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Jacob Funds IRA Application For Traditional, ROTH, SEP, and SIMPLE IRAs

4rd Quarterly Newsletter: June—August 2017 4-H GROWS HERE

Jacob Funds IRA Application For Traditional, ROTH, SEP, and SIMPLE IRAs arkansashighways fiscal services division using post tax dollars or funds transferred by a direct rollover from a 401k, traditional IRA, or a 457 deferred compensation plan “Actuarial Equivalent” means the amount the member will pay is the same as the actuarial cost of the benefit The calculator

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arkansashighways fiscal services division using post tax dollars or funds transferred by a direct rollover from a 401k, traditional IRA, or a 457 deferred compensation plan “Actuarial Equivalent” means the amount the member will pay is the same as the actuarial cost of the benefit The calculator used by the System is furnished by the actuary
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A Application For Traditional,

ROTH,

and SIMPLE IRAs >> Mail to: Jacob Funds c/o U.S.

Bancorp...

Description

Jacob Funds IRA Application

For Traditional,

ROTH,

and SIMPLE IRAs Mail to: Jacob Funds c/o U.S.

Bancorp Fund Services,

LLC PO Box 701 Milwaukee,

WI 53201-0701

Overnight Express Mail To: Jacob Funds c/o U.S.

Bancorp Fund Services,

LLC 615 E.

Michigan St.,

FL3 Milwaukee,

WI 53202-5207

>> In compliance with the USA PATRIOT Act,

all mutual funds are required to obtain the following information for all registered owners and all

authorized individuals: full name,

Social Security number,

This information will be used to verify your true identity.

We will return your application if any of this information is missing,

and we may request additional information from you for verification purposes.

In the rare event that we are unable to verify your identity,

the Fund reserves the right to redeem your account as an ageappropriate distribution at the current day’s net asset value.

we will assume it is for the current tax year.

Refer to disclosure statement for eligibility requirements and contribution limits.

Choose ONE of the following account types:

 Traditional IRA Account  For tax year ____________  IRA to IRA Transfer (please complete IRA Transfer Form)  Rollover (shareholder had receipt of funds)  Inherited IRA

Please check the type of qualified plan:

 Corporate  Pension  Profit Sharing Plan  401(k)  403(b)  Other _________________________  ROTH IRA Account  For tax year ____________  Roth IRA to Roth IRA Transfer (please complete IRA Transfer Form)  Traditional IRA to Roth IRA – year of conversion ________ in which Traditional IRA was converted to Roth IRA  Rollover from Roth IRA (shareholder had receipt of funds)  Inherited IRA

 Contribution  Transfer from another SEP IRA Account  Rollover (shareholder had receipt of funds)  SIMPLE IRA (Be sure to complete Section 10)  Contribution  Transfer from another SIMPLE IRA Account  Rollover (shareholder had receipt of funds)

SOCIAL SECURITY NUMBER

LAST NAME

DRIVER’S LICENSE OR STATE I.D.

NUMBER

DATE OF BIRTH (MM/DD/YYYY)

STATE OF ISSUE

Page 1 of 5

Boxes are not allowed.

STREET

 Mailing Address* (if different from Permanent Address) If completed,

this address will be used as the Address of Record for all statements,

Foreign addresses are not allowed.

APT / SUITE APT / SUITE

STREET CITY

STATE

ZIP CODE CITY

DAYTIME PHONE NUMBER

EVENING PHONE NUMBER

STATE

ZIP CODE

* A P.O.

Box may be used as the mailing address.

E-MAIL ADDRESS

COMPANY NAME

COMPANY NAME

Complete only if you wish someone other than the account owner(s) to receive duplicate statements.

STREET

STATE

Complete only if you wish someone other than the account owner(s) to receive duplicate statements.

APT / SUITE

STREET

ZIP CODE

APT / SUITE

STATE

ZIP CODE

Note: Generally,

cashier’s checks of $10,000 or less,

money orders of any amount and third party checks are not accepted.

 By wire: Call 1-888-522-6239.

Note: A completed application is required in advance of a wire.

Investment Amount $1,000 Minimum

 Jacob Internet Fund Investor Class Shares (705)  Jacob Small Cap Growth Fund Investor Class Shares (706)  Jacob Wisdom Fund Investor Class Shares (707)  Jacob Micro Cap Growth Fund Investor Class Shares (1487)

Page 2 of 5

If you choose this option,

funds will be automatically transferred from your bank account.

Please attach a voided check or savings deposit slip to Section 7 of this application.

We are unable to debit mutual fund or pass-through (“for further credit”) accounts.

Draw money for my AIP (check one):  Monthly  Quarterly  Semi-Annually  Annually If no option is selected,

the frequency will default to monthly.

 Jacob Internet Fund Investor Class Shares (705)  Jacob Small Cap Growth Fund Investor Class Shares (706)  Jacob Wisdom Fund Investor Class Shares (707)  Jacob Micro Cap Growth Fund Investor Class Shares (1487)

AMOUNT PER DRAW

AIP START MONTH

AIP START DAY

AMOUNT PER DRAW

AIP START MONTH

AIP START DAY

AMOUNT PER DRAW

AIP START MONTH

AIP START DAY

AMOUNT PER DRAW

AIP START MONTH

AIP START DAY

Please keep in mind that: • There is a fee if the automatic purchase cannot be made (assessed by redeeming shares from your account).

