Fillable Beneficiary Individual Retirement Account (IRA) Application-TDA 0619

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Beneficiary Individual Retirement Account (IRA) Application-TDA 0619

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The Beneficiary Individual Retirement Account (IRA) Application-TDA 0619 form is 8 pages long and contains:

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TDA 1586 A 06/19
Page 1 of 10
PO Box 2760
Omaha, NE 68103-2760
Fax: 866-468-6268
. TYPE OF BENEFICIARY IRA (Please select only one.)
N
Traditional Beneficiary IRA
N
Roth Beneficiary IRA
N
Minor Traditional Beneficiary IRA*
N
Minor Roth Beneficiary IRA*
Please complete for Minor Beneficiary IRAs:
This Minor Beneficiary IRA will be opened pursuant to state UTMA/UGMA statutes. Please indicate the age of termination of custodianship
and the state law under which this Minor Beneficiary IRA account will be governed:
(State)* ______ Age of Termination* _______. (state of UGMA/UTMA establishment must be provided)
*If you do not indicate the age of termination, the account will be set up with the state’s default age of termination according to the applicable
state law. Certain states permit the age of termination to be extended beyond the default statutory age of termination (usually up to 21 or 25
years of age). This election may be exercised only in those states that specifically provide for it, and only insofar as the extension complies with
any applicable requirements.
I understand that electing to extend the age of termination to age 25 may cause me to lose my annual exclusion from federal gift tax
and that I should consult with an attorney or tax advisor before making this election.
. BENEFICIARY OPTIONS
A copy of the death certificate is required.
A Beneficiary IRA must be established unless the spousal option to treat the IRA as your own is chosen below.
If the decedent’s IRA is held at another firm, a Beneficiary IRA must be established at the other firm prior to transferring to TD Ameritrade. You
will also need to complete a TD Ameritrade Transfer Form.
Name of Deceased:
U.S. Social Security Number:
(SSN)
Date of Birth:
(MM-DD-YYYY)
Date of Death:
(MM-DD-YYYY)
An IRA beneficiary has until December 31 of the year following the IRA owner’s death to determine the appropriate beneficiary election and take
possession of the funds. IRA beneficiary options depend on the relationship to the deceased and if the deceased had begun Required Minimum
Distributions (RMDs). If the decedent had begun RMDs or was required to begin them but didn’t because of death, the beneficiary must start or
continue those distributions. Please consult a qualified tax advisor or IRS Publication 590 should you have any questions or concerns.
Had the decedent begun, or was the decedent required to begin RMDs?
N
Yes
N
No
An IRA owner is required to begin RMDs on April 1 of the year following the calendar year in which the owner reached age 70½.
My relationship to the deceased is: (One relationship must be selected.)
N
Spouse Beneficiary (Choose from elections listed below. Must choose one option.)
N
Treat as Own – Transfer the decedent’s IRA assets to my TD Ameritrade IRA, account number: ____________________________.
If the decedent had begun RMDs, the spouse beneficiary must satisfy any remaining RMDs at TD Ameritrade. If any remaining
RMDs need to be taken, please complete an IRA Distribution Form. Important: You must be listed as 100% sole primary beneficiary
to qualify for Treat as Own. If you do not qualify for Treat as Own, your election will default to Life Expectancy Payments.
N
Five-Year Rule (decedent had not begun RMDs) – The spouse beneficiary must withdraw the entire balance by December 31 of the
fifth year after the IRA owner’s death.
N
Life Expectancy Payments (available if decedent had or had not begun RMDs) – The spouse beneficiary can take distributions over
life expectancy using either the recalculation or nonrecalculation method. These distributions must begin by December 31 of the
year after the IRA owner’s death, or December 31 of the year the deceased IRA owner would have attained age 70½.
Beneficiary Individual Retirement
Account (IRA) Application
*TDA1586*
Questions? Call a New Accounts representative at 800-276-8746.
