EFTA01268283.pdf

I
Account Transfer Form
ArruevE I:made
Mall or Fax to:
PO Box 2760 . Omaha, Na 68103-2760
Fox. Receiving Firm DTC Clearing Number: 188
Please use the Direct Registration System (ORS) 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 ragas:rating the transfer from,
(dated within 90 days) in order for the transfer to be processed. Please submit the completed form to TO Ameritrade Attn:
TO Amerltrade, PO Box 2760, Omaha, NE 68103-2760 or fax to 866-468-6268. To submit the completed 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 > Massage Center to write us, and attach the scanned document(s) to your message.
"it you are requesting to transfer from your Qualified Retirement Plan, please contact your plan administrator; this form may not be required.
it you are transferring between two TO At:twittede accounts, please use the Internal transfer form. Please now you cannot use this form
to transfer from a standard checking account and tor savings account from a banklcredit union. For IRAs, and Beneficiary IRAs where the
original owner was 7054 years °raider at death, please attach a copy°, your and of year statement to enable us to calculate the required
Minimum &Unbutton for the account.
1. ACCOUNT INFORMATION.. , 2. PLEASE PROVIDE INFORMATION ABOUT THE
DELIVERING ACCOUNT
Your 1D Amodtrado Account
(The registration of the account being transferred should match your (As directed in Section 1 Doak regisvation and max WSW:NI
TD Anteritrade account and the Tax ID for both the TO Amentrade TO Amentrade account and account being transferred should match.)
account end account being transferred.)
Account Number (Required). Account Number (Required):
(Only one per form) (Oivy one perform)
Account Registra AecouMReolalreilonfrille:
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
Sods' Se /Tax ID Number sods sea-40,1as ID Maitre:
SSRBT 5.cvunrty7l3 ID Numb.- Soda? Secunty/Tax ID Number:
(Secondabt It appecebid (Secondary. a apprcebie)
ContraiDolocnno Firm Name (Requirodb
Account Typo (select one) DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
RJoInt OTraditionai
lanais/Wu& - (Non IRA) or Rdlover IRA ContneDaliverino Firm Addeo:sr
El Roth IRA 345 PARK AVE 26TH FLOOR NY,NY10154
Trust Elgenoliciary IRA C,. gmaYrdt.
OCorp/Business O Beneficiary Roth IRA
q UCMAAJTMA El Qualified Plan (401k, 4038, POP etc.) ConttoDalinuing rem Cmail:
oEstate
El SIMPLE IRA
El SEP IRA
Account Typo (select ono)
I:Other.
q
O lndrvidual — (Non IRA) Traditional or Rollover IRA
0JOIN O Roth IRA
EITrisat O Beneficiary IRA
EIC0NYBUSIneSS O Beneficiary Roth IRA
OUGMNUTMA
El Qualified Plan (4osc. 4030. r0I1
q
ElEstate SIMPLE IRA
El SEP IRA
ElOlher
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 all delivering aeorount owners mulct sign coction 4. For unlike etielregletratIon transfer; pleas* call the transfer department
at 888-723-8504, option 4 for additional requirements. *Please note it 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.
lull1 11I1I I fII III
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r °Amens/ids Pica #
A. BROKERAGE FIRM TRANSFER (Unless otherwise indicated, TD &mikado mil transfer in Full)
OFuti Transfer—Tn transfer entire arra mt. r.herk here and skip to SactInn 4
[Werth, Transfer—UM specific security and/or cash amount below. If bonds are being transferred, please supply the CUSP
Only whole shares can be requested as fractional shares cannot be transferred. Please contact the delivering firm regarding your options.
Asset Description (CUSIP or syrignY) Quantity Asset Description (CUSIP or symbol) Quantity
(Poetise Transfer> Only) (Indoors et:Inhale shares rectal Transfers Orly) (Wale a *Arno., enema
orALL7 orALL7
1. 04621XAK4 2,000,000 3. 30162RAA9 3,000,000
2. 172967JZ6 3,000,000 6. 361860208 80,000
3. 172967341 79.000 7. A29866A85 2.000.000
4. 17453BAW1 1,000,000 8. 46625HHA1 5,760,000
B. BANKfCREDIT UNION & ANNUITY TRANSFER
Transfer cash only. Unless otherwise Indicated, all cash will be transferred. Banks, Annuity, and Trust Companies require Original
Client Signature. Please mall the Original form to complete the transfer request.
IRA Savings Accounts—Typically held with Bank/Credit Union.
OTotal Transfer (Transfer entire account) O Wire
(fees may apply)
OPartia I Transfer (Transfer pert 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.
ORedeem my CD at maturity. Maturity Date:
Submit request at least 21 days prior to maturity. Please advise your bank not to roll over your CO to a new term.
Indicoto In II713 section whether you wish to liquidate the CD immediately or at Tottnity. For any investment inatniMents that have a renewal
deadline, maturity date, surrender charge period/window etc., paperwork must be received by TO Ameritrade in good order three weeks
prior to the firm deadline to allow /or proper processing times. To liquidate a CO held in a non-refirement account, confect the bank a
credit union at which the assets are being held.
Annuity Transfer
OTransfer my Annuity
O Fut/ O Partial $ • O Wire
I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf. q (lees may apply)
am aware of, and acknowledge, that am responsible for any penalties that I may incur from n 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 Arnerltrade Is not responsible for the liming or execution of liquidations processed by the delivering firm.
