WAP
Alpine Mutual Funds
New Account Application
Please do not use this form for IRA accounts.
Mail To: A
lpine Mutual Funds
Overnight Express Mail To:
Alpine Mutual Funds
c/o Boston Financial Data Servicesc/o Boston Financial Data Services
P.O. Box 8061
30 Dan Road
Boston, MA 02266-8061
Canton, MA 02021-2809
For additional information please call toll-free 1-888-785-5578 or visit us on the web at www.alpinefunds.com.
In compliance with the USA PATRIOT Act, all financial institutions (including mutual funds) are required to obtain, verify and record the following
information for all registered owners or others who may be authorized to act on an account: full name, date of birth, Social Security number and
permanent street address. Corporate, trust, and other entity accounts require additional documentation. 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 at the current day’s net asset value.
1. Investor Information – Select one
□ Individual
_________________________________________________________
FIRST NAME
_______________________________________________________________________ SOCIAL SECURITY NUMBER
________________________________________________________________ DRIVER’S LICENSE OR STATE I.D. NUMBER
_________________________________________________________
FIRST NAME
_________________________________________________________________________________
LAST NAME
□ Joint Owner
__________ M.I.
__________ M.I.
_________________________________________________________________________________
LAST NAME
_______________________________________________________________________ ________________________________________________________________ SOCIAL SECURITY NUMBER
DRIVER’S LICENSE OR STATE I.D. NUMBER
Registration will be Joint Tenancy with Rights of Survivorship (JTWROS), unless otherwise specified.
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Gift or _________________________________________________________
__________ ���������������������������������������
STATE OF ISSUE
_________________________________________________________________________________
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DOB (Mo / Dy / Yr)
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STATE OF ISSUE
_________________________________________________________
MINOR’S FIRST NAME
(ONLY ONE MINOR MAY BE LISTED)
___________________________________________________________________________ MINOR’S SOCIAL SECURITY NUMBER
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NAME OF TRUST/CORPORATION/PARTNERSHIP OR OTHER ENTITY AND STATE OF ORGANIZATION OR LEGAL RESIDENCE
���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
NAME(S) AND TITLES OF TRUSTEES OR OTHER PERSONS AUTHORIZED TO ACT FOR THE ENTITY
____________________________________________________________________________________________
SOCIAL SECURITY NUMBER / TAX I.D. NUMBER
** You must supply documentation to substantiate existence of your organization. (i.e., Articles of Incorporation/Formation /
Organization, Trust Agreements, Partnership Agreement, or other official documents.)
C
Corporation*
□
Trust*
__________ M.I.
________________________________________________________________ DRIVER’S LICENSE OR STATE I.D. NUMBER
����������������������
DOB (Mo / Dy / Yr)
���������������������������������������
STATE OF ISSUE
FIRST NAME
M.I.
LAST NAME
_CUSTODIAN’S
(ONLY ONE CUSTODIAN MAY BE LISTED, UNLESS YOUR STATE’S LAW ALLOWS FOR TWO CUSTODIANS)
Transfer
to
Minor
________________________________________________________________________ (UGMA/UTMA)
CUSTODIAN’S SOCIAL SECURITY NUMBER
����������������������
DOB (Mo / Dy / Yr)
_________________________________________________________________________________
LAST NAME
����������������������
DOB (Mo / Dy / Yr)
______________________________________________________
MINOR’S STATE OF RESIDENCE
□
Partnership*
□
Other Entity* □
S Corporation*
����������������������������������������������������������������������������
DATE OF AGREEMENT (Mo / Dy / Yr)
**Remember to include a separate sheet detailing the full name, date of birth, Social Security number, and permanent
street address for all authorized individuals.
02/16_v1
□ Mailing Address (if different from Permanent):
If completed, this address will be used as the Address of Record for all
2.Permanent Street Address
(P.O. Box is not acceptable except for APO and FPO.)
statements, checks and required mailings. No foreign addresses.
______________________________________________________________________
STREET
������������������������
APT/SUITE
______________________________________________________ CITY
������������������������
ZIP CODE
______________________________________________________________________
STREET
������������������������
APT/SUITE
__________________________________________________________
DAYTIME PHONE NUMBER
������������������������
ZIP CODE
������������������������������������������������������������������������������������������������
EMAIL ADDRESS
____________ STATE
��������������������������������������������
EVENING PHONE NUMBER
□ Duplicate Statement #1
______________________________________________________ CITY
____________ STATE
□ Duplicate Statement #2
Complete only if you wish someone other than the account owner(s) to
Complete only if you wish someone other than the account owner(s) to
receive duplicate statements.
receive duplicate statements.