Reset Form
TDA 1586 A 06/19
Page 2 of 10
N
Non-Spouse Beneficiary (Choose from elections listed below. Must choose one option.)
N
Five-Year Rule (decedent had not begun RMDs) – The nonspouse beneficiary must withdraw the entire balance by December 31 of
the fifth year after the IRA owner’s death.
N
Life Expectancy Payments (available if decedent had or had not begun RMDs) – The nonspouse beneficiary can take distributions
over life expectancy using the nonrecalculation method. These distributions must begin by December 31 of the year after the IRA
owner’s death.
N
Entity Beneficiary
If the decedent had not begun RMDs, the Five-Year Rule will be applied and the nonindividual beneficiary must withdraw the entire
balance by December 31 of the fifth year after the IRA owner’s death. If the decedent had begun RMDs, the Life Expectancy Payment
method will be applied and the nonindividual can take distributions over the life expectancy using the nonrecalculation method. These
distributions must begin by December 31 of the year after the IRA owner’s death. Restrictions may apply.
N
Non-Spouse Minor Beneficiary (Please complete the Custodian Information Section.)
N
Five-Year Rule (decedent had not begun RMDs) – The nonspouse beneficiary must withdraw the entire balance by December 31 of
the fifth year after the IRA owner’s death.
N
Life Expectancy Payments (available if decedent had or had not begun RMDs) – The nonspouse beneficiary can take distributions
over life expectancy using the nonrecalculation method. These distributions must begin by December 31 of the year after the IRA
owner’s death.
. FUNDING YOUR ACCOUNT
N
A transfer from a TD Ameritrade account. Decedent’s account number: ______________________________________________
N
A direct transfer from another firm. Please submit an Account Transfer Form and a copy of your most recent statement.
Firm name:
________________________________________________________________________________________________
. ACCOUNT OWNER INFORMATION
Name Prefix (optional): M Mr. M Mrs. M Ms. M Dr. M Rev.
Full Legal Name:
(Required)
Name of Entity:
(if applicable)
Tax ID:
Date of Birth:
(MM-DD-YYYY)
U.S. Social Security Number:
(SSN/ITIN)
Number of Dependents: Mother’s Maiden Name:
Home Address:
(no PO box or mail drop)
City: State: ZIP Code: Country:
Mailing Address:
(if dierent from above)
City: State: ZIP Code: Country:
Primary Phone: M Check here if this is not a U.S. phone number Secondary Phone: M Check here if this is not a U.S. phone number
Fax Number:
Email Address (required for electronic delivery of
your account statement and trade confirmations):
Please specify if you are:
M Employed M Unemployed M Retired M Homemaker M Student M Self-Employed
Employer Name (If Self Employed,
provide the name of your business):
Please choose from the list provided on page  the occupation code and industry of occupation code that most accurately describes your situation.
Occupation: Industry of Occupation:
Employer Street Address:
City: State: ZIP Code: Country:
Page 3 of 10
TDA 1586 A 06/19
Annual Income:
M $0 - $24,999 M $25,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999 M $250,000+
Approximate net worth: M $0 - $14,999 M $15,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999
(not including primary residence)
M $250,000 - $499,999 M $500,000 - $999,999 M $1,000,000 - $1,999,999 M $2,000,000+
Approximate liquid net worth: M $0 - $14,999 M $15,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999
(cash, stocks, etc.)
M $250,000 - $499,999 M $500,000 - $999,999 M $1,000,000 - $1,999,999 M $2,000,000+
What best describes the initial M Employment/Wages M Retirement Funds M Gift M Savings
source of funds for this account? M Inheritance/Trust M Investments M Unemployment/Disability M Legal Settlement
M Lottery/Gaming M Spousal/Parental Support M Other (describe source of funds): ______________________________
What best describes the ongoing M Employment/Wages M Retirement Funds M Gift M Savings
source of funds for this account? M Inheritance/Trust M Investments M Unemployment/Disability M Legal Settlement
M Lottery/Gaming M Spousal/Parental Support M Other (describe source of funds): ______________________________
M Check here if you are NOT a U.S. citizen.
