Beneficiaries — Transfer on Death
1
Account Information
Owner’s Name Social Security Number (SSN)
Joint Owner’s Name (if applicable) SSN
A Transfer on Death (TOD) ownership is a method to designate benefi-
ciaries. NOTE: TOD is not available for residents of Louisiana.
Applies to all identically owned accounts including Brokerage. Check one:
Open a new account with TOD. Attach a completed Mutual Fund
New Account form or Brokerage New Account form.
Remove all beneficiaries.
Change beneficiaries on an existing TOD account.
Change an existing account to TOD.
Fund Name Account Number
Brokerage Account Number (if applicable)
2
Beneficiaries
Beneficiary designations must be identical for all identically registered
accounts. Failure to provide the percentage for each named beneficiary,
or if the percentages provided do not total 100%, will result in equal
allocation. If a primary beneficiary dies before you, the percentages will
be recalculated proportionately among the surviving primary beneficiaries.
Similar rules apply to secondary beneficiaries. Secondary beneficiaries
inherit assets only if no primary beneficiaries survive you. Unless you indi-
cate otherwise, T. Rowe Price will distribute to your beneficiaries on a per
capita basis. A spouse is any individual who is a spouse under federal law.
You may wish to speak to an estate planner about your personal situation.
A
Primary Beneficiaries
1. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
2. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
3. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
% Must total 100%
B
Secondary Beneficiaries
1. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
2. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
3. Name Date of Birth (mm/dd/yyyy)
Percentage (%) Relationship Check one: SSN
Spouse Other
% Must total 100%
For more beneficiaries, check this box and attach a separate page.
3
Signature(s)
By signing below:
• The owner or owners of the account(s) authorize the transfer of
shares in an existing account(s) into a TOD registration under the
Maryland Uniform Transfer on Death Security Registration Act.
• The owner or owners authorize the establishment of any new
account(s) with a TOD registration under the Maryland Uniform
Transfer on Death Security Registration Act and have attached a
completed New Account form.
• The owner or owners agree that the beneficiary designations set
forth on this form will apply to any identically registered accounts
opened after the execution of this form.
• The owner or owners authorize the requested changes to the
beneficiaries.
Signature(s) and Date(s) Required
Owner Date (mm/dd/yyyy)
X
Joint Owner (if applicable) Date (mm/dd/yyyy)
X
✓ Use this form to:
• Name or change beneficiaries on a taxable account.
✗ Do not use this form to:
• Change beneficiaries on an IRA. Use the IRA Beneficiary form.
• Add or change beneficiaries on an employer-sponsored retire-
ment plan. Use the Employer-Sponsored Retirement Plan
Participant Account form.
Mail to:
T.Rowe Price
P.O. Box 17302
Baltimore, MD 21297-1302
Express delivery only:
T.Rowe Price Mail Code OM-17302
4515 Painters Mill Road
Owings Mills, MD 21117-4903
This paper clip indicates you may need to attach documentation.
FMF3TODA 3/19_w
Questions? troweprice.com | 800-225-5132
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