Page 9 of 11 TDA 1199 F 03/21
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; (2) 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; (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 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 (2) in this certication.
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 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 8. The
agreement to arbitrate does not constitute a waiver of any right provided to me by the Advisers
Act, including the right to choose the forum, whether arbitration or adjudication, in which to seek
resolution of disputes.
I have received and read the Client Agreement, which is incorporated by this reference, and which 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. I
hereby certify that this request is consistent with the terms and conditions of the trust agreement and that there are no other trustees
other than the undersigned. I jointly and severally indemnify TD Ameritrade, Inc. and hold you harmless from any and all liability and
claims for damages arising out of or related to any instructions given by any trustee to you. This indemnication is made by me in both
my capacity as trustee and in my individual capacity. If converting to a Trust Account, I agree to inform you, in writing, of any amendment
to the Trust, any change in the composition of the trustees, or any other event which could alter the certications contained herein. I
acknowledge your right to examine the trust agreement and hereby agree to provide you with a copy of trust documents if so requested
in writing. I understand that by adding a cotrustee to my Account, I am authorizing you to follow and act upon all instructions from
cotrustee, including but not limited to, the ability to place trades, change account information, disburse funds, and or delete services,
and, if applicable, write checks and use debit card services. 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 it has 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
nondeposit 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. 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 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.
All Account trustees must sign. If you wish to trade options in your account, complete the Options Account section.
If an options account has been requested, I 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 eect and as amended from time to time. I am aware of the risks involved in
options trading and represent that I am nancially able to bear such risks and withstand options-trading losses. I understand that
TD Ameritrade will not review the Trust Agreement and I represent and warrant that the Trust allows for the trading of options in this
Account at the level requested by me.
fonts are not
Trustee’s Signature: Co-Trustee’s Signature:
TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members FINRA/SIPC, and TD Ameritrade Investment Management, LLC are separate but
aliated companies and 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.
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value