Country of Citizenship:
Country of Dual or Secondary Citizenship: Country of Birth:
Non-U.S. citizens:* Do you hold a current U.S. immigration visa?
M Yes M No
Specify visa type: Visa Number: Expiration:
* Nonresident aliens must submit a Form W-8BEN, a copy of a current passport, and a copy of a bank or brokerage statement. If a U.S. address is listed, then
attach a Letter of Explanation for U.S. Mailing Address/U.S. Phone Number Attachment to form W-8. This form can be found on the TD Ameritrade Forms Library:
https://www.tdameritrade.com/form-library.
M Check here if you, your spouse, any member of your immediate families, including parents, in-laws, siblings, and dependents, is a member of the board of
directors, 10% shareholder, or policy-making officer of a publicly traded company. Specify the company ticker symbol, name, address, city, and state:
M Check here if you, your spouse, any member of your families living in the same household, 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. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter (with this application):
. CUSTODIAN INFORMATION (For Minor Beneficiary IRAs Only)
Relationship to Minor: M Parent M Legal Guardian** M Other:
______________________________
**If you are the Legal Guardian of the Minor, you must submit legal documentation with this application showing your appointment as guardian.
Name Prefix (optional): M Mr. M Mrs. M Ms. M Dr. M Rev.
Full Legal Name (required):
Date of Birth:
(MM-DD-YYYY)
Number of
Dependents:
U.S. Social Security Number:
(SSN)
Home Address (if dierent from
minor, no PO box or mail drop)
:
City: State: ZIP Code: Country:
Mailing Address:
(if dierent from above)
City: State: ZIP Code: Country:
Primary Phone: M Check here if this is not a U.S. phone number Secondary Phone: M Check here if this is not a U.S. phone number
Fax Number:
Email Address (required for electronic delivery of
your account statement and trade confirmations):
Please specify if you are:
M Employed M Unemployed M Retired M Homemaker M Student M Self-Employed
Employer Name (If Self-Employed,
provide the name of your business):
Please choose from the list provided on page  the occupation code and industry of occupation code that most accurately describes your situation.
Occupation: Industry of Occupation:
Employer Street Address:
City: State: ZIP Code: Country:
TDA 1586 A 06/19
Page 4 of 10
Annual Income:
M $0 - $24,999 M $25,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999 M $250,000+
Approximate net worth: M $0 - $14,999 M $15,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999
(not including primary residence)
M $250,000 - $499,999 M $500,000 - $999,999 M $1,000,000 - $1,999,999 M $2,000,000+
Approximate liquid net worth: M $0 - $14,999 M $15,000 - $49,999 M $50,000 - $99,999 M $100,000 - $249,999
(cash, stocks, etc.)
M $250,000 - $499,999 M $500,000 - $999,999 M $1,000,000 - $1,999,999 M $2,000,000+
What best describes the initial M Employment/Wages M Retirement Funds M Gift M Savings
source of funds for this account? M Inheritance/Trust M Investments M Unemployment/Disability M Legal Settlement
M Lottery/Gaming M Spousal/Parental Support M Other (describe source of funds): ______________________________
What best describes the ongoing M Employment/Wages M Retirement Funds M Gift M Savings
source of funds for this account? M Inheritance/Trust M Investments M Unemployment/Disability M Legal Settlement
M Lottery/Gaming M Spousal/Parental Support M Other (describe source of funds): ______________________________
M Check here if you are NOT a U.S. citizen.
Country of Citizenship:
Country of Dual or Secondary Citizenship: Country of Birth:
Non-U.S. citizens:* Do you hold a current U.S. immigration visa?
M Yes M No
Specify visa type: Visa Number: Expiration:
* Nonresident aliens must submit a form W-8BEN, a copy of a current passport, and a copy of a bank or brokerage statement. If a U.S. address is listed, then
attach a Letter of Explanation for U.S. Mailing Address/U.S. Phone Number Attachment to form W-8. This form can be found on the TD Ameritrade Forms Library:
https://www.tdameritrade.com/form-library.
