new account applications - Life Enhancement Investments

Reset Form
STANDARD ACCOUNT APPLICATION
Account # _____________________
Advisor # _____________________
Case # _____________________
INVESTMENT ADVISOR
Investment Advisor Firm (Agent) and Primary Contact:
Firm Name: ____________________________________________ Primary Contact: ____________________________________________
1
ACCOUNT TYPE: PLEASE CHECK THE APPROPRIATE BOX
! Individual
Custodian for a Minor* Please indicate the state of establishment: _____________. If the state is left blank, the minor’s state of residence will default.
Joint Tenants with Rights of Survivorship If one Joint owner dies, his/her interest passes to the surviving owner(s).
! Tenants in Common _______% Owner _______% Co-owner If one Joint owner dies, his/her interest passes to his/her estate (50/50, unless otherwise noted).
! Community Property For AZ, CA, ID, LA, NM, NV, TX, WA, and WI only. Laws vary by state.
! Tenants by the Entireties If one Joint owner dies, his/her interest passes to the surviving owner (Spouses only).
! Estate Decedent’s account number at TD Ameritrade: _______________________. Provide estate name and estate tax ID in Section 2, and the
!
!
executor’s information in Section 3. Include a copy of the decedent’s death certificate, and a copy of the Letters of Testamentary.
!
!
Guardianship** Please include a copy of the court certified letter of guardianship.
Conservatorship** Please include a copy of the court certified letter of conservatorship.
* Provide minor’s information in the Primary Account Owner information portion of Section 2, and the custodian’s information in the Joint Account Owner portion of Section 3.
Complete the Custodian’s Designation of Successor Custodian to UTMA/UGMA Account form. If the custodian dies or becomes incapacitated without designating a successor,
a court certified Appointment of Successor Custodian may be required.
**Additional information and/or paperwork may be required. Please contact your advisor.
2
PRIMARY ACCOUNT OWNER: COMPLETE ALL INFORMATION BELOW FOR THE PRIMARY OR MINOR ACCOUNT OWNER
|
|
|
First Name:
Estate Name:
Primary Telephone Number:
Middle Initial:
|
Last Name:
Social Security Number/ Estate Tax ID:
! Check here if this is not a U.S. phone number. Secondary Telephone Number:
Home Street Address (No PO Boxes):
|
City:
Mailing Address (If different from above):
City:
Please specify if you are:
! Employed ! Self-employed ! Unemployed ! Retired
|
State:
! Student
Employer Name (If self-employed, please provide the name of your business and industry):
Type of Business:
|
Date of Birth:
! Check here if this is not a U.S. phone number.
|
State:
! Homemaker
|
|
ZIP Code:
ZIP Code:
Source of income (if Unemployed, Retired, Homemaker, or Student):
|
Occupation:
Employer Street Address:
City:
Check here if you are a:
! U.S. Citizen ! Permanent Resident ! Not a U.S. Citizen
Country of Dual or Secondary Citizenship (if applicable):
Non-U.S. citizens: Do you hold a current U.S. immigration visa?
! Yes
|
|
|
State:
|
ZIP Code:
Country of Citizenship (For non-U.S. Citizens and Permanent Residents):
Country of Birth (For non-U.S. Citizens and Permanent Residents):
! No Specify Visa type: _______________ Visa Number: _______________ Expiration: ___________
(Nonresident aliens must submit Form W-8BEN and a copy of a current passport. If a U.S. address is listed, then attach a signed letter of instruction explaining why you have a U.S. address.)
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, and any personal or business associates is a
senior political figure (SPF). Specify the name of the SPF, political title, relationship to Account owner, and country of office:
_________________________________________________________________________________________________________________________________________
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, is a director, 10% shareholder, or policy-making officer of a publicly traded company. Specify the company name, address, city, and state:
_________________________________________________________________________________________________________________________________________
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents is licensed, employed by, or associated with, a
broker-dealer firm, a financial services regulator, securities exchange, or member of a securities exchange. If checked, please specify entity below, and provide a copy of the
required authorization letter (with this application):
_________________________________________________________________________________________________________________________________________
*TDAI9017*
Page 1 of 4
TDAI 9017 REV. 09/14
3
JOINT ACCOUNT OWNER: COMPLETE ALL INFORMATION BELOW FOR THE JOINT ACCOUNT OWNER OR CUSTODIAN
First Name:
Estate Name:
Primary Telephone Number:
! Check here if this is not a U.S. phone number.
Home Street Address (no PO boxes):
|
|
|
|
City:
Mailing Address (if different from above):
|
City:
Please specify if you are:
! Employed ! Self-employed ! Unemployed ! Retired
Middle Initial:
Secondary Telephone Number:
State:
! Student
Type of Business:
Check here if you are a:
! U.S. Citizen ! Permanent Resident ! Not a U.S. Citizen
Country of Dual or Secondary Citizenship (if applicable):
Non-U.S. citizens: Do you hold a current U.S. immigration visa?
! Yes
|
|
|
ZIP Code:
ZIP Code:
Source of income (if Unemployed, Retired, Homemaker, or Student):
|
|
City:
Date of Birth:
! Check here if this is not a U.S. phone number.
|
State:
Employer Name (If self-employed, please provide the name of your business and industry):
|
|
|
Last Name:
Social Security Number\ Estate Tax ID:
! Homemaker
Employer Street Address:
|
Occupation:
State:
Country of Citizenship (For non-U.S. Citizens and Permanent Residents):
Country of Birth (For non-U.S. Citizens and Permanent Residents):
! No Specify Visa type: _______________ Visa Number: _______________ Expiration: ___________
(Nonresident aliens must submit Form W-8BEN and a copy of a current passport. If a U.S. address is listed, then attach a signed letter of instruction explaining why you have a U.S. address.)
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, and any personal or business associates is a
senior political figure (SPF). Specify the name of the SPF, political title, relationship to Account owner, and country of office:
_________________________________________________________________________________________________________________________________________
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, is a director, 10% shareholder, or policy-making officer of a publicly traded company. Specify the company name, address, city, and state:
_________________________________________________________________________________________________________________________________________
! Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents is licensed, employed by, or associated with, a
broker-dealer firm, a financial services regulator, securities exchange, or member of a securities exchange. If checked, please specify entity below, and provide a copy of the
required authorization letter (with this application):
_________________________________________________________________________________________________________________________________________
4
CASH SWEEP VEHICLE CHOICES (PLEASE SELECT ONLY ONE)
!
!
TD Ameritrade FDIC Insured Deposit Account (IDA)
Pays interest on credit balances.
!
TD Asset Management USA Funds (TDAM)
TD Ameritrade Cash (Protected by the Securities Investor
Protection Corporation (SIPC))
Pays interest on credit balances.
TDAM Municipal Portfolio
Invests primarily in high-quality municipal securities that pay
dividends exempt from federal income tax.
!
TDAM New York Municipal Money Market Portfolio
Invests primarily in high-quality municipal securities that pay
dividends that are exempt from federal, New York state, and
New York City income tax.
!
TDAM California Municipal Money Market Portfolio
Invests primarily in high-quality municipal securities that pay
dividends that are exempt from federal and California state
income taxes.
