Page 3 of 3 TDA 190 F 07/20
TD Ameritrade Client
Authorization (Required)
All TD Ameritrade account holders (clients or trustees) as indicated
by the account registration must sign this section.
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Unless otherwise indicated in the instructions above, please transfer, in-kind, all assets into my account with TDAmeritrade. I understand that the extent any assets in
my account are not readily transferable, with or without any penalties, such assets may not be transferred within the time frames required by applicable regulations.
I understand I will be contacted by the carrying and/or receiving rm with regard to any assets that are not transferable. I authorize the Transferor to deduct any
outstanding fees due to transfer from the credit balance, or if the credit balance in the account is insucient to satisfy any outstanding fees. If certicates or other
instruments in my account are in your physical possession, I instruct Transferor to transfer them in good deliverable form, including axing any necessary tax waivers,
to enable the successor custodian to transfer them in its name for the purpose of sale, when and as directed by me. I understand that upon receiving a copy of this
transfer instruction, for a full account transfer, Transferor will freeze my account and cancel all open orders. I also understand that no new orders may/will be taken. I
arm that I have destroyed or returned to the Transferor all credit/debit cards and/or unused checks issued to me in connection with my account.
If this TDAmeritrade account is a qualied retirement account, I have amended the applicable plan to designate the successor custodian. Alternatively, if this
TDAmeritrade account is an Individual Retirement Account (IRA), I have adopted an IRA plan so that it names the successor custodian.
Registration Dierences: All delivering and receiving account owners are required to sign the transfer form. For unlike titled or type transfers, such as Individual
to Joint, Individual to Trust, or other non-like titles, I authorized the transfer by signing below.
One and the Same Name Discrepancies: If you are transferring an account, and the name(s) at TD Ameritrade do not exactly match the delivering account title
but you are still one and the same person, the owner must sign the form using all variations. This would apply if your name has changed due to one or more of the
following: Marriage, Divorce, Name Spelling Error, or any type of name change including Jr., Sr., etc. For last name dierences, you must supply legal documentation
along with the transfer form; such as state issued driver’s license, passport, or government ID. I authorize the transfer by signing below.
(Medallion Signature Guarantee — For TD Ameritrade Use Only)
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Printed Name: Owner Signature: Date:
Printed Name: Co-Owner Signature: Date:
Printed Name: Co-Owner Signature: Date:
Printed Name: Co-Owner Signature: Date:
Sign Here
Original
signatures
are required;
electronic
signatures
and/or
signature
fonts are not
authorized
Letter of Acceptance
(For Oce Use Only)
The undersigned organization agrees to serve as successor custodian for the amount of the
above-named individual, and as custodian, we agree to accept the assets being transferred.
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Representative Signature:
Date:
Representative Printed Name:
(Medallion Signature Guarantee — For TD Ameritrade Use Only)
For TD Ameritrade Clearing, Inc. use only
Please be advised that TDAmeritrade Clearing, Inc. is an “Approved 0(b)() Vendor”
and/or has entered into an Information Sharing Agreement with the Employer for the
above-captioned 0(b)() account. The Employer/Agent Signature above hereby
authorizes TDAmeritrade Clearing, Inc. to accept this exchange.
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TDAmeritrade, Inc. and TDAmeritrade Clearing, Inc., members FINRA/SIPC. TDAmeritrade is a trademark jointly owned by
TDAmeritrade IP Company, Inc. and The Toronto-Dominion Bank. © 020 TDAmeritrade.
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
