ACCOUNT TRANSFER FORM
Ameritrade
TO TRANSFER YOUR EXISTING
ACCOUNT TO TD AMERITRADE
lnstitutional
Account #
Advisor Code
Case #
PLEASE ATTACH A COPY OF YOUR LATEST STATEMENT.
ureanng Numoer:
Social Security Numberffax lD:
EPersonal
llndividual
Trust !
Limiteo Liability
Company I
Rotn
tRn
figg
f]
(Non-Qualified)
flEstate
flCorporate
l.toint
EPa(nership/lnvestmentClub
ETraditional lRA,/Rollover
IRA
Qualiried Retirement Plan
Employer Plan Type:
ESEPIRA
ESimplelRA
ECoverdell ESA I Beneficiary IRA
lother:
INFORMATION ON THE ACCOUNT YOU ARE TRANSFERRING FROM
Ac@unt Number
Account Title/Registralion as shown on your staiement:
Name of Delivering Firm
Physical Address of
Fin
Telephone Number (requiredr:
(no PO BOX):
lne
E
Oualified Retirement Plan
club Esep tnn
E
simple IRA
Has SIMPLE IRA been lunded for at least two years?
Trust E Limiteo Liabitity Company
llndividual
(Non-Qualitied)
ElPersonat
lJoint
EEstate
E
[Corporate
ElTraditional lRA,/Rollover
ERotn
Employer Plan Type:
Partnership/lnvestment
[Yes
IRA
ICoverdell
ESA I
Eruo
Beneficiary IRA
LIST THE ASSETS YOU WANT TO TRANSFER
A. Transfer from an ACAT eligible Brokerage Firm, Bank, lnsurance/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 requesls. To place trades, please contact your current custodian prior to
submitting the transfer request. Most banks, insurancelannuity, and trust companies require original welink signature mailed to TD Ameritrade.
lf transfening in Alternative lnvestments, please obtain a copy of the Transfer ln Only Alternative lnvestment Client Gustody
Agreement from your Advisor, the terms of which will apply to our custody of your Alternative lnvestments. No signature is required.
El Full Transfer - To transfer entire account, check box
skip to Section 4 (if applicable), then to the Signature
and
EI Partial Transfer - List specific security. lf bonds are being transfened,
please supply the Bond CUSIP.
Section.
D€scription of Asset
Quanttty
(Parlial tran sfers only)
(lndicate # ot shares or "ALLJ
Descriptlon of Assot
(P a rtia I tran
sfers on ly)
For additional securities, see attached list.
r
ilililil ilil ilil ilil ilil Iilil ililililil ilil ilil
Page l of 5
Quarttty
(lndicate # of *]€,res or
iqll?
fi
TDAr 9582 REV 07/15
Annuity/Life lnsurance 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:
E
E
E
E
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 behatf. 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):
I
Redeem my CD immediately.
E
Redeem my CD at maturity. Maturity date:
bank not to roll over the CD to a new term.
I understand
that penalties may apply for any withdrawals prior to maturity
Submit request at least
21 days prior
to maturity. Please advise your
Dividend Reinvestment Plan:
I
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
(ldicate
#
of
shares @
Handfing (Check one)
"Nl)
E
!Transfer my shares
Sell my shares, transfer cash
EReinvested shares
ICash
!
!Transfer my shares
Sell my shares, transfer cash
EReinvestedshares
ICash
Transfer my shares
my shares, transfer cash
EReinvestedshares
!Cash
Transfer my shares
my shares, transfer cash
EReinvestedshares ECash
Transfer my shares
my shares, transfer cash
EReinvestedshares ECash
!
flSell
!
flSell
!
ISell
For additional mutual funds, see attached list.
Crcdit Gains .nd Dividondg aB
(Check one if tanslering dtares)
E
To transfer Money Markels, please indicate the Money Market name or symbol if available
Page 2 of 5
Liquidate Money Maftetl
EAil
E
Only:
$_
TDA| 9582 REV 07/15
reby authorize a transfer from the account
of
to the account at TD Ameritrade for
(Detiwring Ac@unt
fidelRegistation)
tD
Amadllade A@ount fiaelReeisnatkn)
Account Oxne/s Signature:
Ac€ount Coownor's Signature:
TD Ameritrade, the party losing ownership of the assets
at
when transferring from a joint account at a contra firm to an individual account
account at TD Ameritrade, please attiach a notarized letter of aulhorization
must sign section 4. lf the party losing ownership does not have an
provide a copy
is a resuh of.a name change for an account owner, please
signed by the party losing ownersnip-ot the assets. lf the discrepancy
Further documentation may be required, depending on the situation'
of the legal document such as a marriage certificate, divorce decree, etc.