NOTE: If not specified, all credit balances will automatically be swept daily to the TD Ameritrade FDIC Insured Deposit Account. See the Client
Agreement for a complete description of the Cash Sweep program. An investment in a money market mutual fund is not insured or guaranteed
by the Federal Deposit Insurance Corporation (FDIC) or any other government agency. Although a money market fund seeks to preserve the
value of your investment at $1 per share, it is possible to lose money by investing in a money market fund. Tax-exempt portfolios may pay
dividends that are subject to the alternative minimum tax, and also may pay taxable dividends due to investments in taxable obligations. More
complete information about the money market funds, including management fees and expenses, is contained in the prospectus, which can be
obtained by calling your advisor. Please read the prospectus carefully before you invest or send money.
5
DIVIDEND & INTEREST PREFERENCES (PLEASE SELECT ONLY ONE OPTION FOR DIVIDEND & INTEREST DELIVERY)
Please select one of the below choices. If no selection is made TD Ameritrade will default to holding all dividends and interest at TD Ameritrade.
! Hold all dividends and interest at TD Ameritrade
! ACH all dividends and interest on the last business day of the month*
*Electronic Funds Transfer Form required
!
Mail check for all dividends and interest on the last business day of the month
Page 2 of 4
TDAI 9017 REV. 09/14
6
CONFIRMATION AND STATEMENT PREFERENCES
By providing your email address, you consent to receive electronic trade confirmations and statements. Account statements and trade
confirmations will be available at advisorclient.com through your user ID and login. We will send a notification to the email address you provide
below when new documents are available to view and/or print.
!
!
Monthly Paper Statements
Monthly Electronic Statements
!
!
Paper Trade Confirmations
Electronic Trade Confirmations
Email Address: _______________________________________________________________________________________
In the event that no email address is provided or an email sent to the address above is returned as undeliverable, TD Ameritrade will send
paper statements and trade confirmations to the address of record.
!
7
TD Ameritrade will provide my name to corporations whose securities I hold in my account for the purpose of additional corporate
communications, unless I have checked here.
DUPLICATE STATEMENTS & CONFIRMS FOR AN INTERESTED PARTY
If you would like to provide duplicate paper statements and/or duplicate paper trade confirmations to an interested party please complete the
information below:
Please check all that apply
! Statements
! Trade Confirmations
Name:
Street Address:
8
PROXY AUTHORIZATION
|
|
Company Name (if any):
City:
|
State:
|
ZIP Code:
Please select one of the below choices. If no selection is made TD Ameritrade will default to sending me proxies. The Agent can only vote my
proxies if they have discretion over my account.
! I would like to receive and vote on proxies.
! Agent receives and votes proxies. I hereby authorize TD Ameritrade to forward proxy soliciting materials, annual reports, and other related
issuer materials, normally sent to me, to my advisor (Agent) and to allow Agent to vote Proxies on my behalf.*
! Agent receives and votes proxies but I would like to receive informational copies. I hereby authorize TD Ameritrade to forward proxy soliciting
materials, annual reports, and other related issuer materials, normally sent to me, to my advisor (Agent) and to allow Agent to vote Proxies on
my behalf.*
* I confirm that the Agent holds discretionary authority over my account pursuant to an advisory contract with the Agent. I understand that this authorization may be
rescinded at any time for any reason, by a written notice addressed to TD Ameritrade and delivered to your office. This authorization shall extend to the benefit of your
successors and assigns.
9
LIMITED POWER OF ATTORNEY
LIMITED TO PURCHASE AND SALE OF SECURITIES, INCLUDING THE TRADING OF OPTIONS, IF APPLICABLE.
By my initials in Section 9, and to the extent indicated herein, I hereby constitute and appoint the Advisory Firm or individual named herein as my agent and
attorney-in-fact (“Agent”), to buy, sell (including short sales), and trade in stocks, bonds, and any other securities and/or contracts relating to the same on margin (if
I have signed a margin agreement) or otherwise in accordance with the Client Agreement (incorporated by reference) applicable to this account held in my name,
or number on your books, without notice to me. My Agent is authorized to effect such transactions in my account via any available medium, electronic access or
otherwise, including but not limited to electronic access via personal computer or touch-tone phone.
If I have signed an options agreement, my Agent is specifically authorized to effect options transactions in my account, including uncovered options transactions
or to uncover a covered options position for my account, as such terms are defined in the booklet “Characteristics and Risks of Standardized Options,” a copy of
which I have received. I hereby agree to indemnify and hold harmless TD Ameritrade, Inc. (“TD Ameritrade”), its affiliates and their directors, officers, employees,
and agents from and against all claims, actions, costs, and liabilities, including attorneys’ fees, arising out of or related to reliance on this authorization and to pay
promptly on demand any and all losses arising therefrom or debit balance due thereon. In all such purchases, sales, or trades, you are authorized to follow the
instructions of my Agent in every respect concerning my account with you; and my Agent is authorized to act for me and on my behalf in the same manner and with
the same force and effect as I might or could do with respect to such purchases, sales, or trades, as well as with respect to all other things necessary or incidental
to the furtherance or conduct of such purchases, sales, or trades, including without limitation the delivery of securities or monies from the account in the Account
Owner(s) name and the provision of securities cost basis method selection and/or information for purposes of cost basis or tax reporting.
I hereby ratify and confirm any and all transactions with you heretofore or hereafter made by my Agent for my account. This authorization and indemnity is in
addition to, and in no way limits or restricts, any rights which you may have under any other agreement or agreements between me and TD Ameritrade.
If this is a fiduciary account, Account Owner(s) affirm(s) that this grant of limited trading authority has been conferred consistent with any fiduciary duties or powers
of Account Owner(s).
This authorization is a continuing one and shall remain in full force and effect until (i) you are notified by a written notice delivered to TD Ameritrade of my death
or incapacity or (ii) I change or revoke this authorization by a written notice to TD Ameritrade. You shall have no duty of inquiry. Until you receive such written
revocation, you are entitled to act in reliance on this authorization and indemnity. Any revocation of this authorization shall have no effect on any liability which
results from transactions initiated before you receive written notice of revocation. This authorization and indemnity shall inure to the benefit of your firm and of any
successor firm or firms, irrespective of any change or changes at any time in the personnel thereof for any causes whatsoever, and of the assigns of your present
firm or any successor firms.
I have carefully read this power of attorney and indemnity and understand that it authorizes my Agent named herein to exercise rights and powers over
my accounts as if I had exercised them myself and that my Agent’s actions and instructions with respect to my accounts are fully binding on me.
I also understand and agree that TD Ameritrade has no duty or responsibility to monitor trading in my accounts by my Agent or to notify me prior to
accepting instructions. I agree to have my Agent receive duplicate statements and trade confirmations.
Please initial to indicate your approval. (if joint account, both parties must initial)
Primary Account Owner Initials:
Joint Account Owner Initials:
I hereby authorize the Agent listed on page 1 to execute trades in my account.
Page 3 of 4
TDAI 9017 REV. 09/14
10
8
AUTHORIZATION TO PAY FEES TO AGENT
By my initials in Section 10, and to the extent indicated herein, I hereby authorize TD Ameritrade to pay Agent from my account the Agent’s management fees as
invoiced by Agent. I also authorize TD Ameritrade to liquidate shares of any money market mutual fund I may hold in my account to the extent necessary to pay
such fees. TD Ameritrade shall rely on Agent’s invoices and have no responsibility for the calculation or verification of fees.
