Fillable Beneficiary Form (Ally Bank)

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Beneficiary Form (Ally Bank)

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Mail
Ally Invest Securities
P.O. Box 30248
Charlotte, NC 28230
RETURN INSTRUCTIONS
Transfer on Death (TOD)
Beneficiary Designation Form
Please note that Transfer on Death Beneficiary Designations are not available to residents in all jurisdictions.
Please also note that TOD Accounts are subject to receipt and acceptance by our clearing firm, Apex Clearing Corporation
(“Apex”). No TOD designation will be effected until all required documentation is received and accepted.
Account Information
Beneficiary Designation
To my Broker/Dealer (You or Your):
I (We) wish to create a transfer on death (TOD) registration for the account listed above. I (We) hereby designate the person(s) identified
below ( Beneficiary(ies) ) to receive all monies, securities and other assets held in the account listed above upon my (our) death, or the
death of the last surviving account owner in the case of a joint account. I (We) may change the designation of the beneficiary(ies) only
by completing a new Transfer on Death Beneficiary Designation Form. The Beneficiary Designation may not be revoked or changed
by will, codicil, trust document or other testamentary document. You may rely on the latest Beneficiary Designation in your possession
and no change in Beneficiary shall be effective until actually received and accepted by you.
I (We) understand that you have entered into an agreement with Apex with respect to the execution and clearance of securities. I (We
also understand that because of the complex legal and tax issues involved, neither you nor Apex will advise whether the TOD
designation is appropriate for tax or estate planning. I (We) acknowledge that the ability to register a securities account in TOD form is
created by state law and not all states have enacted such laws. I (We) have been advised that I (we) should consult my (our) own legal
and tax advisers before electing or revoking the TOD account designation as I (we) deem appropriate.
This Beneficiary Designation is: An Original TOD A Beneficiary Designation Change to an Existing TOD
I (We) hereby designate the person(s) named below as beneficiary(ies) to receive the assets remaining in the account listed above upon
my (our) death:
* Please note: Share totals must equal 100%. Do not use fractional percentages or dollar amounts.
Primary Account Holder Name
Apex Account Number
Social Security Number or Taxpayer ID Number
Date of Birth
Joint Account Holder (if Applicable)
Social Security Number or Taxpayer ID Number
Date of Birth
Primary Beneficiaries (If a trust, please provide trust name, names of all trustees and date established.)
1.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
2.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
3.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
69448P-UTOD 09/06/2018
Contingent Beneficiaries (If a trust, please provide trust name, names of all trustees and date established.)
1.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
2.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
3.
Name: % Share*: Relationship:
Address: Telephone:
Date of Birth: Social Security Number or Taxpayer ID Number:
* Please note: Share totals must equal 100%. Do not use fractional percentages or dollar amounts.
I (We) understand that upon my (our) death you many require my (our) Beneficiary(ies) to provide you with certain documents as you
may deem necessary prior to instructing Apex to move the assets from my (our) TOD account into the Designated beneficiary(ies’)
account(s).
I acknowledge and agree that upon my (our) death, distribution will be made to my (our) designated beneficiaries in the following manner:
PRIMARY BENEFICIARY(IES)
Any interest I (We) may have in this account will be paid in equal proportions, unless otherwise indicated, to the primary
beneficiary(ies) I have designated
If the death of one or more designated Primary Beneficiary(ies) precedes my (our) death, the interest they would have
received from this account will be paid, upon my (our) death, to my surviving Primary Beneficiary(ies) Pro Rata such
that 100% is paid to the surviving primary beneficiary(ies)
CONTINGENT BENEFICIARY(IES)
If none of my Primary Beneficiaries survives me (us), any interest I (We) have in this account will be paid in equal
proportions unless otherwise indicated to the Contingent Beneficiary(ies) I (We) have designated
If the death of one or more designated Contingent Beneficiary precedes my (our) death, the interest they would have
received from this account will be paid, upon my (our) death, to my surviving Contingent Beneficiary(ies) Pro Rata such
that 100% is paid to the surviving Contingent beneficiary(ies)
NO SURVIVING BENEFICIARY(IES)
If none of the Primary or Contingent beneficiaries I (We) have designated survives me (us), any interest I (We) may
have in this account shall pass as if my (our) Transfer on Death instructions did not exist.
I (We) understand and agree that Apex, may register and hold the securities in my (our) TOD account in Apex’s name or other “street”
or nominee name and that this will create no duty on Apex’s part to determine registration or ownership of the account as a whole before
or after my (our) death.
In consideration for establishing this registration and accepting the Beneficiary Designation, I (we) (including my (our) estate(s), heirs,
spouse, successors in interest, and all Beneficiaries named herein) shall indemnify and hold harmless you and Apex (and affiliates,
directors, officers, control persons, agents and employees thereof) from and against all claims, actions, costs and liabilities, including
attorneys’ fees, by person or entity arising out of or relating to this account registration and transfers hereunder.
Miscellaneous Provisions
Apex reserves the right the refuse to accept or renew this TOD Beneficiary Designation Form and may terminate it at any time in
its sole discretion and for any reason.
If any provision hereof is or at any time should become inconsistent with any present or future law, rule or regulation of any
securities or commodities exchange or of any state or other sovereign government or an agency or regulatory body thereof, and if
any of these entities have jurisdiction over the subject matter of this TOD Beneficiary Designation Form, said provision shall be
deemed to be superseded or modified to conform to such law, rule or regulation, but in all other respects the TOD Beneficiary
Designation Form shall continue and remain in full force and effect.
The provisions of this TOD Beneficiary Designation Form, including indemnities stated herein, shall be binding upon the Account
Holder’s estate, Beneficiaries, heirs, executors, administrators, successors, and assigns, shall insure to the benefit of each of you
and Apex as your respective successors, assigns and affiliated companies, and shall survive the termination of this TOD Beneficiary
Designation Form or the TOD Account.
69448P-UTOD 09/06/2018
MUST BE SIGNED IN THE PRESENCE OF A NOTARY
Account Owner Signature Date
Joint Account Owner Signature Date
____________________________________________________________________________________________________________
Signature of Spouse (if required)* Date
*Note: Spouse’s signature is required if the spouse and/or Account Holder resides in Arizona, California, Idaho, Louisiana, Nev
New Mexico, Texas, Washington or Wisconsin, and the spouse is not an account holder or named as the sole primary beneficiary.
signing, spouse voluntarily and irrevocably consents to the beneficiary designation and to Apex paying all sums due upon
death as designated above subject to the provisions of this Transfer on Death (TOD) Beneficiary Designation Form.
Notary Public
County of _______________________________________________________}
State of _______________________________________________________}
On this __________ day of __________________________________________, ______________ before me personally came
_____________________________________________and ___________________________________________ to me known and
known to me to be the individual(s) described in and who executed the foregoing instrument, and he/she/they duly acknowledge to
that he/she/they executed the same.
_________________________________________________
Notary Public
[Seal]
69448P-UTOD 09/06/2018
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Beneficiary Form (Ally Bank)

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Completed 30 July 2020

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