EFTA01268279.pdf

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Account Transfer Form
ID Ameritrade
Mall or Fax to:
■ Omaha, NE 68103-2760
Fax: Receiving Firm DTC Clearing Number: 0188
Please use the Direct Registration System (DRS) Transfer Form TDA 100557 for transfer from a transfer agent.
Instructions: Attach a complete copy of your most recent statement, of the account you are requesting the transfer from.
(dated within 90 days) In order for the transfer to be processed. Please submit the completed form to TD Ameritrade Attn:
TO Amer/trade, PO Rox 2780, Omaha, NF 6R103-7760 or fax to 886-4613-878/3. To submit tha compIntml and signed form(s)
electronically through our secure Message Center, scan it, along with any other material you're sending. Then log in to your
account and go to Client Services > Message Center to write us. and attach the scanned document(s) to your message.
"If you are requesting to transfer from your Qualified Retirement Plan, please contact your plan administrator; this form may not be required.
If you are transferring between two TD Amerluade accounts, please use the Internal transfer form. Please note you cannot use tills form
to transfer from a standard checking account and /Or savings account from a banklcredit union. For IRAs, and Beneficiary IRAs where the
original owner was 7014 years or older at death, please) attach a copy of your end of year statement to enable ut to calculate the required
minimum distribution for the account.
1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE
Your TD Ameritrade Account DELIVERING ACCOUNT
(As directed in Section loom registration and tax IDS tor the
(The registration of the account being transferred should match your
TO Amerifrade account and account being transferred should match.)
TD Ameritrade account and the Tax ID for both the TO Amentrade
account and account being transferred.)
Account Number (Required): Account Number (Reoulredl:
(Only one perform) (Only ono perform)
Account Reputation/Tide: Account Resestrationclitle:
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
Social Secunly/Tax ID Number: Social Security/Tax ID Number.
Social Security/Tax II) Number- Social Security/Tax ID Number:
(Secondsy II applicable) (Secondary If applicable)
ConfrodOelkedng arm Nome (Rogukoco.
Account Type (select one)
DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
Eilndividi pal — (Non IRA) O Traditional or Rollover IRA Corterulaelneering firm Addro,a:
IDJoint El Roth IRA NY,N Y10154
EI
Trust OBeneficiary IRA v er (:cow/ad)
ECorp/Business o Beneficiary Roth IRA
Ducwvvrtm LI Qualified Nan (401k, 4038, PER ate.) Cvntiathrliveiiny Fi; lit 'toil
Et
DEstate El SIMPLE IRA
q 3EP IRA
EI Account Type (select one)
Other:
O
OInclividual (Non IRA) Traditional or Rollover IRA
EJoint q Roth IRA
O
OTrust 0eneficiary IRA
O
EJCorp/Business Beneficiary Roth IRA
DUG:AAA/7MA 0
Qualified Plan (401k, 4038. P3P, etc.)
EIESIalb ❑SIMPLE IRA
O
SEP IRA
['Other:
If the registrations do not match, you may either establish a new account online at www.tdameritrade.com or you must supply additional
documentation and ell delivering account owners must sign section 4. For unlike tifielreglatretion transfer; please eon the transfer department
at n8423-8504, option 4 for additional requirements. 'Please note if there are any issues with processing your transfer, we will communicate
that to you via your secure message center when you log In to your account
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TD Ametibetha AW P 867-730320
3. TRANSFER INSTRUCTIONS-PLEASE COMPLETE ONLY ONE OF THE FOLLOWING SECTIONS (A.6, OR C)
A. BROKERAGE FIRM TRANSFER (Unless otherwise indicated, TD Ameritrade will transfer in Full)
[Full Transfer—To transfer entire account. check here and skip to Section 4.
['Partial Transfer—List specific security and/or cash amount bakes If bonds aro being transferred, please supply the CUSIP.
Only whole shams can ba requested as fractional shares cannot be transferred. Please contact the delivering firm regarding your options.