I will indemnify and hold TD Ameritrade and its affiliates, directors, officers, employees, successors, and assigns harmless from all losses, claims, damages,
liabilities, and costs, including attorneys’ fees, which TD Ameritrade may incur by relying upon representation of Agent or upon this authorization.
This authorization will remain in full force and effect until revoked by me by a written notice addressed and delivered to TD Ameritrade.
Please initial to indicate your approval. (if joint account, both parties must initial)
Primary Account Owner Initials:
11
I hereby authorize TD Ameritrade to pay my Agent’s fee from my account as
directed by my Agent.
Joint Account Owner Initials:
AGREEMENT — BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT:
I acknowledge that I have received and read the Client Agreement, available at advisorclient.com or by calling 800-431-3500, that will govern my account. I agree to
be bound by the Client Agreement, which may be amended from time to time and which is incorporated by this reference. I release and agree to indemnify and hold
harmless TD Ameritrade Institutional from any and all liability and claims for damages resulting from any action taken pursuant to this Agreement. By my signature
below, I attest that I am of legal age to contract and that the information contained in this application is true and correct. I hereby request, subject to acceptance by
TD Ameritrade Institutional, an account as indicated in Section 1 be opened in the name(s) set forth below.
If I have requested an options account, I agree to be bound by the Client Agreement and any supplemental options agreements that will govern my account
applicable to the trading of options contracts. I agree to abide by the rules of the listed options exchanges and the Options Clearing Corporation and will not violate
current position and exercise limits. I am aware of the risks involved in options trading and represent that I am financially able to bear such risks and withstand
options-trading losses.
All securities, dividends, and proceeds will be held at TD Ameritrade Clearing, Inc. (the “Clearing Firm”), unless otherwise instructed.
I understand that TD Ameritrade Institutional may obtain a current consumer or credit report to determine my eligibility, or continuing eligibility, for credit or for other
legitimate business purposes. Any decision by TD Ameritrade Institutional to extend credit may be based on information contained in a consumer or credit report, as
well as the policies of TD Ameritrade Institutional and the Clearing Firm.
I understand that TD Ameritrade Institutional may relate information regarding this account, including account delinquency and voluntary closures, to consumer or
credit reporting agencies. Upon my request, TD Ameritrade Institutional shall inform me of each consumer or credit reporting agency from which they have obtained
and/or reported my consumer or credit report. TD Ameritrade Institutional agrees to notify the consumer or credit reporting agencies if I dispute the completeness
or accuracy of the information furnished by TD Ameritrade Institutional. By my signature below, I authorize TD Ameritrade Institutional to obtain consumer or credit
reports for the name(s) set forth below.
Unless specified otherwise, I understand that non-deposit investments purchased through TD Ameritrade Institutional are not insured by the Federal
Deposit Insurance Corporation (FDIC), are not obligations of or guaranteed by any financial institution, and are subject to investment risk and loss that
may exceed the principal invested.
Important information about procedures for opening a new account: 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.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to
identify you. We may also utilize a third-party information provider for verification purposes and/or ask for a copy of your driver’s license or other
identifying documents.
Successors and Heirs. This Authorization supplements and in no way limits or restricts rights that TD Ameritrade Institutional and the Clearing Firm may have
under any other agreement with me. This Authorization will bind my heirs, executors, administrators, successors, and assigns and will benefit TD Ameritrade
Institutional and the Clearing Firm’s successors and assigns.
The Client Agreement applicable to this brokerage account agreement contains predispute arbitration clauses. By signing this agreement, the parties
agree to be bound by the terms of the agreement, including the arbitration agreement located in section 12 of the Client Agreement on page 8.
Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number, and (2) I am not subject to
backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I
am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject
to backup withholding, and (3) I am a U.S. citizen or other U.S. person, and (4) the FATCA code(s) entered on this form (if any) indicating that I am
exempt from FATCA reporting is correct.
If I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding because I have failed to report all interest and
dividends on my tax return, I must cross out (2) in this certification.
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
12
ACCOUNT OWNER(S) SIGNATURE:
Primary Account Owner’s Printed Name: _________________________________________________________________________________________________
Primary Account Owner’s Signature: ___________________________________________________________________________ Date: ___________________
Joint Account Owner’s Printed Name: ___________________________________________________________________________________________________
Joint Account Owner’s Signature: _____________________________________________________________________________ Date: ___________________
Mailing Address:
TD Ameritrade Institutional
PO BOX 919094
San Diego, CA 92191-9094
Overnight Address:
TD Ameritrade Institutional
5010 Wateridge Vista Drive
San Diego, CA 92121-5775
TDAI 9017 REV. 09/14
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
TD Ameritrade Institutional, Division of TD Ameritrade, Inc., and TD Ameritrade Clearing, Inc., members FINRA/SIPC. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. © 2014 TD Ameritrade IP Company, Inc. All rights reserved. Used with permission.
Page 4 of 4
Reset Form
ACCOUNT TRANSFER FORM
TO TRANSFER YOUR EXISTING
ACCOUNT TO TD AMERITRADE
Account # ___________________
Advisor # ___________________
Case # ___________________
PLEASE ATTACH A COPY OF YOUR LATEST STATEMENT.
1
TD AMERITRADE ACCOUNT INFORMATION
Account Title/Registration:
|
Social Security Number/Tax ID:
Clearing Number:
0188
! Individual
(Non-Qualified)
! Personal Trust
! Limited Liability Company
! Roth IRA
! Qualified Retirement Plan
Employer Plan Type: ____________________________
! Joint
! Estate
! Partnership/Investment Club
! SEP IRA
! Simple IRA
! UTMA/UGMA
! Corporate
! Traditional IRA/Rollover IRA
! Coverdell ESA
! Beneficiary IRA
! Other: __________________________________________________________________________________________________________________________
2
INFORMATION ON THE ACCOUNT YOU ARE TRANSFERRING FROM
|
Account Title/Registration as shown on your statement:
Name of Delivering Firm:
|
Physical Address of Firm (no PO BOX):
Account Number:
Telephone Number (required):
! Individual
(Non-Qualified)
! Personal Trust
! Limited Liability Company
! Roth IRA
! Qualified Retirement Plan
Employer Plan Type: ____________________________
! Joint
! Estate
! Partnership/Investment Club
! SEP IRA
! Simple IRA
Has SIMPLE IRA been funded for at least two years?
! Yes
! No
! UTMA/UGMA
! Corporate
! Traditional IRA/Rollover IRA
! Coverdell ESA
! Beneficiary IRA
! Other: __________________________________________________________________________________________________________________________
3
LIST THE ASSETS YOU WANT TO TRANSFER
A. Transfer from an ACAT eligible Brokerage Firm, Bank, Insurance/Annuity Co., Trust Co., or Transfer Agent – Check box for full
or partial transfer. For partial transfers, list descriptions of assets and shares. Unless otherwise indicated, TD Ameritrade will transfer in full.
Please note – The ACAT system does not allow for liquidation requests. To place trades, please contact your current custodian prior to
submitting the transfer request. Most banks, insurance/annuity, and trust companies require original wet-ink signature mailed to TD Ameritrade.
! Full Transfer – To transfer entire account, check box and
skip to Section 4 (if applicable), then to the Signature Section.
Description of Asset
(Partial transfers only)
! Partial Transfer – List specific security. If bonds are being transferred,
please supply the Bond CUSIP.