M Check here if you, your spouse, any member of your immediate families, including parents, in-laws, siblings, and dependents is a member of the board of directors,
10% shareholder, or policy-making officer of a publicly traded company. Specify the company ticker symbol, name, address, city, and state:
M Check here if you, your spouse, any member of your immediate families living in the same household, 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. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter
(with this application):
. INVESTMENT OBJECTIVES
For definitions regarding investment objectives, please see page 9 of the application.
Select the degree of risk you are willing to take with the assets in this account:
M Conservative M Moderate M Aggressive M Speculative
Select the primary investment objective for this account:
M Conservation M Moderate M Moderate Growth M Growth M Aggressive Growth
Select the secondary investment objectives for this account:
(Check at least one or all that apply) M Conservation M Moderate M Moderate Growth M Growth M Aggressive Growth M None
Select the liquidity needs for this account:
(Check only one that applies)
M Within 3 months M 4 - 6 months M 7 - 9 months M 10 - 12 months M More than 1 year
Select the investment time horizon for this account:
M Less than 1 year M 1 - 3 years M 4 - 6 years M 7 - 9 years M 10 - 12 years M 13 years or more
. MARGIN PRIVILEGES
N
Check this box to decline margin privileges.
All qualified accounts are opened as margin eligible accounts.
To learn more about the use of margin in a retirement account and the associated risks involved, read the Margin Disclosure Document.
. CASH SWEEP VEHICLE
My uninvested cash will be deposited in the TD Ameritrade FDIC Insured Deposit Account (IDA) as a part of the Cash Balance programs.
See the Client Agreement for a complete description of the Cash Sweep program. Other sweep choices are available for clients with
household values greater than $500,000 and cash balances of more than $100,000. I understand my account statement will include sweep
transactions involving bank deposits or money market funds in lieu of immediate trade confirmations.
. TRADE CONFIRMATIONS
I understand that I will receive monthly account statements and trade confirmations electronically, unless I make a selection below. If I do not
provide a valid email address, I will receive a quarterly paper statement or a monthly paper statement. Certain types of accounts or activity
(such as options trading) require a monthly statement, either electronically or via U.S. mail. I will be responsible for any fees that apply. Accounts
with a total liquidation value of $10,000 or an average of five trades per month over a three-month period are eligible to receive free paper
statement and confirmation delivery.
If I elect to receive either electronic statements or electronic confirmations, I will receive shareholder information electronically when available.
Account Statement:
N
Electronic Monthly
N
Paper Monthly ($2 fee may apply each month)
N
Paper Quarterly ($2 fee may apply each quarter)
Trade Confirmation:
N
Electronic
N
Paper
N
Unless I have checked this box, TD Ameritrade will provide my name to corporations whose securities I hold in my account for the purpose of
additional corporate communications.
Page 5 of 10
TDA 1586 A 06/19
. DESIGNATION OF BENEFICIARY
You must designate at least one primary beneficiary. If you select coprimary beneficiaries, indicate the percentage of your account you are
designating to each. If a primary beneficiary dies prior to the Account Owner, the remaining portion shall be payable proportionately to any
surviving primary beneficiaries. You may also designate contingent beneficiaries in the event that your primary beneficiaries do not outlive you.
In the event that TD Ameritrade is unable to identify the beneficiaries from the documents provided, the Custodial Agreement will control.
State trust law may vary as to the legality of IRA beneficiaries naming subsequent beneficiaries. Please consult a qualified tax advisor or
attorney regarding the applicable trust law for your state of residence.
If this is a Minor Beneficiary IRA, only the Minor’s estate can be the beneficiary until such time as the Minor reaches the age of
termination and assumes control of the IRA assets by converting the IRA assets to a standard Beneficiary IRA Account.
If you are married and live in a state with community property statutes and do not designate your spouse as the sole beneficiary, you
represent and warrant that your spouse has consented to such designation.
