Fillable Non Qualified Transfer Of Assets Form printable pdf download

-Q

UALIFIED

RANSFER OF

SSETS

ORM

Please complete this form only if you are transferring assets directly to a new or existing non-qualified account with the Issachar

Fund (the “Fund”). Please complete a separate form for each account you wish to transfer. Transfers may take 3 to 5 weeks to

complete after your paperwork is received in good order.

For Additional Copies or Assistance

If you need additional copies of this form, or would like assistance completing it, please 1-866-787-8355 or go to

Instructions

If you are establishing a new account, please contact 1-866-787-8355 or go to

about additional

information that must be submitted with this Form.

2. Mail this Transfer Form to:

Overnight Delivery:

Issachar Fund

c/o Gemini Fund Services, LLC

P.O. Box 541150

17605 Wright Street, Suite 2

Omaha, Nebraska 68154

Omaha, Nebraska 68130

3. Retain a copy for your records.

Fund’s Privacy Policy Statement

Your privacy is important to us. The Fund is committed to maintaining the confidentiality, integrity and security of your personal

information. When you provide personal information, the Fund believes that you should be aware of policies to protect the

confidentiality of that information.

The Fund collects the following nonpublic personal information about you:

Information we receive from you on or in applications or other forms, correspondence, or conversations, including, but not



limited to, your name, address, phone number, social security number, assets, income and date of birth; and

Information about your transactions with us, our affiliates, or others, including, but not limited to, your account number and



balance, payments history, parties to transactions, cost basis information, and other financial information.

The Fund does not disclose any nonpublic personal information about our current or former shareholders to nonaffiliated third

parties, except as permitted by law. For example, the Fund is permitted by law to disclose all of the information we collect, as

described above, to our transfer agent to process your transactions. Furthermore, the Fund restricts access to your nonpublic

personal information to those persons who require such information to provide products or services to you. The Fund maintains

physical, electronic, and procedural safeguards that comply with federal standards to guard your nonpublic personal information.

In the event that you hold shares of the Fund through a financial intermediary, including, but not limited to, a broker-dealer,

bank, or trust company, the privacy policy of your financial intermediary would govern how your nonpublic personal information

would be shared with nonaffiliated third parties.

Anti-Money Laundering

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial

institutions to obtain, verify, and record information that identifies each person who opens an account effective October 1, 2003.

What this means for you: When you open an account, we will ask for your name, address, date of birth, social security number/

Tax ID number and other information that will allow us to identify you. We may also ask to see other identifying documents. Until

you provide the information or documents we need, we may not be able to open an account or effect any additional transactions

for you.

For questions about these policies, or for additional copies of the Privacy Policy Statement, please go to

contact the Fund at 17605 Wright Street, Suite 2, Omaha, Nebraska, 68130 or 1-866-787-8355.

Issachar Fund: Transfer Form Page 1 of 3

Non Qualified Transfer Of Assets Form

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