Quantity
(Indicate # of shares or “ALL”)
Description of Asset
(Partial transfers only)
Quantity
(Indicate # of shares or “ALL”)
For additional securities, see attached list. !
*TDAI9582*
Page 1 of 5
TDAI 9582 REV. 01/14
Annuity/Life Insurance Policy: I have an annuity or life insurance policy I wish to liquidate and have the proceeds sent to TD Ameritrade.
Please choose one option:
! Please redeem and terminate entire contract or policy on my behalf. I understand that penalties may apply.
! Please redeem and terminate entire contract or policy on my behalf. The entire contract or policy is penalty-free.
! Please redeem only the penalty-free amount of $_____________.
! Please withdraw a partial amount of $____________. The entire contract or policy is penalty-free
Certificates of Deposit (CDs):
! Redeem my CD immediately. I understand that penalties may apply for any withdrawals prior to maturity.
! Redeem my CD at maturity. Maturity date:_____________________ Submit request at least 21 days prior to maturity. Please advise your
bank not to roll over the CD to a new term.
Dividend Reinvestment Plan:
! I am transferring positions in Book Entry form and liquidating accumulated fractional shares.
B. Transfer from a Mutual Fund company – Unless otherwise indicated, TD Ameritrade will transfer all shares in kind and reinvest your
dividends and capital gains. I acknowledge that ineligible proprietary mutual funds and all no-load money market funds cannot be transferred
in kind and must be liquidated by the mutual fund company.
Fund Name or Symbol
Fund Account Number
Quantity
(Indicate # of shares or “All”)
Handling (Check one)
Credit Gains and Dividends as
(Check one if transferring shares)
! Transfer my shares
! Sell my shares, transfer cash
! Reinvested shares
! Cash
! Transfer my shares
! Sell my shares, transfer cash
! Reinvested shares
! Cash
! Transfer my shares
! Sell my shares, transfer cash
! Reinvested shares
! Cash
! Transfer my shares
! Sell my shares, transfer cash
! Reinvested shares
! Cash
! Transfer my shares
! Sell my shares, transfer cash
! Reinvested shares
! Cash
For additional mutual funds, see attached list. !
To transfer Money Markets, please indicate the Money Market name or symbol if available:
Page 2 of 5
|
Liquidate Money Market:
! All
! Only: $______________
TDAI 9582 REV. 01/14
4
DISCREPANCIES OF ACCOUNT NAME AND TYPE (IF APPLICABLE)
If the account you are transferring is not like titled, please complete the following authorization. We hereby authorize a transfer from the account
of ________________________________________ to the account at TD Ameritrade for ___________________________________.
(Delivering Account Title/Registration)
(TD Ameritrade Account Title/Registration)
Account Owner’s Signature: _________________________________________________________________________ Date: __________________________
Account Co-Owner’s Signature: ______________________________________________________________________ Date: __________________________
If the discrepancy is a result of a name change for an account owner, please provide a copy of the legal document such as marriage certificate,
divorce decree, etc.
5
SIGNATURE(S): PLEASE READ AND SIGN THIS SECTION (A COPY OF YOUR LATEST STATEMENT IS REQUIRED)
If this account is a qualified retirement account, I have amended the applicable plan so that it names TD Ameritrade Clearing, Inc. as a
successor custodian.
Unless otherwise indicated in the instructions above, please transfer all assets in my account in kind to TD Ameritrade. I understand
that to the extent any assets in my account are not readily transferable, with or without penalties, such assets may not be transferred within the
time frames required by applicable regulations.
Unless otherwise indicated in the instructions above, I authorize you to liquidate any non-transferable proprietary money market fund assets that
are part of my account and transfer the resulting credit balance to TD Ameritrade Clearing, Inc. I authorize you to deduct any outstanding fees due
you from the credit balance in my account. If my account does not contain a credit balance, or if the credit balance in the account is insufficient
to satisfy any outstanding fees due you, I authorize you to liquidate the assets in my account to the extent necessary to satisfy that obligation. If
certificates or other instruments in my account are in your physical possession, I instruct you to transfer them in good deliverable form, including
affixing any necessary tax waivers, to enable the successor custodian to transfer them in its name for the purpose of sale, when and as directed
by me. I understand that upon receiving a copy of this transfer instruction, you will cancel all open orders for my account on your books.
Account Owner’s Printed Name: _____________________________________________________________________________________________________
Account Owner’s Signature: _________________________________________________________________________ Date: __________________________
Account Co-Owner’s Printed Name (if Joint Account): ____________________________________________________________________________________
Account Co-Owner’s Signature (if Joint Account): ________________________________________________________ Date: __________________________
Plan Administrator Signature (optional): _______________________________________________________________ Date: __________________________
6
LETTER OF ACCEPTANCE FOR RETIREMENT PLANS (TD AMERITRADE COMPLETES)
To the prior trustee or custodian: Please be advised that TD Ameritrade Clearing, Inc. will accept the above-captioned account as successor custodian.
Successor Custodian Authorized Signature: ____________________________________________________________ Date: __________________________
Page 3 of 5
TDAI 9582 REV. 01/14
FOR TD AMERITRADE USE ONLY:
Receiving Firm Information
Clearing Firm: TD Ameritrade Clearing, Inc.
Tax ID Number: 47-0533629
Name and Address: TD Ameritrade, Inc.
Attn: Transfer of Accounts Department
200 S 108th Ave
Omaha, NE 68154
All deliveries MUST include client name and TD Ameritrade, Inc. (“TD Ameritrade”) account number.
Depository Trust Company
DTC # 0188
Physical Delivery of Securities
TD Ameritrade Clearing, Inc.
FBO Client Name and
Account Number
PO Box 2226
Omaha, NE 68103-2226
200 S 108th Ave
Omaha, NE 68154-2631
Book-Entry GNMA Securities
PTC Instructions are: BKNYCATP
Federal Book Entry
(for example, Treasury Notes)
BK of NYC/TD Ameritrade
ABA #021000018
Fed Wired Monies
Wire to:
First National Bank of Omaha
16th & Dodge Streets
Omaha, NE 68102
A/C of TD Ameritrade, Inc.
ABA #104000016
A/C #16424641
For Further Credit to:
Client’s Name and Account Number.
Forward Checks
TD Ameritrade Clearing, Inc.
FBO Client Name and
Account Number
PO BOX 919031
San Diego, CA 92191-9031
5010 Wateridge Vista Drive
San Diego, CA 92121-5775
Mutual Fund Registration
TD Ameritrade, Inc.
Tax ID Number: 47-0533629
FBO Client’s Name and
Account Number
PO Box 2226
Omaha, NE 68103-2226
Broker/Dealer: TD Ameritrade, Inc.
200 S 108th Ave
Omaha, NE 68154-2631
Options
Options Clearing Corporation: OCC #0777
Cost Basis Information (**Required**)
TD Ameritrade is a CBRS Participant
Mailing Address (for Transfer Statements and general questions)
TD Ameritrade
PO Box 2209
Omaha, NE 68103-2209
Or
Fax Number: 1-866-468-6268
Please include the client’s name and TD Ameritrade account number in all correspondence.
