DONOR/PRIMARY ADVISER APPLICATION for ENTITIES

DONOR/PRIMARY ADVISER APPLICATION for ENTITIES

To open a charitable donor-advised fund (the ¡°Account¡±) with BNY Mellon Charitable Gift Fund (¡°Gift

Fund¡±), please complete this form. Please type or print clearly using black or blue ink. This

Donor/Primary Adviser Application must contain details about your irrevocable gift of at least $10,000 in

value (see Section 2 below). However, please do not send the contribution until you are notified that your

Application has been accepted. Donors may not pool contributions together as part of the initial $10,000

contribution.

NOTE: Donor Advised Funds opened by an Entity cannot have Additional Donors.

Please contact the Gift Fund for additional information by calling (888) 213-7605 during normal business

hours (Monday-Friday, 8:30am-5:00pm ET) or sending an email to bnymcharitable@.

When your form is complete, please review it, sign it, and send it via mail, overnight delivery, email or fax to:

BNY Mellon Charitable Gift Fund

201 Washington Street

Suite 024-0035

Boston, MA 02108

Email: bnymcharitable@

Fax to (866) 231-7663

1. DONOR/PRIMARY ADVISER INFORMATION

Donor/Primary Adviser Information (primary recipient for all Account correspondence):

Organization Name:

_________________________________________________________________

Tax Identification Number:

Date Established (mm/dd/yyyy):

_______________________

_______________________

In care of or Contact Name: _______________________________________________

Legal Street Address:

_________________________________________________________________

City, State, Zip Code:

_________________________________________________________________

BNY Mellon Charitable Gift Fund

Donor/Primary Adviser Application for Entities

Country (if not United States):

_________________________________________________________________

Mailing Address (if different from above):

_________________________________________________________________

City, State, Zip Code:

_________________________________________________________________

Country (if not United States):

_________________________________________________________________

Business Telephone Number:

Email Address:

_______________________

_______________________

Organization Type _________________________________________ (See below for examples)

Organization Type Examples:

501c Entity (Corporation/Trust), Corporation/Association, Estate, General Partnership, Limited Liability Company,

Limited Partnership, Real Estate Investment Trust, S Corporation, Sole Proprietorship, Trust, Other (requires

explanation)

Country of Establishment/Incorporation ________________________________________________

Country of Primary Business Operations________________________________________________

Industry Type ____________________________________________ (See below for examples)

Industry Type Examples: Art and Antique Dealers; Casinos and Other Gaming or Wagering Establishments; Charities,

Endowments or Foundations; Dealers in precious metals, stones or jewels; Deposit Brokers; Embassies, Consulates or

Ministries; Import/Export Brokers; Import/Export Businesses; Internet Businesses; Leather Goods Stores; Money

Services Businesses (MSBs); Non-bank financial institutions (Securities/commodities firms; Broker-dealers; Mutual

funds; Hedge funds; Commodity traders; Investment advisors; Insurance companies (underwriters, not agencies),

Pawnbrokers; Loan or finance companies; Car, boat, and airplane dealers); Personal Investment Companies; Privatelyowned ATM machines; Professional Service Providers; Third-party payment processors; Weapons/Arms Dealers;

Other (requires explanation)

Source of Wealth/Income ___________________________________ (See below for examples)

Source of Wealth/Income Examples:

Business profits, Court Awards/Legal Settlement, Donations, Insurance benefits, Investments, Owner(s) contributions,

Sale of Assets, Transfer from Deceased/Trustor, Other (requires explanation)

Details of Source of Wealth/Income (include names, dates, etc. as applicable) _____________________

Authorized Individual(s) Information

Name of Principal, Executive, Trustee or Executor _______________________________________

Position/Title ________________________________________________________

Is the Authorized Individual a 25% or greater beneficial owner of the entity? __YES

If YES, what is the ownership %? _______________

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__NO

BNY Mellon Charitable Gift Fund

Donor/Primary Adviser Application for Entities

Date of Birth (mm/dd/yyyy) _________________

Home address________________________________________________________________

Phone number_______________________ Email Address ___________________________

Name of Authorized Person (if other than above Individual). If more than one, please attach list with all

the information below:

Name ___________________________________________________________________

Position/Title _____________________________________________________________

Is the Authorized Person a 25% or greater beneficial owner of the entity? __YES

__NO

If YES, what is the ownership %? _______________

Date of Birth (mm/dd/yyyy) _________________

Home address________________________________________________________________

Phone number _______________________ Email Address ___________________________

Please list other 25% or greater beneficial owners of the entity who are not Authorized Persons. If more

than one, please attach list with all the information below:

Name _____________________________________________________________________

Ownership % _______________________________________________________________

Home address _______________________________________________________________

Is this organization a corporation or other entity that has been formed by or for the benefit of a Senior

Political Figure? __YES __NO

Is any principal or authorized person of the business a Senior Political Figure? __YES

__NO

If YES, to any of the questions above:

Head of State __YES

__NO

Reason for Senior Political Figure Status _______________________________

Date of Position ___________________________________________________

Country of Position _________________________________________________

A copy of documents for identity verification purposes may be requested. These include but are not

limited to government issued photo ID, Articles of Incorporation, Partnership Agreement, Operating

Agreement, Trust Agreement, Letters Testamentary, Registered Fictitious Name Statement, US Internal

Rev Code 501 Determination Letter/Form 990, etc.

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BNY Mellon Charitable Gift Fund

Donor/Primary Adviser Application for Entities

2. ACCOUNT TITLE

There is the option to name the Account being established. The Gift Fund will review and must approve

the name for an Account. The Gift Fund recommends using ¡°Fund¡± in the name to signify the separate

nature of the Account. To preclude certain legal implications, the words ¡°Foundation,¡± ¡°Trust,¡± or

¡°Endowment,¡± should not be used to designate Accounts.

Grants made by the Gift Fund to a charitable recipient are accompanied by an acknowledgment letter,

which will reference the Account name, unless anonymity is specifically requested.

Proposed Account Name:

3. MAKING THE INITIAL CONTRIBUTION

($10,000 minimum)

Contributions to the Account can include cash, cash equivalents, or publicly traded securities, including

stocks, most mutual fund shares, and bonds. Contributions in the form of any other asset than those

provided above may be accepted pursuant to the rules provided in the Gift Fund¡¯s Policies and Guidelines

on a case-by-case basis.

Initial contributions must be made by the Donor/Primary Adviser and must be in the amount of $10,000

or more. No pooling of contributions among various donors will be accepted in establishing the Account.

Please do not send the contribution until notified that the Application has been accepted. All

contributions are irrevocable. Once assets are transferred to and accepted by the Gift Fund, they

may not be returned.

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BNY Mellon Charitable Gift Fund

Donor/Primary Adviser Application for Entities

Please select the type of contribution(s) being made and provide the requested information for such

contribution(s):

#1 Making a Contribution of Cash (or cash equivalents) through Check and/or Wire Transfer

NOTE: Please use the instructions in this section #1 if transferring the partial or entire

balance of an existing donor advised fund from another institution.

Check (Make check payable to BNY Mellon Charitable Gift Fund)

Amount of check: $_______________________

Name on account check is drawn on: __________________________________

If account is not held in the name of the Entity Donor, then an explanation must be attached to

this application along with authorization from the account holder

Financial institution/Country check is drawn on: ________________________

Forward Checks to:

BNY Mellon Charitable Gift Fund

201 Washington Street

Suite 024-0035

Boston, MA 02108

Wire

Amount of wire: $_____________________

Name on account wire being sent from: __________________________________

If account is not held in the name of the Entity Donor, then an explanation must be attached to

this application along with authorization from the account holder

Financial institution/Country wire being sent from: ________________________

Approximate date of wire (mm/dd/yyyy): __________________

Wire Transfer Instructions:

ABA = 011001234 BNY Mellon, NA

DDA: = 0000108138

A/C 10011823020 / BNY Mellon Charitable Gift Fund

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