Community National Bank

COMMUNITY
NATIONAL
BANK

Retirement Plans Division

305 Main Street, P.O. Box 210, Seneca, KS 66538

Phone: 800-680-0340 Fax: 785-336-2214

Email: irainfo@communitynationalbank.net

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Click Here for Four Easy Steps to an IRA!

Please Note: If you have a deadline for transfer paperwork to reach your previous custodian, please submit your IRA Application and Transfer Request to
Community National Bank at least 5 business days prior to the deadline.

New Account Forms:
IRA Application (Effective January 1, 2010) (Includes the IRA Application, Custodial Agreement, Disclosure Statement, and Instructions for both a Traditional IRA and a Roth IRA)

2010 Fee Schedule (Effective January 1, 2010)
IRS Form 5305-SEP & Instructions
Wire Instructions
RMD Form for New Accounts (Please complete for account owners 70 1/2 or older. This is not applicable for ROTH IRAs.)
Online/eStatement Forms: (Please fax or mail the following online forms to CNB. Fax number and mailing address are printed on the forms. Online submission not available.)
Online/eStatement Authorization for Account Holder (Updated 8/20/10)
Online/eStatement Authorization for Representative (Updated 8/20/10)
Transfer/Rollover/Contribution Forms:
Transfer Request
Roth Conversion Request
Rollover Deposit Statement
Contribution Form

Purchase/Sale/Exchange Forms:

Investment Authorization
(Client's signature REQUIRED on all non-publicly traded investments.)

Distribution Forms:

Cash Distribution

Direct Deposit (Update Bank Information ONLY!)

Investment Distribution

Waiver to Distribute Required Minimum Distribution

Claim by Beneficiary Form

Claim of Premature Distribution Due to Total & Permanent Disability

Recharacterization Form

Other Forms:

Account Update Form
(Please complete for ALL account changes, like address information, etc.)

Designation of Beneficiary

Trust Certification

Change of Representative’s Firm Information

Change of Financial Representative

Periodic Transfer Request
(Used Only for Periodic Transfers $5,000 or under)

NOTE: These forms are in Portable Document Format (PDF) and you will need Adobe Acrobat Reader to view them. Click on the Acrobat Reader icon and follow the instructions to download it if you don't have it. Our fillable PDF forms vary in size. Please allow sufficient time for them to download. If you experience a continued problem with a particular form on our website, please contact Community National Bank at (800)680-0340 or by e-mail at irainfo@communitynationalbank.net

The investments in your account, with the exception of the Community National Bank (CNB) savings balance and any CNB certificates of deposit, are not FDIC insured; are not obligations of the bank; are not guaranteed by the bank; and involve risks, including possible loss of principal.