Page 4 of 5
TDAI 9582 REV. 01/14
ACCOUNT TRANSFER FORM
Instructions to transfer securities, mutual funds, or other assets to
your TD Ameritrade Institutional account:
t$PNQMFUFSections 1-5 of the attached Transfer Form. For new accounts, a new account application must also be completed.
tSection 1 – TD Ameritrade Institutional Account Information — complete your TD Ameritrade account registration information.
tSection 2 – Delivering Firm Information — complete Delivering Firm’s account registration information.
tSection 3 – Transfer details; see below for requirements. Depending on where the assets are coming in from, please
complete section 3A or 3B.
t4FDUJPOƀ"o#SPLFSBHF'JSN5SBOTGFS
t'PSGVMMBDDPVOUUSBOTGFSTDPNQMFUFSection 3A, then the Discrepancies of Account Name and Type Section
4 (if applicable) and sign in Section 5.
t'PSQBSUJBMBDDPVOUUSBOTGFSTDPNQMFUFSection 3A, list description of asset, number of shares or “all”, then
the Discrepancies of Account Name and Type Section 4 (if applicable) and sign in Section 5.
t*GZPVSFUSBOTGFSSJOHQBSUPGZPVSBDDPVOUMJTUPOMZUIFBTTFUTZPVXBOUUSBOTGFSSFEUP5%"NFSJUSBEFJOTFDUJPO
Brokerage Firm, Bank, Insurance/Annuity Co., Trust Co. or Transfer Agent
t5PUSBOTGFSB.POFZ.BSLFU"DDPVOUQMFBTFDPNQMFUFUIJTTFDUJPO
t5PUSBOTGFSUIFQSPDFFETPGBNBUVSJOH$%JOJUJBUFZPVSUSBOTGFSBUMFBTUUXPUPUISFFXFFLTCFGPSFUIFNBUVSJUZEBUF
t5PUSBOTGFSBO"OOVJUZPS-JGF*OTVSBODF1PMJDZQMFBTFDIFDLUIFBQQSPQSJBUFCPY
t5PUSBOTGFSTIBSFTJOCPPLFOUSZGPSNVTVBMMZBTTPDJBUFEXJUIB%JWJEFOE3FJOWFTUNFOU1MBODIFDLUIF
appropriate box.
Please note: fractional shares will be liquidated and transferred as cash.
t4FDUJPOƀ#o.VUVBM'VOE$PNQBOZ5SBOTGFS
t'PSGVMMUSBOTGFSToJOEJDBUFBMMBOENBSLUSBOTGFSTIBSFTiJOLJOEwPSMJRVJEBUFBOETFOEQSPDFFET
t'PSQBSUJBMUSBOTGFSToMJTUJOEJWJEVBMGVOEOBNFOVNCFSPGTIBSFTUSBOTGFSJOLJOEPSMJRVJEBUFBOETFOEQSPDFFET
t$BMM5%"NFSJUSBEF*OTUJUVUJPOBMBUƅŽŽƁƀžƀƂŽŽUPNBLFTVSFUIFNVUVBMGVOEJTUSBOTGFSBCMFUP5%"NFSJUSBEF
Over 13,000 funds are available.
t4FOEBTFQBSBUF5SBOTGFS'PSNGPSFBDINVUVBMGVOEDPNQBOZGPSFYBNQMF7BOHVBSE'JEFMJUZ#FSHFSFUD
from which you’re transferring. Photocopy our form if necessary or call for additional forms.
tSection 4 – Discrepancies of Account type and name, if applicable. Please note that not all carrying firms will accept this
section to allow a transfer between unlike titles. The ultimate discretion to allow a transfer between unlike titles lies with the
carrying custodian.
tSection 5 – Signatures – all parties listed on the account registration information must sign. Please verify that the Social
Security Number and the title of the account at TD Ameritrade are exactly the same as the account at the other institution.
tSection 6 – Letter of Acceptance to be completed by TD Ameritrade if needed.
IMPORTANT
t1MFBTFBUUBDIBCOPY of the most recent statement from the institution you are transferring from. The statement
should be from within the past 6 months to best display the most accurate holdings. Please note the statement is
used to process your request so an accurate statement allows for best results.
t%POPUVTFUIJTGPSNUPUSBOTGFSCFUXFFO5%"NFSJUSBEFBDDPVOUT
t3PUI*3"o*OPSEFSUPDPOWFSUZPVS5SBEJUJPOBM*3"BUBOPUIFSmSNUPB3PUI*3"BU5%"NFSJUSBEFQMFBTFDPOWFSUUPUIF
Roth IRA with your existing custodian and then complete a transfer to a Roth IRA at TD Ameritrade.
IF YOU HAVE ANY QUESTIONS, PLEASE Contact your advisor.
Need more forms? Photocopy this form, call us, or visit our website at advisorclient.com for additional forms.
Mailing Address:
TD Ameritrade Institutional
PO BOX 919094
San Diego, CA 92191-9094
Overnight Address:
TD Ameritrade Institutional
5010 Wateridge Vista Drive
San Diego, CA 92121-5775
TDAI 9582 REV. 01/14
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
TD Ameritrade Institutional, Division of TD Ameritrade, Inc., member FINRA/SIPC/NFA and TD Ameritrade Clearing, Inc., member FINRA/SIPC.
TD Ameritrade is a trademark jointly owned by TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank.
© 2014 TD Ameritrade IP Company, Inc. All rights reserved. Used with permission.
Page 5 of 5
Reset Form
MOVE MONEY
ADVISOR AUTHORIZATION
Account # _____________________
Advisor # _____________________
Case # _____________________
By enrolling in TD Ameritrade Move Money, you are establishing a standing authorization to request checks to the address of record, internal
transfers, and/or electronic funding transfers between your TD Ameritrade account and the account at another financial institution specified below.
Please note that you must be an account owner on both accounts to enable your advisor to request transfers from the other account to your
TD Ameritrade account. Not all account types are eligible for Move Money; please contact your Service Team for information. For retirement Move
Money authorization, please complete and submit an IRA Move Money form. There are certain types of distribution instructions that cannot
be pre-authorized with this form. An appropriate Distribution Request Form with your signature will always be required for the following
instruction requests:
t$IFDLXJUIESBXBMUPBOBEESFTTEJøFSFOUUIBOUIFBDDPVOUBEESFTTPGSFDPSE
1
INVESTMENT ADVISOR AUTHORITY (REQUIRED)
Name of the Advisory Firm you wish to have Move Money authorization on your behalf:
2
TYPE OF REQUEST
▫ New instructions
▫ Replace existing instructions
▫ Remove ALL authorizations (all existing ACH, Fed Wire, and Internal Transfer Move Money Investment Advisor authorizations on account will be removed)
3
ACCOUNT OWNER INFORMATION
Name (First, Middle Initial, Last):
|
Primary Telephone Number:
34
|
Social Security Number:
Secondary Telephone Number:
AUTHORIZED METHOD(S) OF PAYMENT (SELECT ALL THAT APPLY)
I/We authorize my/our Investment Advisor to utilize the following methods to disburse funds from, or to contribute funds to (ACH and internal
transfers only), my/our account for one-time or recurring cash transactions:
NOTE: THIRD PARTY REQUESTS MAY REQUIRE PHONE VERIFICATION
"
Like-Titled Internal Transfers*
▫ Third Party Internal Transfers (Complete section 5)
"
Checks to the Address of Record*
▫ ACH (Complete section 7)
▫ Fed Wires (Complete section 8)
*Your Investment Advisor currently maintains authority to request internal transfers between like-registered accounts and checks payable to the account registration and mailed
to the address on record. This authority is granted within the Limited Power of Attorney language included on this form.