Asset Description (CUSIP or symbol) Quantity Asset Description (CUSIP or symbol) Quantity
(Porno/ Translort Only) (Indkolo ll al whoa shams (Psival rilloStolO Only) hkuttiota Al °lank, Atka/lit
or "ALL") or -ALL)
1. CASH 5,000,000 S. AMZN 1,000
2. GOOG 3,000 6. BABA 5,000
3. CVNA 25.000 7. BIIB 2.095
4. UTX 15,000 8. KPTI 25,000
B. BANK/CREDIT UNION & ANNUITY TRANSFER
Transfer cash only. Unless otherwise Indicated, all cash will be transferred. Banks, Annuity, and Trust Companies require Original
Client Signature. Please mail the Original form to complete the transfer request.
IRA Savings Accounts—Typically held with Bank/Credit Union.
El total Transfer ( transfer entire account) O Wire
(fees troy OPPlY)
['Partial Transfer (Transfer part of account) Portion to transfer O Check
Certificates of Deposit (CDs).
['Redeem my CD immediately.
I am aware of, and acknowledge, that lam responsible for any penalties that I may incur from any early withdrawal.
['Redeem my CD at maturity. Maturity Date:
Submit request at least 21d ays prior to maturity. Please advise your bank not to roll over your CD to a new term.
Indicate in this °action whether you wish to liquidate the CD immediately or at maturity For any investment instruments that have a renewal
deadline, maturity dare. surrender charge periodlvdndow. etc., paperwork must be received by TO Ameritrade in good order three weeks
prior to the firm deadline to allow for proper processing times. To liquidate a CD held kit non-retirement account, contact the bank or
credit union at which the assets are being held.
Annuity Transfer
['Transfer my Annuity
0 Full O Partial $ Wire
I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf. q (fees may apply)
ri
lam aware of. acknowledge. that lam responsible for any penalties that I may incur from Check
any early withdrawal.
Select only one: Liquidate annuity in full or partial liquidation. If partial is selected, amount for partial must be Included.
TO Amenlrade is not responsible for the timing or execution of liquidations processed by the delivering firm.
C. MUTUAL FUND COMPANY TRANSFER
Check box for In-kind or Liquidation Transfer. Please list the Symbol or CUSIP for the Mutual Fund s) you wish to move.
Unless otherwise Indicated, TO Ameritrade will transfer shares in-kind. This section pertains only to shares of Mutual Funds held directly
with the fund company, for brokerage accounts containing Mutual Funds and/or Stocks please complete the Brokerage Firm Transfer section
(Section 3A, above).
Proprietary Mutual Funds and all no-load Money Market funds cannot be transferred in-kind and must be liquidated.
Quantity H wiling Gains &Dividends
Fund Name or Symbol Mutual Fund Accounts
(Indicate e of shares or ACC) (Chock ono) (Clock ono ifh alm;
OIn-Kind M Reinvest
OLiquidate OCash
• InKind ■ Reinvest
M Liquidate ■ Cash
O IwKind 0 Reinvest
M Liquidate • Cash
if you are transferring more funds than will fit above, please include en attached list for the complete list of funds ID Wire
A statement MUST be included to ensure proper handling and processing of your Mutual Fund transfer (tees may apply)
Unless oMenvise indicated, 1 autnonze are transferor to liquidate any nontransferable propnetary money market q Check
and mutual fund assets that are part of my account and to transfer the resulting credit balance to my account with
TO Amoritrodu N tho fund is unoblo to be hold by TDAmeritnadc, I (plcoac initial hare) authorize the Transferor
to liquidate and transfer as cash.
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To ornerier:ale OW U 867.730320
Registration Difference
For unlike tilled or typo transfers, such as Individual to Joint, I authorize the transfer from account to account.
All parties on the dekvering account must sign below All TD Ameritrade parties must sign In section 6 for transfer authorization.
XClient Signature: Date:
XClient Signature. Date.
XClient Signature. Dale.