�������������������������������������������������������������������������������������������������
NAME
�������������������������������������������������������������������������������������������������
NAME
______________________________________________________________________
STREET
������������������������
APT/SUITE
______________________________________________________________________
STREET
������������������������
APT/SUITE
������������������������
ZIP CODE
������������������������
ZIP CODE
______________________________________________________ CITY
3.Investment
Choices
____________ STATE
______________________________________________________ CITY
Note: Cashier’s checks of $10,000 or less, money orders of any amount, and third party checks are not accepted.
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By check: Make check payable to The A
lpine Mutual Funds. $ _____________
By wire: Call 1-888-785-5578. Indicate amount of wire $ _____________
(A completed application is required in advance of a wire.)
Fund Name - Institutional Class
Investment Amount
$1,000,000 minimum
(may be waived in certain situations as described below)
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Dynamic Dividend Fund
(3773)$_____________________
Emerging Markets Real Estate Fund
(3777)$_____________________
Financial Services Fund
(3774)$_____________________
Global Infrastructure Fund
(3778)$_____________________
Global Realty Growth & Income Fund
(3457)$_____________________
International Real Estate Equity Fund
(3779)$_____________________
Realty Income & Growth Fund
(3781)$_____________________
Rising Dividend Fund
(3770)$_____________________
Small Cap Fund
(3775)$_____________________
____________________________________
_____ $_____________________
(may be waived in certain situations as described below)
High Yield Managed Duration Municipal Fund
(3768)$_____________________
Ultra Short Municipal Income Fund
(3783)$_____________________
____________________________________
_____ $_____________________
Distribution Options
Capital Gains
Reinvested &
Dividends in Cash*
Capital Gains
& Dividends
in Cash*
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Capital Gains
& Dividends
Reinvested
$250,000 minimum
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____________ STATE
If nothing is checked, all distributions will be reinvested.* Unless otherwise indicated, cash distributions will be mailed to the address in Section 2.
Minimum initial purchase amounts for the Institutional Class are waived for the following:
I am a/an:
□ Shareholder as of the close of business January 3, 2012
□ Employee of the Adviser or its affiliates and their immediate family
□ Current and former Trustee of funds advised by the Adviser
□ The Adviser or affiliates
□ Investor in employee retirement, stock, bonus, pension or profit sharing plans
□ Investment advisory client of the Adviser or its affiliates
□ Registered Investment Adviser
□ Broker/Dealer or Registered Investment Adviser with clients participating in comprehensive fee programs
□ Corporation, partnership, association, joint-stock company, trust, fund or any organized group of persons wether i_ncorporated or not __ that has a formal or informal consulting or advisory relationship with the Adviser or a third _party through which the investment is made
These waivers may be discontinued at any time without notice.
4.Cost Basis Method
Selection
As part of the Emergency Economic Stabilization Act of 2008, mutual fund companies will be required to report
cost basis information to shareholders and to the Internal Revenue Service (IRS) on mutual fund shares acquired
and subsequently redeemed after January 1, 2012. In order to provide you and the IRS with accurate cost basis
accounting you are being asked to select a cost basis method for your new account.
If you do not elect a method, the fund default of Average Cost will be used.
Please choose one of the following available methods:
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AVERAGE COST (ACST) — the purchase price of all covered shares in the account are averaged
FIRST IN, FIRST OUT (FIFO) — depletes shares beginning with the earliest acquisition date
LAST IN, FIRST OUT (LIFO) — depletes shares beginning with the most recent acquisition date
HIGH COST (HIFO) — depletes shares beginning with the most expensive shares
LOW COST (LOFO) — depletes shares beginning with the least expensive shares
L
OSS/GAIN UTILIZATION (LGUT) — depletes shares with losses prior to shares with gains and
short-term shares prior to long-term shares
SPECIFIC LOT IDENTIFICATION — depletes shares according to the lots chosen by the shareholder
When selecting Specific Lot Identification, please choose a secondary method to be used in the
event that specific lot depletion information is not provided.