5
INTERNAL TRANSFERS* (IF APPLICABLE)
Destination Account Number:
Destination Account Number:
Destination Account Number:
Destination Account Number:
|
|
|
|
Account Registration:
Account Registration:
Account Registration:
Account Registration:
* Certain other restrictions apply.
6
ACH AUTHORIZATION FOR OTHER ACCOUNT(S)
By signing the Account Owner Authorization below, I/we, each of the registered holders of the other account(s) specified below, authorize TD Ameritrade to act
upon the instructions of the Investment Advisor named above to: (i) initiate credit entries to the other account(s) and to credit that account; (ii) initiate debit entries
to the other account(s) and to debit that account; and (iii) initiate reversals to the other account(s) of erroneous or duplicate credit or debit entries and to credit or
debit the other account(s) as appropriate. I/We agree to jointly and severally indemnify and hold TD Ameritrade harmless for any liabilities occurring as a result
of TD Ameritrade relying on this authorization or instructions given pursuant to it. I/We acknowledge that these transactions shall be governed by the Rules of
the National Automated Clearing House Association and other applicable rules or regulations, and agree to abide by such rules. I/We agree to settle by binding
arbitration any dispute involving TD Ameritrade that may arise with respect to the Move Money Service. This authorization will remain in full force and effect until
TD Ameritrade has received notification of its termination, such notice which may be provided by any of the registered owners of the other account(s) at any time
by writing to TD Ameritrade Institutional (5010 Wateridge Vista Drive, San Diego, CA 92121-5775, phone 800-431-3500). I/We acknowledge that TD Ameritrade
must receive this notification in a time and manner so as to give TD Ameritrade and the other financial institution(s) a reasonable opportunity to act on it.
*TDAI9341*
Page 1 of 4
TDAI 9341 REV. 06/14
7
ACH BANKS OF RECORD (IF APPLICABLE)
Authorize ACH Direction (Select one or both): ! TD Ameritrade to Bank
Select one: ! Checking
! Bank to TD Ameritrade
! Savings
|
|
|
Bank Name:
Bank City/State:
Name on Bank Account (exact):
ABA (Routing) Number:
Bank Phone Number:
Bank Account Number:
Please attach voided check.
ADDITIONAL BANK (OPTIONAL)
Authorize ACH Direction (Select one or both): ! TD Ameritrade to Bank
Select one: ! Checking
! Bank to TD Ameritrade
! Savings
|
|
|
Bank Name:
Bank City/State:
Name on Bank Account (exact):
ABA (Routing) Number:
Bank Phone Number:
Bank Account Number:
Please attach voided check.
8
DELIVERY DETAILS
DOMESTIC WIRE INFORMATION
Receiving Bank Name:
|
|
Bank City/State:
ABA/Routing #:
Bank Telephone #:
Receiving Bank Account #:
Name on Receiving Bank Account (list name as it appears at Bank and if name contains initials, please provide full name):
Please provide the following information if this request is for an escrow/mortgage or brokerage account:
For Further Credit to Name (if name contains initials, please provide full name):
For Further Credit to:
! Escrow/Mortgage File # __________________________
! Brokerage Account # __________________________
OPTIONAL: Intermediary Bank (Please verify this information with the receiving bank above if applicable)
Intermediary Bank Name:
Intermediary Bank City/State:
|
Intermediary Bank ABA/Routing #:
INTERNATIONAL WIRE INFORMATION (to ensure accuracy, please contact financial institution for correct routing information)
International wires requests may require disclosure of fees. If we cannot reach you by phone, your International wire request may be cancelled.
International Bank Name:
Bank Street Address:
Bank City/Country:
SWIFT/BIC Code:
|
Bank Telephone #:
Additional Bank Routing Information – (such as, Sort – U.K., IBAN – Euro, Transit – Canada, CLABE – Mexico, etc.):
Name on Receiving Bank Account (List name as it appears at Bank and if name contains initials, please provide full name):
Receiving Bank Account #:
For Further Credit Name and Account # (if applicable):
Purpose of Wire (REQUIRED) Providing a non-specific purpose may cause delays in processing the wire request:
Page 2 of 4
TDAI 9341 REV. 06/14
9
LIMITED POWER OF ATTORNEY
I/We hereby agree to indemnify and hold harmless TD Ameritrade, Inc., its affiliates and their directors, officers, employees, and agents from
and against all claims, actions, costs, and liabilities, including attorney’s fee arising out of, or related to, reliance on this authorization and to pay
promptly on demand any and all losses arising there from or debit balance due thereon. In all such purchases, sales, or trades, you are authorized
to follow the instructions of my/our Agent in every concern concerning my/our account with you; and my/our Agent is authorized to act for me/us
and on my/our behalf in the same manner and with the same force and effect as I /we might or could do with respect to such purchases, sales,
or trades, as well as with respect to all other things necessary or incidental to the furtherance or conduct of such purchases, sales, or trades,
including the delivery of monies from the account in the Account Owner’s(s’) name(s) to an account in the Account Owner’s(s’) name(s).
I/We hereby ratify and confirm any and all transactions with you heretofore or hereafter made by my/our Agent for my/our account. This
authorization and indemnity is in addition to, and in no way limits or restricts, any rights that you may have under any other agreement or
agreements between me/us and TD Ameritrade.
This authorization is a continuing one and shall remain in full force and effect and you shall have no duty of inquiry. I/We may change or revoke
this authorization by a written notice addressed and delivered to TD Ameritrade. Until you receive such written revocation, you are entitled to
act in reliance on this authorization and indemnity. Any revocation of this authorization shall have no effect on any liability that results from
transactions initiated before you receive written notice of revocation. This authorization and indemnity shall inure to the benefit of your present
firm and of any successor firm or firms, irrespective of any change or changes at any time in the personnel thereof for any causes whatsoever,
and of the assigns of your present firm or any successor firms.
I/We have carefully read this power of attorney and indemnity and understand that it authorizes my/our Agent named herein to
exercise rights and powers over my/our accounts as if I/we had exercised them myself/ourselves, and that my/our Agent’s actions
and instructions with respect to my/our accounts are fully binding on me/us.
10
ACCOUNT OWNER AUTHORIZATION
As the account owner(s), I/we grant disbursement and/or contribution authority to the following Investment Advisor in accordance with the
elections made on this form. I/We acknowledge that I/we am/are a registered account owner on any other accounts indicated from which I/we
may request transfers to my/our TD Ameritrade account.
The authority I/we am/are granting to my/our Investment Advisor is subject to the attached Terms and Conditions of this service and this
Advisor Authorization. I/We understand that this authorization only allows my/our Investment Advisor to provide Move Money instructions
between my/our TD Ameritrade account and any other accounts indicated, and does not enable my/our Investment Advisor to instruct
TD Ameritrade to make other types of disbursement requests at its direction, particularly third-party requests, or to request additional
information regarding such disbursements.
By signing below, I/we authorize the electronic transfer of funds between my/our TD Ameritrade account and the other account(s) specified
above to the provisions of this Advisor Disbursement Authorization and which I/we acknowledge receiving and reviewing, which will govern all
transactions initiated under the Move Money service. I/We certify that all the information provided on this form is true and accurate, and that
TD Ameritrade shall have no obligation to verify account registration information. I/We expressly assume the responsibility for any adverse
consequences that may result from Move Money transactions, and I/we indemnify and hold harmless TD Ameritrade, Inc., their divisions,
officers, employees, directors, representatives, owners, affiliates, successors, and assigns. This authorization remains in effect until such time
that TD Ameritrade receives written notification of its termination.