6. ONE AND THE SAME LETTER OF APPLICABL E)
If you aro transferring an account, and the names) at TD Ameritrade do not exactly match but are Still One and the Same person, please complete
this section. This section should be utilized If your name has changed due to one or room of the following: Marriage, Diyuros, Name Suefing EI run,
or any type of Name Change Including Jr, Sr., etc. If last name difference, must supply legal documentation: that is, state issued driver's license,
passport, or government ID. (Please specify account typos, such as Individual to Joint)
(please print name), am One and the Same as
(please print name) as shown on the delivering firm account. (Please specify account types, such as Individual to Joint)
Please sign name BOTH ways.
XSignature: )(/ Signature:
6. TD AMERITRADE CLIENT AUTHORIZATION (REQUIRED)
All TD Ameritrade account holders (clients or trustees) as indicated by the account registration must sign this section.
Unless otherwise indicated in the instructions above, please transfer, in-kind, all assets into my account with TO Ameritrade. 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 lime
frames required by applicable regulations. I understand I will be contacted by the carrying and/or receiving firm 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 insufficient to satisfy any outstanding fees. If cenmcates or other instruments In my account are in your physical IX)55115SILIII . I hisliu,d Toil brut VI to
transfer them in good deliverable form, including affixing any necessary tax waivers, to enable the successor custodian to transfer them in its name
for the purpose of sale. whenan a itected by me. I understand that upon receiving a cony of this !ranee, instruction. for a hill annonni transfer.
Transferor will freeze my account and noel all open orders. I also understand that no new orders mayMS be taken. I affirm that I have destroyed or
returned to the Tra eferor all crediUd cards and/or unused checks issued to me in connection with my account.
If this TD Ameri de account is a lifted retirement account, I have amended the applicable plan to designate the successor custodian.
Alternatively, if t is TD ArneritradOccount is an Individual Retirement Account (IRA),
I have adopted IRA plan so I t it names the successor custodian. (Medallion Signature Guarantee — For TD Amentrade Use Only)
X Client Signalize: --(-.--.-.- .- Dale./
XCo-Caner% Signature. .........„....,..--- Date:
...
4X Co-Owner's Signalize. Dale:
XCo-Owners Signature: Uate:
7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONLY)
The undersigned organization agrees to serve as successor custo Ian for the account of the above-named individual, and as custodian, we agree to
accept the assets being transferred.
XRepresentative Signature: Date: (Medallion Signature Guarantee — For TD Ameritrade Use Only)
Reptesentati.ie Printed Na-ne.
For TO Ameritrodo Clearing, Ina. use only
Please be advised that TO Ameritrade Clearing. Inc. is an Approved 403(bX7)
Vander' and/nr has antnran into an Information Sharing Agreement with tha Frnployer
for the above-captioned 403(b)(7) account. The Employer/Agent Signature above
hereby authorizes TD Ameritrade Clearing, Inc. to accept this exchange.
Investment Products: Not FDIC Insured No Bank Guarantee ' May Lose Value
TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members riNnAtairc. TO Ameritrade is a trademark jointly owned by
TO Ameritrade IP Company. Inc. and The Toronto-Dominion Bank. O 2G18 TD Ameritrade.
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From: "KOFAX PROD PROCESS"
Date: Wed, 6 Feb 2019 19:57:32 -0500
To:
Subject: Transfer status //- messagelD=103373452 //- casel I: 57917391
Attachments: Attachment_20049579.zip
From Address:
Message ID: 103373452
Case ID: 57917391
Form Message
FULL NAME: Chad
ACCOUNT_TITLE: SOUTHERN FINANCIAL LLC
USER1D
ACCOUNT NUMBER:
TRANShh.R._ TYPE: External
NANIEOFTRANSFEREEFI: Deutsche Bank
ACCOUNT_TITLE_AT_TRANSFEREE_FI: Southern Financial LLC
TRANSFER_SUBTYPE: Partial transfer
User-Agent: Mozilla/5.0 (Macintosh; Intel Mac OS X 10.13; rv:65.0) Gecko/20100101 Firefox165.0
ENVIRONMENT: invcatemcritradc.com
Account Tmrzfer form completed
[ Attachment 1 Type: application/pdf Name: TD_Bank_ACAT_transfter_from_DB_2-6-2019.pdfl
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