Percentages must total 100% for all primary beneficiaries and 100% for all contingent beneficiaries. If percentages are not indicated,
they will be deemed equal shares. If percentages indicate an attempt to distribute as equal shares, but do not add up to 100%, the first
named beneficiary will receive a slightly higher percentage (for instance, if you indicate 33%, 33.3%, or 33.33% for all three beneficiaries, TD
Ameritrade will round the first beneficiary’s percentage up to 33.34% and the other two beneficiaries will each receive 33.33% ). Further, when
securities cannot be evenly distributed, or there are unclaimed securities, the Account Owner requests that such securities be liquidated and
any proceeds from the liquidation be distributed in the percentages requested to the named Beneficiaries.
Subject to the condition(s) set forth in this section, I designate the following as the beneficiary(ies) of my IRA:
All Beneficiary information is required. Please complete all fields.
DESIGNATE YOUR PRIMARY BENEFICIARY(IES)
Primary Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Primary Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Primary Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship:
Date of Birth/UA Date/Date of Formation:
Primary Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship:
Date of Birth/UA Date/Date of Formation:
Primary Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship:
Date of Birth/UA Date/Date of Formation:
Total: ________% Total must add up to 100%
0
TDA 1586 A 06/19
Page 6 of 10
DESIGNATE YOUR CONTINGENT BENEFICIARY(IES)
Contingent
Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Contingent
Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Contingent
Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Contingent
Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Contingent
Share %: Beneficiary Is:
N
An individual
N
A trust
N
Other (custodianship, charity, corporation, etc.)
N
Per Stirpes
Beneficiary’s Name: SSN/TIN:
Relationship: Date of Birth/UA Date/Date of Formation:
Total: ________% Total must add up to 100%
. VERBAL PASSWORD (Optional)
You may opt to add an additional level of security to your account by adding a verbal password. This verbal password will be used for verification
purposes when you call in and speak with a TD Ameritrade representative. Once established, if the correct verbal password is not provided to us
when calling, account access will not be permitted.
The verbal password must be no more than 24 characters, it can include letters and numbers, cannot contain special characters, and cannot be
anything inappropriate, as determined by TD Ameritrade in its sole discretion.
Verbal Password: _____________________________________
. OFFER CODE (Optional)
By entering an oer code in this field, you represent and warrant that you have read and agree to the applicable Oer Terms & Conditions. If the
oer code you enter is invalid, no oer will be applied to your account. If you have questions regarding oer codes, please call 1-800-454-9272.
Oer Code: __________________________________________
0
Page 7 of 10
TDA 1586 A 06/19
. TRUSTED CONTACT (Optional)
By completing this section, you authorize TD Ameritrade to contact the person(s) named below for the following reasons: if there are questions
or concerns about my whereabouts or health status; if TD Ameritrade suspects that I may be a victim of fraud or financial exploitation; if
TD Ameritrade suspects that I might no longer be able to handle my financial aairs; to confirm the identity of any legal guardian, executor,
trustee, authorized trader, or holder of a power of attorney; or if TD Ameritrade has any other concerns or is unable to contact me about my
account(s) held at TD Ameritrade. Please review the Client Agreement for the full terms and conditions regarding how TD Ameritrade
uses this information.
NOTE: Your Trusted Contact must be someone other than an account owner. You may provide more than two Trusted Contact
Persons by completing and signing additional Trusted Contact Authorization Forms.
. INDIVIDUAL RETIREMENT ACCOUNT AGREEMENT
I have received and read the Client Agreement that will govern my account. I understand that the Client Agreement contains predispute
arbitration clauses. I agree to be bound by this Client Agreement as amended from time to time. I hereby request an IRA to be opened in the
name set forth below.