By signing this section, I grant my Investment Advisor at the top of this form authority to request transfer of funds on my behalf.
TD Ameritrade Account Owner Signature: ______________________________________________________________ Date: __________________________
TD Ameritrade Account
Co-Owner Signature (if applicable): ___________________________________________________________________ Date: __________________________
TD Ameritrade Account
Co-Owner Signature (if applicable): ___________________________________________________________________ Date: __________________________
11
MOVE MONEY AUTOMATED CLEARING HOUSE (ACH) AND WIRE TRANSFER AGREEMENT
PLEASE READ THIS AGREEMENT CAREFULLY. In this Agreement, “I”, “me”, “my”, “we”, “us”, and “our” refer to the individuals or parties who
are the account owners, have an interest in the account, and consent to be bound by the terms of this Agreement. The following is a legally
binding contract between me and TD Ameritrade Institutional, Division of TD Ameritrade, Inc. (TD Ameritrade). This agreement governs my
use of the TD Ameritrade website (website), services and content in relation to funding of my TD Ameritrade account through the use of an
Automated Clearing House (ACH) Transaction. Please note that the ACH Transaction Client Agreement (Agreement) does not supersede or
limit the Terms and Conditions that govern my TD Ameritrade account.
Changes to the Client Agreement
The policies outlined below are not all-inclusive and may be subject to change. TD Ameritrade reserves the right to amend, change, and revise
the Agreement at any time and without prior notice to me. TD Ameritrade will post such amendments, changes, or modifications on the website,
or at its option, may otherwise choose to deliver to me, electronically or otherwise, the amendments, changes, or modifications or the amended
Agreement. My continued use of the website and the Services after the amended Agreement is posted on the website constitutes my agreement
to and acceptance of the amended Agreement, regardless of whether I have actually read the amendments, changes, or modifications.
Terms of Usage
I understand that TD Ameritrade provides ACH and wire services for the primary purpose of the purchase or sale of securities.
As applicable, TD Ameritrade may modify the client’s electronic bank instructions. From time to time, TD Ameritrade, as the originator, may
receive a notification of change (NOC) from the client’s bank. This may occur when previously provided bank instructions have become
outdated due to changes with the respective bank structure/organization. The Originator is obligated under industry regulation (NACHA 5.3.2)
to effect these updates initiated by the client’s bank.
Electronic Delivery of Information
I understand that TD Ameritrade may electronically deliver to me or my advisor information about electronic funding, including information about
bank setup(s), status of my deposits or withdrawals request(s), and any other information necessary to complete my requested transactions.
I understand that “electronically deliver” means that TD Ameritrade may communicate such information to me or my advisor by email or by
posting the information on the TD Ameritrade website (where I can read and print the information).
I understand that delivery of information related to my bank setup does not guarantee the acceptance of an ACH transaction by my
financial institution.
Page 3 of 4
TDAI 9341 REV. 06/14
Right of Revocation
I understand that usage of ACH services to facilitate my recurring transactions may be revoked and discontinued at any time. My Advisor can
cancel a recurring transaction by logging on to the TD Ameritrade Veo® application and deleting the appropriate transaction. I can cancel a
recurring transaction by calling a TD Ameritrade Client Services Representative at 800-431-3500 or by writing to TD Ameritrade at:
Mailing Address:
Overnight Address:
TD Ameritrade Institutional
TD Ameritrade Institutional
PO BOX 919094
5010 Wateridge Vista Drive
San Diego, CA 92191-9094
San Diego, CA 92121-5775
I understand that TD Ameritrade must receive my request at least five business days prior to the date the payment is scheduled to be made.
I will not be charged for such cancellation requests.
Electronic Deposit and/or Withdrawal Rejects
I understand that unless my ACH or wire transaction is immediately rejected, TD Ameritrade will post my ACH or wire transaction to my
account, subject to restrictions. This action is not a confirmation that my financial institution or TD Ameritrade has completed the transfer of
funds. I understand that a transfer reject may occur, even subsequent to account funding. I will be responsible for any transactions effected in
my account based on those funds.
If TD Ameritrade receives notice that my ACH transaction was not processed as requested, TD Ameritrade may, as a courtesy, attempt to
contact my advisor by email and/or by posting a notice on my account via the website and/or by phone.
Guidelines and Restrictions
I understand the following acceptable deposit guidelines:
A maximum electronic transfer of $250,000 per day must come from a U.S. bank account in U.S. funds.
An ACH transaction may be drawn from a personal checking or savings account titled exactly the same as the TD Ameritrade account to be
funded. An ACH transaction from a joint bank account may be deposited into either bank account owner’s TD Ameritrade account.
An ACH transaction from an individual bank account may be deposited into a joint TD Ameritrade account if that party is one of the TD Ameritrade
account owners.
An ACH transaction from an individual or joint bank account may be deposited into an IRA belonging to either account owner. I understand that
I am responsible for understanding any tax ramifications related to making a deposit into my IRA.
To complete an IRA contribution I must complete an electronic deposit form.
I acknowledge that any funds being withdrawn from a UTMA or UGMA account will be used exclusively for the benefit of the minor.
I understand the following restrictions:
TD Ameritrade currently imposes no transaction charges in connection with my use of ACH or wire transfers. TD Ameritrade does, however,
charge a fee on direct deposit and electronic funds transfer items that are returned to TD Ameritrade due to insufficient or uncollected funds
in my account at my financial institution. The fee will be the same as that charged for returned checks as provided in my TD Ameritrade
account agreement. TD Ameritrade reserves the right to charge a fee for this service. Prior to implementing such a fee, TD Ameritrade will
communicate any transaction fee(s) that may apply.
The IRS has specific regulations with regard to maximum allowable contributions within each tax year for qualified plans. TD Ameritrade does not
give legal or tax advice, and it is my responsibility to contact a tax advisor to determine the maximum allowable contribution for my IRA and any
additional restrictions that may apply.
Funds cannot be withdrawn or used to purchase non-marginable securities, initial public offering (IPO) stocks, or options during the first three
business days. This holding period begins on the settlement date. Additionally, these funds may not be withdrawn within the first 60 days the
account is open, unless they are returned by wire or ACH back to the originating bank account after the holding period (subject to a wire fee).
I may trade most marginable securities immediately after funds are deposited into my account.
Not all financial institutions participate in ACH or wire funding. I will consult my bank to determine if they will approve an ACH or wire transaction
prior to acceptance of this agreement. An ACH Return Fee may be charged if the bank or financial institution rejects an ACH transaction. Please
note: A transfer reject may occur subsequent to the posting of funds to the account. I understand that it is my responsibility to verify the success of
my ACH Transaction request with my financial institution.
TD Ameritrade cannot accept an electronic transaction from accounts drawn on brokerage accounts or some money market accounts. Some
credit unions and savings accounts may not accept a request for an electronic transaction. Some financial institutions may not accept electronic
transactions from savings accounts. The success of a transaction drawn on a credit union or savings account is subject to the acceptance of
the credit union or financial institution.