SECONDARY METHOD:_______________________________________________ to be used in the event that
if lots are not identified, are insufficient or no longer available. If no secondary method is selected,
FIFO will be used. Please note that Average Cost cannot be used as a secondary accounting method.
The cost basis method that is currently on your account will be utilized to deplete the shares for
Systematic Withdrawals (see Item 7). If your elected method is SLID - Specific Lot Identification, your
secondary method will be used. If you have not chosen a secondary method then FIFO - First In, First
Out will be used to deplete the shares.
You may want to consult your tax advisor to determine which method best suits your individual tax situation. Your
elected cost basis method will be applied to future accounts opened in the Alpine Funds with the same account
type and registration. If you have questions about the cost basis methods above, please call our Shareholder
Services team at 1-888-785-5578.
5.Automatic
Investment Plan
If you choose this option, funds will be automatically transferred from your bank account monthly. Please attach
a voided bank check (money market and starter checks are not acceptable) or your savings account and routing
number to Section 8 of this application. We are unable to debit mutual fund or pass-through (“for further credit”)
accounts. The minimum investment amount per month for all funds is $50 with the exception of Alpine Ultra Short
Municipal Income Fund whose minimum is $100 per month.
Your signed Application must be received at least 15 business days prior to initial transaction.
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Amount per Draw
AIP Start Month
AIP Start Day
Dynamic Dividend Fund
(3773)$_______________________
______________________ �����������������������
Emerging Markets Real Estate Fund
(3777)$_______________________
______________________ �����������������������
Financial Services Fund
(3774)$_______________________
______________________ �����������������������
Global Infrastructure Fund
(3778)$_______________________
______________________ �����������������������
Global Realty Growth & Income Fund
(3457)$_______________________
______________________ �����������������������
High Yield Managed Duration Municipal Fund
(3768)$_______________________
______________________ �����������������������
International Real Estate Equity Fund
(3779)$_______________________
______________________ �����������������������
Realty Income & Growth Fund
(3781)$_______________________
______________________ �����������������������
Rising Dividend Fund
(3770)$_______________________
______________________ _____________
Small Cap Fund
(3775)$_______________________
______________________ �����������������������
Ultra Short Municipal Income Fund
(3783)$_______________________
______________________ �����������������������
____________________________________
_____$_______________________
______________________ �����������������������
Please keep in mind that:
•T
here 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.
• If no date is indicated, the default date of the 15th of the month applies.
6.Telephone/Internet
Options
□ Redemption ($1,000 minimum) – permits the transfer of funds via:
Your signed application
must be received at least
15 business days prior to
initial transaction.
□ Check to address in Section 2
□ Federal wire to your bank in Section 8 (There is a charge for each wire)*
□EFT, at no charge, to your bank in Section 8 (funds are typically credited within two days after redemption)*
Purchase (EFT) ($100 minimum) – permits the on-demand purchase of shares from your bank account.*
□
□ Exchange ($1,000 minimum) – permits the exchange of shares between identically registered accounts.
□ E-mail Address – permits the Fund to send you updates��������������������������������������������������
* If you selected any of these options, please attach a voided check to this application. We are unable to draft or credit
your account via EFT if it is a mutual fund or pass-through account.
7.Systematic
Withdrawal Plan
Your signed application
must be received at least
15 business days prior to
initial transaction.
ystematic Withdrawal Plan ($75 minimum and $10,000 account value minimum) – permits the automatic
S
withdrawal of funds.
□_ Payments will be mailed to address in Section 2
-OR-
□ Payments will be deposited directly into your bank account. Please attach a voided bank check (money market and starter
checks are not accepted) or savings account and routing number to Section 7 of this application. We are unable to credit
mutual fund or pass-through (“for further credit”) accounts.
Make payments
□
Quarterly
□
Annually starting with the month given here:
Amount per Withdrawal
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□ Monthly
SWP Start Month
(3773)$_______________________
______________________ �����������������������
Emerging Markets Real Estate Fund
(3777)$_______________________
______________________ �����������������������
Financial Services Fund
(3774)$_______________________
______________________ �����������������������
Global Infrastructure Fund
(3778)$_______________________
______________________ �����������������������
Global Realty Growth & Income Fund
(3457)$_______________________
______________________ �����������������������
High Yield Managed Duration Municipal Fund
(3768)$_______________________
______________________ �����������������������
International Real Estate Equity Fund
(3779)$_______________________
______________________ �����������������������
Realty Income & Growth Fund
(3781)$_______________________
______________________ �����������������������
Rising Dividend Fund
(3770)$_______________________
______________________ �����������������������
Small Cap Fund
(3775)$_______________________
______________________ �����������������������
Ultra Short Municipal Income Fund
(3783)$_______________________
______________________ �����������������������
__________________________________________
_____$_______________________
______________________ �����������������������
Please keep in mind that:
• If no date is indicated, the default date of the 15th of the month applies.