I am establishing an Individual Retirement Account (IRA) Plan under the TD Ameritrade Clearing, Inc. (Custodian) Prototype Individual
Retirement Custodial Account Agreement for the account type specified in Section 1, above, which is incorporated herein by reference. I
understand that the account is subject to rules and regulations of the U.S. Internal Revenue Service, and that the funding of the account
may have significant tax and financial consequences. I accept responsibility for the information contained in this application and arm such
information is true and correct. I agree to indemnify and hold harmless TD Ameritrade Clearing, Inc. from any and all liability and claims for
damages resulting from any action taken pursuant to this Agreement.
I designate TD Ameritrade Clearing, Inc. as Custodian and make the following declaration: Having received and read the Custodial Agreement,
I understand that the Custodian will invest and reinvest my account assets only with written direction from me or from a properly appointed
investment manager. This document constitutes my authority to execute all trades for my IRA. Confirmations and statements will verify such
instructions. All securities, dividends, and proceeds will be held at TD Ameritrade Clearing, Inc. unless otherwise instructed.
For Beneficiary IRAs: I direct TD Ameritrade Clearing, Inc. to maintain my Beneficiary IRA.
For Minor Beneficiary IRAs: I understand that this account will be opened pursuant to state UTMA/UGMA statutes. I agree that the owner
of the assets in this account is the minor according to applicable state UTMA/UGMA statutes and that I will only use the assets for the benefit
of the minor. Upon the minor attaining age of termination as indicated above, I instruct TD Ameritrade, without further notice or instruction, to
restrict my access to the account and register the account in the name of the minor. I further agree to provide TD Ameritrade, upon request, with
the minor’s current address, phone number and other contact information.
This application provides for the deposit of funds or securities into the account. I understand that the funding of this account is
subject to the rules and regulations of the U.S. Internal Revenue Service and that my failure to abide by such rules and regulations may have
important and possibly irrevocable tax and financial consequences. I attest that the funding information provided is true and correct, authorize
TD Ameritrade Clearing, Inc. to deposit the funds or securities according to the funding instructions, and assume full responsibility for this
funding transaction. I release and agree to indemnify and hold harmless TD Ameritrade Clearing, Inc. and its aliates from any and all liability
and claims for damages from any adverse consequences that may result.
I understand that nondeposit investments purchased through TD Ameritrade 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. Unless I have declined the margin feature, I acknowledge that securities securing loans from TD Ameritrade may be lent to
TD Ameritrade and lent by TD Ameritrade to others. I also acknowledge that if I trade “on margin,” I am borrowing money from TD Ameritrade and
that I understand the requirements and risks associated with margin as summarized in the Margin Handbook and Margin Disclosure Document.
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.
First Name:
Middle Initial: Last Name:
Relationship:
Primary Telephone Number: Email Address:
Mailing Address:
City: State: Zip Code: Country:
First Name: Middle Initial: Last Name:
Relationship:
Primary Telephone Number:
Email Address:
Mailing Address:
City: State: Zip Code: Country:
TDA 1586 A 06/19
Page 8 of 10
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.
If you wish to trade options in your account, complete the Options Objectives, Account Owner Options Objectives and sign the Options
Account Agreement.
If I am a U.S. person for tax purposes:
Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number; (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 Services (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; (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 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.
If I am not a U.S. Person for tax purposes:
I am submitting the applicable Form W-8 with this form to certify my foreign status.
The IRS does not require your consent
to any provision of this document
other than the certifications required
to avoid backup withholding.
The Client Agreement applicable to this brokerage account contains a predispute arbitration
clause. By signing this agreement, the parties agree to be bound by the terms of the Client
Agreement, including the arbitration agreement located in Section 12 of the Client Agreement
on page 8.
✗
Account Owner’s/Custodian’s Signature:
Date:
Original signatures required; electronic signatures and/or signature fonts are not authorized.
OPTIONS ACCOUNT
Due to the risks involved in options, we are required to obtain the following information. The income information above must be completed to be
considered for options.
N
Check this box to decline options privileges.
. OPTIONS OBJECTIVES
For definitions regarding options objectives, please see page 9 of the application.
Types of Transactions:
(Check all that apply.)