• Participation in the plan will be terminated upon redemption of all shares.

You have the ability to make telephone and/or internet purchases* per the prospectus by checking the box below.

See the prospectus for minimum and maximum amounts.

 I accept telephone and/or internet transaction privileges.

We are unable to debit or credit mutual fund or pass-through (“for further credit”) accounts.

Please contact your financial institution to determine if it participates in the Automated Clearing House system (ACH).

John Doe Jane Doe 123 Main St.

Anytown,

USA 12345

53289

D I VO

Pay to the order of _____________________________________________________ $ _______________ ____________________________________________________________________________DOLLARS

Memo___________________________

Signed_________________________________________

Page 3 of 5

please enclose a separate sheet of paper.

Primary NAME

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

RELATIONSHIP

CITY/STATE/ZIP

SOCIAL SECURITY NUMBER DATE OF BIRTH

Secondary

Spousal Consent: If you name someone other than or in addition to your spouse as primary beneficiary and reside in a community or marital property state,

your spouse must consent by signing below.

X SIGNATURE OF SPOUSE

I adopt the Jacob Funds Custodial Account Agreement,

and appoint the Custodian or its agent to perform those functions and appropriate administrative services specified.

I have received and read the prospectus for the Jacob Funds (the “Fund”).

I understand the Fund’s objectives and policies and agree to be bound to the terms of the prospectus.

Before I request an exchange,

I will obtain the current prospectus for each Fund.

I acknowledge and consent to the householding (i.e.

consolidation of mailings) of documents such as prospectuses,

I may contact the Fund to revoke my consent.

I agree to notify the Fund of any errors or discrepancies within 45 days after the date of the statement confirming a transaction.

The statement will be deemed to be correct,

and the Fund and its transfer agent shall not be liable if I fail to notify the Jacob Funds within such time period.

I certify that I am of legal age and have the legal capacity to make this purchase.

[If the Grantor is a minor under the laws of the Grantor’s state of residence,

a parent or guardian must sign the IRA Application (i.e.

Until the Grantor reaches the age of majority,

the parent or guardian will exercise the duties of the Grantor.

(If not a parent,

the guardian must provide a copy of the letters of appointment.)] If I am opening a Traditional IRA with a distribution from an employer-sponsored retirement plan,

I elect to treat the distribution as a partial or total distribution and certify that the distribution qualifies as a rollover contribution.

I understand that the fees relating to my account may be collected by redeeming sufficient shares.

The custodian may change the fee schedule at any time.

Your mutual fund account may be transferred to your state of residence if no activity occurs within your account during the inactivity period specified in your State’s abandoned property laws.

I authorize the Fund to perform a credit check in the event that one is needed to verify or establish identity.

or agents of these entities (collectively “Jacob Funds”) will not be responsible for banking system delays beyond their control.

By completing Sections 4,

I authorize my bank to honor all entries to my bank account initiated through U.S.

Bank,

on behalf of the applicable Fund.

Jacob Funds will not be liable for acting upon instruction believed to be genuine and in accordance with the procedures described in the prospectus or the rules of the Automated Clearing House.

When AIP or Telephone Purchase transactions are presented,

sufficient collected funds must be in my account to pay them.

I agree that my bank’s treatment and rights to respect each entry shall be the same as if it were signed by me personally.

I agree that if any such entries are dishonored with good or sufficient cause,

my bank shall be under no liability whatsoever.

I further agree that any such authorization,

unless previously terminated by my bank in writing,

is to remain in effect until the Fund’s transfer agent receives and has had reasonable amount of time to act upon a written notice of revocation.

X DEPOSITOR / LEGALLY RESPONSIBLE INDIVIDUAL’S SIGNATURE

Appointment as Custodian accepted: U.S.

BANK,

Page 4 of 5

DATE (MM/DD/YYYY)

EMPLOYER STREET ADDRESS

EMPLOYER CITY / STATE / ZIP CODE

EMPLOYER CONTACT NAME

EMPLOYER CONTACT BUSINESS PHONE

DEALER NAME

DEALER’S ID

REPRESENTATIVE’S LAST NAME

BRANCH ID

FIRST NAME

REPRESENTATIVE’S ID

DEALER HEAD OFFICE INFORMATION:

REPRESENTATIVE BRANCH OFFICE INFORMATION:

ADDRESS

ADDRESS

CITY / STATE / ZIP

CITY / STATE / ZIP

TELEPHONE NUMBER

TELEPHONE NUMBER

Before you mail,

have you:  Completed all USA PATRIOT Act required information

?  Enclosed your check made payable to Jacob Funds

? – Social Security or Tax ID Number in Section 2

?  Included a voided check,

?  Signed your application in Section 9

? – Permanent street address in Section 3

? For additional information please call toll-free 1-888-522-6239 or visit us on the web at www.jacobmutualfunds.com.

05/2011

Page 5 of 5