C. MUTUAL FUND COMPANY TRANSFER
Check box for In-ItInd or Liquidation Transfer. Please list the Symbol or CUSP 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•Idnd and must be liquidated.
Quantity Handling Gains & Dividends
Fund Name or Symbol Mutual Fund Account #
(Indicate a ofs hares a AU? (Check one) (Check one rf halms)
aln•Kind aReinveal
ILni-qluaidnated Cash
OReirnest
Liquidate O Cash
Oln•Kind pReiment
OLiquidate LICash
'If you are transferring more funds than will 6f above, please include an attached list for the complete list of funds ❑wire
'A statement MUST bo included to ensure proper handling and processing of your Mutual Fund transfer (fees may taPPlY)
Unless otherwise Indicated, I authonle the Transferor to liquidate anynon-trans:orate proprietary money market O Cheek
and mutual fund assets that are parf of my account and to transfer the resulting credit balance to my armint with
TO Arnenesda.11 the fund is unable to be hell by TO Amcwitrade, I (please initial hero) authorize the Transferor
10 liquidate and transfer as cash.
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TO Amman:de Ama
Registration Difference
For uniam titled or typo trariefers, such at Individual to Joint. I authorize the transfer from account to SOCOunt.
NI parties on the delivering account must sign below. All TO Amentrade parties must sign Si section 6 Icr transfer authorization.
Count Sennett Mit
XChant Signature. Date:
XChau &annum: Dar.
5. ONE AND THE SAME LETTER (IFIIPPLICABLE)
If you we transferring an account. and the name(s) at TD Amerittade do not exactly match but are dB one arid the same person, please cornplete
this section. This section should be utilized if your name has changed due to one or more of the following. Moulage. (Divorce, Name Spelling CrTor.
or any type of Name Change including Jr., Sr, etc. If last name difference, must supply legal documentation that is, state Issued drives license.
patsprirt, nr grivernment ID (Pkiace T.perity arrant types, sort ac Individual In.h int)
(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 Jo/nd
Please sign name BOTH ways.
dArr Signatia: XSIgnallet
6. TD AMERI (RADE, CLIENTADTHORIZATION (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, Irkk ind. an assets into my account with TD Amentrade. I understand that
the extent any assets in my account are not readily transferable, with or without any penalties, such assets may not bo transferred within the time
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 W the credit balance in the account
is Insufficient to satisfy any outstanding feet II certificate, or other instrument, in my account are in your physical possession, I Instruct Transferor 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. when and as directed by me. I understand that upon retaking a copy of this transfer instruction, for a full account transfer.
Transferor wil freeze my account and cancel all open orders. I also understand that no new orders mayAvill be taken. I affirm that I have destroyed or
returned to the TIa fWQ, aedittdebit cards anWor unused checks issued to me In connection with my account.
If this TO a acco t Is a qualified retirement account. I have amended the applicable plan to designate tho successor custodian.
Alone if this TO Am trade account is an Individual Retirement Account (IRA),
I have led an IRA plaint so that It names the successor custodian. (fitodolien Signature Guarantor/ - For TO Arrentraie Use Only)
X9icl Signahre: 7/075/xer
X0s-OirmitTSifte: z Date:
XCceOrmer's 3 1u Date
XCo-Owner's Saner...Fe. Dale
The end- signed organizati' agrees to serve as successor custodian for the account of the above-named inenridual, and as custodian, we agree to
accent I assets being Ira -erred
XFtercelatin Signaler (Medalbon Signature Guarantee- For TDPmeltrate Use Only)
1172.5/2o/
Representative PitntedNarnir
of
For TO Ameritrade Cl ring. . use only
Please be advised tha TO °Tilted° Clearing, Inc. Is an 'Approved 403(b)(7)
Vendor' and/or has enterEd into an Information Sharing Agreement with the Employer
for the abovecaplioned 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
To
Ameritrade. Inc. and TO Ameritrade Clearing. Inc.. members FINRA/SIPC TO Amergrade is a trademark jointly owned by
TO Amentrade IP Company, Inc. and The Toronto-Dominion Bar*. 0 2018 TO Ametitrade.
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Page 1
From: "KOFAX PROD PROCESS" <
Date: Mon, 25 Feb 2019 18:32:2 -0..00
To:
Subject ACAT transfer from DB revised //- messagelD=103747981 //- caselD=58160354
Attachments: Attachment_20196564.zip, Attachment_20196565.zip
From Address:
Message ID: 103747981
Case ID: 58160354
Form Message
FULL NAME: Richard Kahn
ACCOUNT TITLE: SOUTHERN FINANCIAL LLC
USERID: 867730320z
ACCOUNT NUMBER:
User-Agent: Mozillad5.0 (Macintosh; Intel Mac OS X 10.13; rv:65.0) Gecko/20100101 Firefox/65.0
ENVIRONMENT: invcstameritradecom
Attached arc revised forms with signature on correct line #6. Thank you
[ Attachment 1 Type: applicattonipdf Name: TD_Bank_ACAT_transfer_from_DB_2-25-2019_1_of 2.pcla
[ Attachment 2 Type: application/11dt' Name: TD_Bank_ACAT_transfer_from_DB_2•25.2019 2_of 2.pdfl
CONFIDENTIAL SDNY_GM_00012162
EFTA [X1122813
EFTA01268286