N
Stocks
N
Bonds
N
Options
What Are Your Options
Investment Objectives?
(Check all that apply.)
N
Growth
N
Speculative
N
Income
N
Conservation of Capital
What Type of Activity Do
You Plan to Conduct in Your
Options Account?
N
Tier 1 - Covered
Write covered calls
Write cash-secured puts
N
Tier 2 - Standard Cash
Purchase options
+ Tier 1 - Covered
N
Tier 2 - Standard Margin
Create spreads
Write covered puts
+ Tier 2 - Standard Cash
MARGIN REQUIRED
Tier 2 - Standard Margin requires a margin account.
If you select this tier, you will automatically be applying
for options and margin approval.
ACCOUNT OWNER OPTIONS OBJECTIVES (For Minor Beneficiary IRAs, please use Custodian information to complete this section)
Years of Investment Experience:
N
Less than 1 year
N
1 - 2 years
N
3 - 5 years
N
6 - 9 years
N
10+ years
Investment Knowledge
or Education:
N
Limited
N
Good
N
Extensive
N
Professional Trader
. OPTIONS ACCOUNT AGREEMENT
I hereby apply for an options account and 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 have received and read the Client Agreement that will govern my account, and agree to be bound by
it as currently in eect and as amended from time to time. 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.
✗
Account Owner’s/Custodian’s Signature:
Date:
Original signatures required; electronic signatures and/or signature fonts are not authorized.
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
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. © 2019 TD Ameritrade.
Page 9 of 10
TDA 1586 A 06/19
INVESTMENT OBJECTIVES DEFINITIONS
Conservation:
Reects your desire to seek very low risk and minimize potential loss of principal. You may seek income from your investments while
understanding that returns may not keep pace with ination. You may also intend to invest over a short period of time.
Moderate:
Reects your desire to seek lower risk and uctuation in your portfolio, while striving to achieve more stable returns on your investments. It may
also mean that you plan to invest over a short period of time.
Moderate growth:
Reects your desire to seek growth in your portfolio by typically using a balance of growth and conservative investment types. It may also mean
that you are moderately tolerant of risk and plan to invest for a medium to long period of time.
Growth:
Reects your desire to seek the potential for investment growth, as well as your tolerance for more signicant market uctuations and risk of loss.
It may also mean that you plan to invest over a long period of time.
Aggressive Growth:
Reects your desire for potentially substantial investment growth, as well as your tolerance for large market uctuations and increased risk of
loss. It may also mean that you plan to invest over a long period of time.
OPTIONS OBJECTIVES DEFINITIONS
Growth:
Investors are seeking the potential for investment growth and have a tolerance for more signicant market uctuations and risk of loss.
Speculative:
Investors are seeking short-term market gains that generally have above average, maximum risk, but offer the potential for short-term, maximum
gains. These strategies also have the potential for signicant losses and investors understand they could lose most, or all, of the money they
have invested.
Income:
Investors are seeking income with a modest degree of risk. These investors are typically willing to accept lower potential returns in exchange for
lower risk and volatility, and understand their returns may not keep pace with ination.
Conservation of Capital:
Investors are seeking to avoid risk and minimize potential loss of principal.
