resident alien, or a representative of a U.S. entity, I certify underpenalty of perjury that:1. The taxpayer ID number I have given on this form is correct (or I am waiting for a number to beissued to me).2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) Ihave not been notified by the Internal Revenue Service (IRS) that I am subject to backupwithholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified methat I am no longer subject to backup withholding.Important: Cross out item 2 if you have been notified by the IRS that you are currently subject tobackup withholding because you failed to report all interest or dividends on your tax return.3. I am a U.S. citizen or other U.S. person (as defined by the IRS in its Form W-9 instructions).4. The Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicatingthat I am exempt from FATCA reporting is correct.If I am not a U.S. person, I will complete the appropriate Form W-8 electronically to certify my foreignstatus, including my FATCA status, and to claim treaty benefits if applicable. The IRS does not requireyour consent to any provision of this document other than the certification required to avoid backupwithholding.Account owner's signatureDate (mm/dd/yyyy)Vanguard Fiduciary Trust CompanyTitleOfficerMake a copy of your completed form for your records.Mail your completed form and any attached information in the enclosed postage-paid envelope.Mailing information(09/20/2016)If you do not have a postage-paid P.O. Box 1101 envelope, mail to:Valley Forge, PA 19482-1101For overnightdelivery, mail to: 400 Devon Park Drive Wayne, PA 19087T33355 0920169 of 9
An existing SEP or SIMPLE IRA* *You cannot use this form to open a new SEP IRA or SIMPLE IRA. You can only roll over to a SIMPLE IRA if it has been at least 2 years since the first contribution was made to your SIMPLE IRA. (09/20/2016) T33355_092016 **You must take required mini