ffirementaccount,lhaue","ndedthe-pplicableplansothatitnamesTDAmeritradeClearing,lnc.asa
successor custodian.
all asse. is in my account ln klnd to TD Amerltrade' I underst'and
Unless otherwlse lndicated in the lnstruc,tions abo\re, please transfur
with
or without penalties, such assets may not be transferred within the
transferable,
readily
not
are
in
my
account
assets
that to the extent any
time frames required by applicable regulations.
you to liquidate any non-transferable proprietary money market fund assets that
unless otherwise indicated in the insrudions abow, I authorize
fees due
TD Ameritrade clearing, lnc. I authorize you to deduct any oubtanding
io
balance
credit
the
resulting
are part of my account and transfer
in the account is insumcient
balance
if
credit
or
the
balance,
credit
a
contiain
not
does
you from the credit balance in my account. lf my account
lf
assets in_ my account to the extent necessary to satisfy that obligation'
to satisfy any outstanding Ees due you, I authorize you to liqukJate the
you to transfer them in good delinerable form' including
possession,
I
initrua
piv.ior
in
are
in
my
account
vorr
certificates or other instrumonts
purpose of sale, when and as direc-ted
successor custodLn to transfer them in its name for the
afiixing any necessary tax waivers, to enable the
your books
inslrudion, you will cancel all open orders for my account on
by me. I understand that upon receiving a copy of ihis transfer
Account Ot/vnafs Printed Name:
Date:
Acrount Oryune/s Signatur€:
Account
rf,ner's Printed Name
(l
nacessary):
Account Coown€r's Signature (if nacessryI.
Account Co-Owner's Printed Name (ff necossary):
Account CoOwner's Signature (if necessary):
Plan Administrator Signatur€ (optional):
ffiPbasebeadviSedt'"troa'n",ir"o"ctearing,lnc.willaccepttheaboecaptionedaccountassucc6soroJ$odian.
Date:
Succ$sor Custodian Aithorized Signature:
Page 3 of 5
TDA| 9582 REV 07/15
FOR TD AMERITRADE USE ONLY:
Receiving Firm lnformation
Clearing Firm: TD Ameritrade Clearing, lnc.
Tax lD Number: 47-0533629
Name and Address: TD Amerihade, lnc.
Attn: Transfer of Acmunts Departmenl
200 S 108th Ave
Omaha NE 68154
All deliveries MUST include client name and TD Ameritrade, lnc. ("TD Ameritrade') accounl number
DTC # OT88
Physical Delivery of Securities
TD Ameritrade C,earing, lnc.
FBO Client Name and
Account Number
PA Box 2226
omaha. NE 68103-2226
200 S 108th Ave
Omaha, NE 68154-2631
PTC lnstructions are: BKNYCATP
Federal Book Entry
(for exanple, Treasury Notes)
BK of NYo/Ameritrade
ABA #021000018
Fed Wired Monies
lf yourlinancial institution is located
in th€ unlled States, wire lo:
Wells Fargo Bank, NA
420 N,4ontgomery Street
San Francisco, CA 94104
ABA transit routing # 12000248
Fo. crodil lo:
TD Ameritrade Clearing, lnc.
Account * 4123214 561
'For beneft of:
You. ninedigit TD Ameritrade
account number
Your name
Your address
' Raqwed lot tinely and accotate pacesing ol
It your linancial institution is located
outside the United Stalos, wire lo:
First National Bank of Omaha
16th & Dodge Streets
Omaha. NE 68102
ABA # 104000016
Swifl Code / BIC: FNBOUS44XXX
(lf your bank requires it)
For credlt lo:
TD Ameritrade Clearing, lnc.
Account # 1924641
'For benelil of:
Your nine{igit TD Ameritrade
account numt€r
Your name
Your address
' Roquircd lar tin6t ahd arcudte ptmsing ar teur
Contact TD Ameritrade, and not the banks, with questions about wire iransfers.
Foaward Checks
TD Amerilrade Clearing, lnc.
FBO Client Name and
Account Number
PO BOX 919031
San Diego, CA 92191-9031
5010 Wateridge Vista Drive
San Diego, CA 92421-5175
Mutual Fund Registration
TD Ameritrade, lnc.
Tax lD Number: 47-0533629
FBO Client's Name and
Account Number
PO Aox 2226
Omaha, NE 68103-2226
Broker/Dealer: TO Ameritrade, lnc.
