TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members FINRA/SIPC, are subsidiaries of The Charles Schwab Corporation.
TD Ameritrade is a trademark jointly owned by TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank.
©01 Charles Schwab & Co. Inc. All rights reserved.
I have received and read the Client Agreement, which is incorporated by this reference, that will govern my account. I agree to be bound
by this Client Agreement, as amended from time to time, and request an account to be opened in the name(s) set forth below. All
securities, dividends, and proceeds will be held at TD Ameritrade Clearing, Inc., unless otherwise instructed. I understand that
TD Ameritrade 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 to extend credit may be based on information contained in a consumer
or credit report, as well as the policies of TD Ameritrade and TD Ameritrade Clearing, Inc. I understand that TD Ameritrade may relate
information regarding this account, including account delinquency and voluntary closures, to consumer or credit reporting agencies.
Upon my request, TD Ameritrade 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 agrees to notify the consumer or credit reporting agencies if I dispute the
completeness or accuracy of the information furnished by TD Ameritrade. By my signature below, I authorize TD Ameritrade to obtain
consumer or credit reports for the name(s) set forth below. I understand that non deposit investments purchased through
TD Ameritrade are not insured by the FDIC, are not obligations of or guaranteed by any nancial institution, and are subject to
investment risk and loss that may exceed the principal invested.
The undersigned hereby acknowledges that he/she has received and read the TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc.
Section 0(b) () Disclosure Summary document.
Important information about procedures for opening a new account:
To help the government ght the funding of terrorism and money laundering activities, federal law requires all nancial
institutions to obtain, verify, and record information that identies 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 verication purposes and/or ask for a copy
of your driver’s license or other identifying documents. By my signature below, I attest that I am of legal age to contract, and I
certify, to the best of my knowledge that the information provided on this application is complete and correct.
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 identication number; () I
am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notied 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 notied me that I am no longer subject to backup withholding; () I am a U.S. citizen or other U.S. person; and
() the FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
If I have been notied 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 () in this certication.
If I am not a U.S. Person for tax purposes:
I am submitting the applicable Form W- with this form to certify my foreign status.
The IRS does not require your consent
to any provision of this document
other than the certications 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 .
Participant's Signature: Employer's Signature:
fonts are not
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
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