1457-E (5/12) 053012 © 2012 First Command Bank

INVESTMENT MANAGEMENT ACCOUNT

IMA REMITTANCE SLIP

A. Please invest the attached check for $__________________________________ into my Investment Management Account (IMA).

__________________________________________________________________________________ ___________________________________________

IMA Account Registration IMA Account Number

Note: If investing into a trust, single-registered, or joint-registered account, skip sections B and C, print form and mail with check as indicated at bottom of page.

B. FOR IRAs ONLY: If you are depositing these funds into an Individual Retirement Account (IRA), please complete this section:

I. IRA TYPE (select one) TRADITIONAL IRA ROTH IRA SEP IRA

II. CONTRIBUTION TYPE In keeping with Internal Revenue Service (IRS) tax reporting requirements, employer contributions (including employee salary deferrals) must be processed and reported in the year they actually occur, regardless of the year of designation. Obtain and refer to the instructions on filing IRS Form 5498.

Current Year Prior Year Total

TRADITIONAL / ROTH CONTRIBUTION $_____________________ $_____________________ $_____________________

SEP CONTRIBUTION (see SEP note below) $_____________________ $_____________________ $_____________________

ROLLOVER (see Age 70½ Rollover note below) $_____________________ $_____________________

TOTAL DEPOSIT:

(Attached check should equal this amount) $_____________________

SEP CONTRIBUTION NOTE

SEP Contributions made for prior year will be reported in the current year on the 5498. It is the responsibility of the client to report to the IRS the current and prior year SEP contributions.

AGE 70½ ROLLOVER / TRANSFER RESTRICTION

If you are over the age of 70½ this year, you may not rollover or transfer required minimum distribution amounts. If necessary, instruct your present custodian to either: 1) pay your required minimum distribution to you now; or 2) retain that amount for distribution to you later.

C. FOR IRAs ONLY: SIGNATURE

For IRA contributions, please sign below.

For IRA rollovers, please read the following certification and sign below.

I am making a rollover contribution to the retirement account indicated above. I hereby certify that I understand the rollover rules and

conditions as they pertain to this retirement account, and I have met the requirements for making such a transaction. Due to the important

tax consequences of rolling over funds or property, I have been advised to consult with a tax professional. All information provided by me is

true and correct and may be relied upon by First Command Bank. I assume full responsibility for these transactions and will not hold First

Command Bank liable for any adverse consequences that may result. I hereby irrevocably designate the rollover of funds or other property

as rollover contributions.

_____________________________________________________ ____________________________________________________ ____________________

Printed Name of Owner Signature of Owner Date

Make checks payable to: First Command Bank

Mail the completed form and attached check to the First Command Bank Trust Department PO Box 901075, Fort Worth, TX 76101

For questions or concerns, call 1.888.763.7603, option 3