200 S 108th Ave
Omaha, NE 68154-2631
Options
Options Clearing Corporation: OCC #0777
Cost Basis lnformation ('"Required'*)
TD Ameritrade is a CBRS Pa.liclpant
Mailing Address (for Transfer Statements and general questions)
TD Ameritrade
PO Box 2209
Omaha. NE 68103-2209
Or
Fax Number: 1-E66-468-6268
Please include the clbnt's nane and TD Ametitrade account numbet in all conespondence_
Page 4 of 5
T0Al 9582 REV 07/15
ACCOUNT TRANSFER FORM
Ameritrade
lnstitutional
lnstructions to transfer securities, mutual funds, or other assets to
your TD Ameritrade lnstitutional account:
. Complete Seclrons 1-5 of the attached Transfer Form. For new accounts, a new account application must also be completed.
. Sec{ion 1 - TD Ameritade lnstitutional Accounl lnformation complete your TD Ameritrade account registration information- Firm's account regislration information.
. Seclion 2 - Delivering Firm lnformation complele Delivering
-for requiremenls. Depending
on where the assels are coming in from, please
' Section 3 - lransfer detaalsi see below
complete sectjon 3A or 38.
. Section 3A - Brokerage Fi.m Transfer
' For full account transfers, complete Section 3A, then the Discrepancies of Account Name and Type
Seclion 4 (if applicable) and sign in Section 5.
. For partial account transfe.s, complete Section 3A, lisl description of asset, number of shares or 'all,'lhen
the Discrepancies of Account Name and Type Section 4 (if applicable) and sign in Section 5.
lf you're transferring part of your account, list only the assets you want transJerred lo TD Amentrade in sectton.
Brokerage Fi.m, Bank, lnsurance/Annuily Co., Trust Co., or Transfer Agont
. To transfer a Money Market Account, please complete this section.
'
To tGnsfer the proceeds of a matLrring CD, initiale your transfer at least two to &ree weeks before the maturity date.
. To transfer an Annuity or Life lnsurance Policy, please check the appropriate box.
. To kansfer shares in book entry form, usually associated with a Dividend Reinveslment Plan, check the
app.opriate box.
'
Please note:fractional shares will be laquidated and lransferred as cash.
. section 3B
- Mut!al Fund Company Transfer
. For fuit transfers - indicate all and mark transfer shares "in-kind" or liquidale and send proceeds.
. For partial transfers
- list individual fund name, number of shares, lransfer in-kind, or liquidate and
send proceeds.
. Call TD Ameritrade lnstitutional at 800-431-3500 to make sure the mutualfund is transferable to
TD Amerilrade. Over 13,000 funds are availabie.
. Send a separate Transfer Form for each mutualfund company (for example, Vanguard, Fidelity, Berger, etc.)
from which youle translerring. Photocopy our form if necessary or call for additional forms.
'
Section 4
.
Section
.
- Discrepancies of Account type and name, if applicable. Please note that not all carrying firms will accepl this
seclion to allow a kansfer between unlike tilles. The ultimate discretion to allow a transfer between unlike titles lies with the
carrying cuslodian.
5 - Signatures - all parties listed on the account registralion information must sign. Please verify lhat the Social
Securi9 Number and the title of the accounl at TD Ameritrade are exactly lhe same as the account al lhe other institution.
Section 6 - Letter of Acceptance to be completed by TD Amerilrade if needed.
IMPORTANT
Pl6ase attach a COPy ot the mosl reaent statement from the institution you are transferrlng from. The statement
should be from within lhe past six monlhs lo best display the most accuralo holdings. Please note the stalemenl is
used lo process your aequest so an accurate statement allows for best resulls.
Do not use this form lo transfer betlveen TD Ameritrade accounts.
Roth lRA - ln order lo convert your Traditional IRA at another firm to a Roth IRA at TD Ameritrade, please convert lo lhe
Rolh lRA with your existing custodian and then complete a t.ansfer to a Roth IRA at ID Ameritrade.
'
'
'
lF YOU HAVE ANY QUESTIONS, PLEASE Contact your advisor
Need more foms? Photocopy lhis form. call us, or visit our websile at advisorclient.com for additionatforms
Address:
lnstltutional
919094
9219I-9094
Mailing
TD Amerit.ade
PO BOX
San Diego, CA
lnvestmenl Products: Nol FDIC lnsured
'
Ovemight Address:
TO Ameritrade lnsfitutional
5010 Wateridge Visla Drive
San Diego, CA
No Bank Guarantee
92121-5775
"
TM|95O2 REV 07/15
Mav Lose Vatue
TD Ame.itrade lnstitutional, Division of rD Amedtrade, lnc. and rD Amerirrade clearing, lnc., members FtNRA,/stpc.
TD Ameritrade is a trademarkjoinfly owned by TD Ameritrade lp company rnc. and rhe Toronro-Dominion
Bank.
O 2015 TD Ameritrade tp Company, lnc. A rights reserved. Used with permission.
Page 5 of 5