TDA 1586 A 06/19
Page 10 of 10
A11 Accounting
A21 Advertising/Marketing
A31 Aerospace/Defense
A41 Agriculture/Forestry
A51 Amusement and Recreation
A61 Animal Services and Veterinary
A71 Architecture/Design
A81 Arts/Antiques
A91 Athletics/Fitness
A32 Automotive
B11 Aviation
C11 Bar/Nightclub/Adult Entertainment Club
C21 Childcare
C31 Cleaning/Janitorial/Housekeeping
C41 Communications/Telecommunications
C51 Construction/Carpentry/Landscaping
C61 Convenience Store/Liquor Store/
Gas Station
C71 Customer Service and Support
E11 Education
E21 Embassy/Consulate
E31 Energy
E41 Engineering
F11 Fashion/Clothing
F21 Financial Services
F51 Firearms and Explosives
G11 Gaming/Casino/Card Club
G21 Government/Public Administration
G31 Grocery/Supermarket
H11 Healthcare/Medical Services
H21 Hotel/Hospitality
I11 Import/Export
I21 Information Technology (IT)
I31 Insurance
J11 Jewelry, Gems, and Precious Metals
L11 Legal Services/Public Safety
L21 Logistics/Supply Chain
M11 Manufacturing
M21 Maritime
M31 Media/Entertainment
M41 Mining, Oil, and Gas
M51 Money Services Businesses (Check
Cashing, Money Transmitting, Payday
Loans, Currency Exchange)
N11 Non-Profit/NGO (Non-Government
Agency)/Charity
O31 Other; If Other, include a description
in the Industry of Occupation box
P11 Parking and Car Washes
P21 Pawn Shops/Brokers
P31 Personal Care/Hygiene (Beauty,
Salon, Cosmetics, Massage, etc.)
P41 Pharmaceuticals
P51 Printing/Publishing
P71 Professional/Civic Organizations
(Non-Retail)
R11 Real Estate
R21 Religious Organization
R31 Repair Services - Home, Auto,
and Other
R41 Restaurant/Food Service
R51 Retail Sales/Retail Trade
S11 Science and Biotechnology
S21 Security
T11 Transportation
T31 Travel
U11 Utilities (Public)
W11 Wholesale Sales/Trade
Industry of Occupation Codes
A42 Accountant/Auditor/Bookkeeper
A62 Adjuster
A82 Advertiser/Marketer/PR Professional
A33 Air Trac Controller
A43 Ambassador/Consulate Professional
A53 Analyst
A63 Appraiser
A73 Architect/Designer
A83 Artist/Performer/Actor/Dancer
A93 Assistant/Executive Assistant
A44 Athlete
A64 Attorney/Judge/Legal Professional
A74 Auctioneer
L51 Banker/Lending Professional
B21 Barber/Beautician/Hairstylist
B31 Broker/Registered Rep
B41 Business Executive (VP, Director, etc.)
B51 Business Owner
C81 Caregiver
C91 Carpenter/Construction Worker/
Contractor
C22 Cashier
C32 Chef/Cook
C42 Chiropractor
C52 Civil Servant
C62 Clergy
C72 Clerk
C82 Compliance/Regulatory Professional
C92 Consultant
C43 Counselor/Therapist
C53 Customer Service Representative
D11 Dealer
D61 Dentist
D31 Distributor
D41 Doctor/Surgeon/Physician
D51 Driver
E51 Engineer
E71 Exterminator
F71 Factory/Warehouse Worker
F81 Farmer/Rancher
F91 Financial Planner/Advisor
F22 Flight Attendant
F32 Human Resources Professional
I41 Importer/Exporter
I51 Inspector/Investigator
I81 Investor
I91 IT Professional/IT Associate
J31 Janitor
J41 Jeweler
L31 Laborer
L41 Landscaper
M91 Mechanic
M22 Military, Ocer or Associated
M32 Mortician/Funeral Director
N21 Nurse
O11 Oce Associate
O21 Other; If Other, include a description
in the Occupation box.
P81 Pharmacist
P91 Physical Therapist
P22 Pilot
P32 Police Ocer/Firefighter/
Law Enforcement Professional
P42 Politician
P52 Project Manager
R81 Real Estate Professional
R71 Researcher
S41 Salesperson
S51 Scientist
S61 Seamstress/Tailor
S71 Security Guard
S81 Social Worker
T41 Teacher/Professor
T51 Technician
T61 Teller
T71 Tradesperson/Craftsperson
T81 Trainer/Instructor
U21 Underwriter
V11 Veterinarian
W21 Writer/Journalist/Editor
Occupation Codes
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Beneficiary Individual Retirement Account (IRA) Application-TDA 0619

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Completed 21 July 2020

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