8.Voided Check for
Bank Information
SWP Start Day
Dynamic Dividend Fund
If you have selected an
automatic investment plan,
wire redemptions, EFT
purchases, EFT redemptions
or a systematic withdrawal
plan, a voided bank check
(money market and starter
checks are not acceptable)
or your savings account and
routing number. We are
unable to debit or credit mutual
fund or pass-through accounts.
Please contact your financial
institution to determine if it
participates in the Automated
Clearing House system (ACH).
ATTACH VOIDED CHECK
9.Signature and
Certification
Required by the
Internal Revenue
Service
I have received and understand the prospectus for The Alpine Mutual Funds (the “Funds”). I understand the Funds’ investment
objectives and policies and agree to be bound by 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 regulatory
documents such as prospectuses, shareholder reports, proxies, and other similar documents. I may contact the Funds to revoke
my consent. I agree to notify the Funds 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 Funds and their transfer agent shall not be liable if I fail to notify
the Funds within such time period. I certify that I am of legal age and have legal capacity to make this purchase.
The Funds, the applicable Fund, its transfer agent, and any officers, directors, employees, or agents of these entities (collectively
“Alpine Mutual Funds”) will not be responsible for banking system delays beyond their control. By completing sections 4, 5, 6, or
7, I authorize my bank to honor all entries to my bank account initiated through Boston Financial Data Services, on behalf of the
applicable Fund. The Alpine Mutual 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 with respect to 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 Funds’ transfer agent receives and
has had reasonable amount of time to act upon a written notice of revocation.
I authorize the Fund to perform a credit check based on the information provided, if necessary.
Under penalty of perjury, I certify that (1) the Social Security number or taxpayer identification number shown on this
form is my correct taxpayer identification number, and (2) I am not subject to backup withholding either as a result of a
failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding. (3) I am a U.S. person (including a U.S. resident alien).
The IRS does not require your consent to any provision of this document other than the certification required to avoid
backup withholding.
___________________________________________________________________________________ SIGNATURE OF OWNER*
��������������������������������������������������������������������������������������
DATE (Mo / Dy / Yr)
___________________________________________________________________________________ SIGNATURE OF OWNER*
��������������������������������������������������������������������������������������
DATE (Mo / Dy / Yr)
*If shares are to be registered in (1) joint names, both persons must sign, (2) a custodian for a minor, the custodian should sign,
(3) a trust, the trustee(s) should sign, or (4) a corporation or other entity, an officer should sign and print name and title on the
space provided for the Joint Owner.
Please be advised that under the laws of certain states, your property may be transferred (escheated) to the state if no
activity occurs in your account for a period specified by state law.
10.Broker/Dealer
Information
lease be sure to complete
P
representative’s first name
and middle initial.
_____________________________________________________________________________
DEALER NAME
�������������������������������������������������������������������������������
REPRESENTATIVE’S LAST NAME
FIRST NAME
MI
DEALER HEAD OFFICE INFORMATION:
REPRESENTATIVE’S BRANCH OFFICE INFORMATION:
_____________________________________________________________________________
ADDRESS
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ADDRESS
_____________________________________________________________________________
CITY / STATE / ZIP
�������������������������������������������������������������������������������
CITY / STATE / ZIP
_____________________________________________________________________________
TELEPHONE NUMBER
�������������������������������������������������������������������������������
TELEPHONE NUMBER
REP’S A.E. NUMBER
Before you mail, have you:
□
Completed
all USA PATRIOT Act required information?
- Social Security or Tax ID Number in Section 1?
- Birth Date in Section 1?
- Full Name in Section 1?
- Permanent street address in Section 2?
□
Enclosed your personal check made payable to The Alpine Mutual Funds?
(Reminder: Cashier’s checks of $10,000 or less, money orders of any
amount, and third party checks are not accepted.)
□ Included a voided check, if applicable?
□ Signed your application in Section 9?
□ Enclosed additional documentation, if applicable?