The withdrawal amount cannot exceed the cash available for withdrawal in the account. I may withdraw funds prior to settlement in a margin
account; however, funds withdrawn before the settlement date will incur additional fees and/or interest charges. Funds cannot be withdrawn
prior to settlement in a cash account.
The withdrawal amount cannot reduce my margin account equity below required minimum equity levels.
If the account is in a margin call, a withdrawal cannot be made.
Other situations may arise when an ACH transfer of funds is deemed unacceptable.
Options involve risks and are not suitable for all investors.
Mailing Address:
TD Ameritrade Institutional
PO BOX 919094
San Diego, CA 92191-9094
Overnight Address:
TD Ameritrade Institutional
5010 Wateridge Vista Drive
San Diego, CA 92121-5775
TDAI 9341 REV. 06/14
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
TD Ameritrade Institutional, Division of TD Ameritrade, Inc., member FINRA/SIPC/NFA. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. © 2014 TD Ameritrade IP Company, Inc. All rights reserved. Used with permission.
Page 4 of 4
Reset Form
SIGNATURE VERIFICATION FORM
Account # ________________________________________
Advisor # ________________________________________
Case # ________________________________________
Thank you for opening an account with TD Ameritrade Institutional. Our mission is to support the relationship between you and your advisor with the best
service, technology and products available.
Our application uses an electronic agreement and signature capture process provided by a third-party and we use various methods to verify the identity
of account owners. However, since it may sometimes become necessary –or simply more convenient –to do business in the account by U.S. mail or by fax,
we strongly recommend that you complete this form, so that you may avoid the inconvenience and delay of having to obtain a signature guarantee for
some future account activity
ACCOUNT OWNER(S) SIGNATURE:
Account Owner’s Printed Name: ______________________________________________________________________________________________________________________________________________________________________________________________________________
Account Owner’s Signature: ______________________________________________________________________________________________________________________________________________________ Date: ____________________________________________________
Account Co-Owner’s Printed Name: ________________________________________________________________________________________________________________________________________________________________________________________________________
Account Co-Owner’s Signature: _________________________________________________________________________________________________________________________________________________ Date: ____________________________________________________
Mailing Address:
TD Ameritrade Institutional
PO BOX 919094
San Diego, CA 92191-9094
Overnight Address:
TD Ameritrade Institutional
5010 Wateridge Vista Drive
San Diego, CA 92121-5775
TDAI 745 REV. 10/12
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
TD Ameritrade Institutional, Division of TD Ameritrade, Inc., member FINRA/SIPC/NFA and TD Ameritrade Clearing, Inc., member FINRA/SIPC. TD Ameritrade
is a trademark jointly owned by TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. © 2012 TD Ameritrade IP Company, Inc. All rights reserved.
Used with permission.
*TDAI745*
Page 1 of 1
Enhance Advisors, LLC
777 S Flagler Drive
West Tower, Penthouse 1
Suite 1800
West Palm Beach, FL 33401
Investment Management Authorization With Right
To Withdraw Management Fees Only
I hereby authorize Enhance Advisors, LLC (EA) as agent to buy, sell and trade
stocks and other securities for my account and in my name.
In order to keep all funds fully invested, a "Money Market" fund should also be
established.
I retain complete ownership of the cash and securities in my account, and all
transactions will be completed in my name only. Except for a quarterly
management fee, neither you nor the broker, custodian or trustee may remove
assets from my account.
The role of EA will be to provide investment research, analysis and judgment in
making investment decisions on my behalf, and to instruct the broker, custodian or
trustee accordingly. I will not hold EA liable for losses sustained by my account
unless those are attributable to fraud, gross or willful negligence, or violation of
applicable statutes.
7KH&OLHQWDFNQRZOHGJHVUHFHLSWRI$GYLVRU¶V)RUP$'93DUW,,RUDGLVFORVXUH
statement containing the equivalent information. If the appropriate disclosure
statement was not delivered to the Client at least 48 hours prior to entering into
this Agreement, then the Client has the right to terminate this Agreement without
penalty within five business days. For purposes of this provision, this Agreement
is considered entered into when all parties have signed this Agreement.
Client also acknowledges receLSWRI$GYLVRU¶V3ULYDF\3ROLF\1RWLFH
Client grants the Advisor discretionary authority over the Account that will be
managed by the Advisor. Client grants the Advisor the authority to make all
decisions to buy, sell or hold securities, cash or other investments for the Account
LQ WKH $GYLVRU¶V VROH GLVFUHWLRQ ZLWKRXW ILUVW FRQVXOWLQJ ZLWK WKH &OLHQW &OLHQW
gives the Advisor full power and authority to carry out investment decisions by
giving instructions, on behalf of the Client, to brokers and dealers and the
custodian for the Account. Client authorizes the advisor to provide a copy of this
Agreement to any broker or dealer, through which transactions will be
LPSOHPHQWHGRQEHKDOIRIWKH&OLHQWDVHYLGHQFHRIWKH$GYLVRU¶VDXWKRULW\XQGHU
this Agreement.
This Agreement cannot be assigned or transferred in any manner by any party
without the consent of all parties or rendering under this Agreement.
Advisor may elect to aggregate or batch Client transactions for execution with
transactions for other clients with accounts at the same broker/dealer. Under this
procedure, transactions will be averaged as to price and will be allocated among
all clients included in the transaction in proportion to the purchase and sale orders
placed for each client account on any given day. The Advisor shall not receive
any additional compensation or remuneration as a result of the aggregation.
EA does not vote on any client proxies.
EA generally recommends the use of a particular broker/dealer.
,W LV WKH &OLHQW¶V responsibility to provide EA with all information necessary for
legal purposes and the conduct of its business. EA will rely solely on the
information provided by the Client and will assume it to be fair and accurate.
EA is not privy to inside or non-public information when making investment
decisions for clients.
EA cannot guarantee the success or profitability of any of its recommendations or
investments
This Agreement will be interpreted under the laws of the State of Florida.
This Agreement can be amended by EA, or the Client, only upon mutual
agreement with the other party.
EA is properly registered as an Investment Advisor and is authorized and
HPSRZHUHG WR HQWHU LQWR WKLV $JUHHPHQW 7KH &OLHQW¶V VLJQDWXUH EHORZ
acknowledges that the Client is authorized and empowered to enter into this
Agreement.
Management fees to EA will be paid quarterly in advance according to the
following annual percentage: 1.50% (150 basis points). (QKDQFH $GYLVRUV¶ asset
management services will be billed quarterly in advance based on the market value
RI WKH FOLHQW¶V DVVHWV DW WKH HQG RI WKH SUHYLRXV TXDUWHU 7KH LQLWLDO IHH IRU QHZ
accounts is pro-rated based on the number of days remaining in the initial quarter.
$OOIHHVZLOOEHGHGXFWHGGLUHFWO\IURPWKH&OLHQW¶VDFcount.
If I choose to cancel this arrangement, I may do so at any time by notifying you
and the broker, custodian or trustee in writing. Enhance Advisors, LLC may also
cancel this arrangement by providing me with 30 days written notice.
We look forward to a long and rewarding relationship with you, thank you
for choosing Enhance Advisors, LLC.
Client Signature
Enhance Advisors, LLC
________________________________
___________________________
Please Print Your Name Here:
G. Putnam Kling
________________________________
___________________________
Client Signature
Christian G. Kling, Ph.D
________________________________
Please Print Your Name Here:
________________________________
Date Signed:
Name of Account:
_______________
___________________________