Donor Advised Fund Application

Please complete all information requested in this form. If you need assistance, you may contact your wealth advisor or call our office at 571-620-3000.

Fund Information

Your fund can be named after you or your family, or it can reflect an area of interest to you (e.g. John Donor Family Fund, or the Donor Fund for the Arts).

Fund Name:

Proposed Charitable Purpose:

Unless you choose to remain anonymous, the name of your fund will be used in correspondence to the charitable organizations that receive grants from the fund; along with a donation page hosted on our website.

I wish to:

Donor Information

Donor Record

Full Name:

Date of Birth:

Street Address: City/State/Zip:

Primary Phone: Alternate Phone:

Email Address:

**Joint Donor Record (optional)**

Full Name:

Date of Birth:

Street Address: City/State/Zip:

Primary Phone: Alternate Phone:

Email Address:

**Wealth Advisor (if applicable)**

This person may manage the DAF investment portfolio if the balance in the fund exceeds $25,000.

You may recommend an investment manager for your fund; however, United Charitable makes the final selection. All managers retained by United Charitable must adhere to United Charitable’s investment policies. If you do not recommend a manager, United Charitable will appoint one for your fund.

Please select type of advisor:

Accountant

Attorney

Wealth Advisor

Other:

Company:

Name:

Street Address: City/State/Zip:

Phone Number: Fax Number:

Email Address:

Please choose the level of access you wish to authorize to your Advisor.

Inquiry Access: Obtain account information (balance, contribution history, grant history) and view-only web access.

Transactional Access: Obtain account information (balance, contribution history, grant history), recommend re-allocation strategy, update founder/director communication information (address, email, phone).

Funding Your DAF

How will your initial contribution be funded?

Costs

Set-Up: A one-time set-up fee of $500* is due upon signing this application. Additional fees may apply, depending on the asset type.

Pay with credit card online

Deduct from initial cash contribution

Check made payable to United Charitable with your fund name on the memo line and mailed to us at 44921 George Washington Boulevard, Suite 230 Ashburn, VA 20147

To pay by credit card, visit https://www.unitedcharitable.org/daf-application-fee/

Ongoing Fees:

Investment Platform: An investment account is open FBO of the DAF.

Fees:

Set-up fee waived for investment accounts.
Bi-annual fees based on AUM from 12/31-6/30

Asset Size	Fee
$0-500K	0.75%
$500,001-$1.5M	0.65%
$1,500,001-$3M	0.45%
Above $3M	0.35%

Cash Platform: Cash is donated into the DAF.

Fees:

$500 Set-up fee
1% on all incoming funds
$250 annual fee

Insurance Platform: An insurance policy is donated or open FBO of the DAF and premiums are paid through the DAF as a donation.

Fees:

$500 Set-up fee
4.5% assessed on Death Benefit and surrenders
No annual fee

LLC Platform: Interest in a charitable LLC is donated to the DAF.

Fees:

$5,000 Set-Up fee
4.5% on all distributions from partnerships
$2,500 annual fee

*Please note that additional processing fees may apply.

Disclosures

Please read and attest to the following:

“I acknowledge that I have been afforded ample opportunity to consult with an attorney, certified public accountant, and/or other independent professional advisors of my choosing in connection with my decision to create a donor advised fund at United Charitable. I affirm that I have made the decision to apply to create a donor advised fund at United Charitable in order to advance the religious, educational, scientific, and/or charitable purposes identified by me above. If and to the extent that I may derive any tax benefit from my charitable contribution to United Charitable, such benefit is incidental to my desire to serve the purposes set forth above. I have made the decision to freely and voluntarily apply to create the donor advised fund after giving administered by United Charitable in accordance with federal tax laws which pertain to publicly supported charities, such as United Charitable.

I UNDERSTAND THAT CONTRIBUTIONS TO UNITED CHARITABLE ARE ABSOLUTE, IRREVOCABLE, AND UNCONDITIONAL CHARITABLE CONTRIBUTIONS AND I HAVE NO RIGHT TO THE RETURN OF THEM. NOR DO I HAVE ANY RIGHT OR ENTITLEMENT TO ANY INCOME FROM THE FUNDS OR PROPERTY I HAVE CONTRIBUTED TO UNITED CHARITABLE. I REALIZE THAT THE FUNDS OR PROPERTY WHICH I SHALL DONATE TO UNITED CHARITABLE BECOME THE SOLE AND EXCLUSIVE PROPERTY OF UNITED CHARITABLE.”
Other than specifically authorized employees of United Charitable, no person is authorized to open any bank accounts, investment accounts, credit cards, merchant accounts, securities accounts, vendor accounts, trade accounts or any account whatsoever in the name of any charitable fund at United Charitable and/or in the name of United Charitable. Additionally, signatories on approved accounts must at times be current authorized employees of United Charitable. The federal tax identification number of United Charitable must be on all accounts.

Other than specifically authorized employees of United Charitable, no person is authorized to cause any charitable fund at United Charitable and/or United Charitable to enter into any contract, lease, property rental, purchase order, loan, an extension of credit on account and/or any other oral or written agreement which may subject any charitable fund at United Charitable and/or United Charitable to monetary or non-monetary liability, obligation, or indebtedness of any type.
Other than specifically authorized employees of United Charitable, no person is authorized to award any scholarship or make any grants from the funds allocated to any charitable fund at United Charitable. I may make recommendations to United Charitable as to scholarships or grants, but only United Charitable can make the final decision and issue the funds.

I will not represent to any person that I am an agent, independent contractor, or employee of United Charitable.
I will not cause United Charitable to be exposed to any liability for injuries or damages as a result of any: (a) negligent act or omission by me or any person related to me or subject to my direction or control; (b) breach of statute, ordinance, or regulation by me or any person related to me or subject to my direction or control; or (c) other wrongful act or omission by me or any person related to me or subject to my direction or control.

I acknowledge that if I am in breach of the provisions set forth above, the result may be for United Charitable to be exposed to liability, to incur federal corporate income tax for unrelated business taxable income, and/or be subject to expenses for legal fees and litigation costs. I agree to reimburse United Charitable for all liability, costs, taxes, damages, and expenses to which it may be subject as a result of a breach by me of any of the provisions set forth above.

My signature below verifies that I have read, understand, and will comply with the above policies.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

April 7, 2022 12:10 pm EDT

Digital DAF Application 2022 Uploaded by United Charitable - daf@unitedcharitable.org IP 72.73.25.226

April 7, 2022 2:27 pm EDT

Kaitlyn Cline - kaitlyn@unitedcharitable.org added by United Charitable - daf@unitedcharitable.org as a CC'd Recipient Ip: 72.73.25.226

April 7, 2022 2:27 pm EDT