EFTA01268291.pdf

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Account Transfer Form
TO Ameritrade
Mail or Fax tot
PO Box 2760 . Omaha, NE 68103-2760
Far 866-4684268 Receiving Firm DTC Clearing Number:
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 TO Ameritrade Attn:
TO Amentrade, PO Box 2760, Omaha, NE 68103.2760 or fax to 866.468-6268.
"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 7D Ameritrade accounts, please use the Internal transfer form. Please note you cannot use this form
to transfer from a standard checking account andl or savings account from a banldcredit union. For IRAs, and FteneficiarylWls where the
original owner was 7074 years or older et death, please attach a copy of your end of year statement to enable us to calculate the required
minimum distribution for the account
1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE
Your TO Ameritrade Account ACCOUNT TO BE TRANSFERRED
(The registration of the account being transferred should match your (As dkected In Section 1b oth registration and Tax lOs for the
TO Ameritrade account and the Tax ID for both the TO Ameritrade To Amerievde account and account being transferred should match.)
account and account being transferred.)
Account Number (Required): Account Number (Required):
(alF on° per norm) 867.730320 (OM' one per form) N46-023804
Account Regleareboraille: Account FtecestralloNTIISe;
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
Social Security/Tax ID Number: Social Secuilty/Tax C Number:
Soctal SectrilytTax ID Monter: Sacral SecurbytTax ID Number
(Secondary If applicable) (Secondare If applicable)
ControCeivering Form NUM (Required):
Account Type (select one)
Deutsche Bank
O Inchuidual - (Non IRA) ['SIMPLE IRA ConuaiDekeering Firm Adders
Joint ['SEP IRA 345 Park Ave, 26th Floor, NY, NY 10154
0Trust ['Traditional or Rollover IRA CortraiDewedng Firm Mom Number (Required):
9Corp/Business ['Roth IRA 410-895-5841 / 212-454-4433
q UGMAAJTMA ['Beneficiary IRA
Account Type (select one)
04038 OBeneficiary Roth IRA
001her: EIEsiate ▪ Individual - (Non IRA) [' SIMPLE IRA
ElQuesnee Plan ("See above) [Polnl ['SEP IRA
0Trust OTrachtional or Rolimer IRA
Int
Corp/Business ['Roth IRA
DOGMA/UT:OA ['Beneficiary IRA
O 4036 OBeneficiary Roth IRA
['Other: ['Estate
['Qualified Plan ("See above)
If fho registrations do not match, you may either establish a new account online at www.tdamodbadtcom or you must supply additional
documentation and all delivering account owners must sign section 5. For unlike title/registration transfer; please call the transfer department
at 888-7234504 for additional requirements. 'Please note if there are any issues with processing your transfer, wo will communicate that to
you via your secure message center when you log in to your account.
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ID Amends Acct
3. TRANSFER INSTRUCTION
Please review the following instructions and complete the proper section(s) for your transfer request. Only one sub-section (such as. A, B. C, or D)
can be selected per transfer.
Check box for Full or Partial Transfer. Only whole shares can be requested, as fractional shares cannot be transferred. Please contact the
delivering frm regarding your options. For Partial Transfers. list descriptions of assets and shares. Unless otherwise indicated. TO Ameritrade
wil transfer in FIJI.
'Please note—TD Ameritrade cannot request Mutual Funds hold at Brokerage Firms to be liquidated. To place trades for liquidation,
please contact the delivering firm prior to submitting the transfer request. Some money market funds are self-liquidating. To liquidate
others, please contact the delivering firm.
A. BROKERAGE FIRM TRANSFER
O Full Transfer—To transfer entice account, check here and then skip to the Signature Section 4, and complete Section 5 and/or Section 6
(if applicable).
Partial Transfer—List specific security and/or cash amount in the lines given below. If bonds are being transferred, pease supply the
Bond CUSIP.
Only whole shares can be requested as fractional shares cannot be transferred. Please contact the delivering firm egarding your options.
Asset Description (CUSIP or symbol) Quantity Asset Description (CUSIP or symbo0 Quantity
(Partial Transfers Only) (Indicate 0 of whole shares (Partial Transfers Only) (Indicate 0 of whde shams
or -ALL7 or •ALL1
ASNA 70500
FM I 49830
SGMO 50000
B. MUTUAL FUND COMPANY TRANSFER
Full Transfer—To transfer entire account, check here.
['Partial Transfer—List specific mutual funds In the lines given below
Check box for In-kind or Liquidation Transfer. Please list the Symbol or CUSIP for the Mutual Fund s) you wish to move.
Unless othenvise Indicated, TD Ameritrade will transfer shares in-kind. This section pertains only to shares of Mutual Funds held Madly
with the fund corrvany, for brokerage accounts containing Mutual Funds and/or Stocks please omit* e the Brokerage Firm TranSfer Section
(Section 3A. above).
'Proprietary Mutual Funds and alln o-load Money Market funds cannot be (tensioned in-kind and must be liquidated.
Quantity Handling Gains & Dividends
Fund Name or Symbol Mutual Fund Accounts
(mdcese a &Mama or ALL) (Chen ono) (Check chi: d In-kind)
Din-Kind CIRemest
ClUqi.idate ['Cash
• In-Kind • Reinvest
M Uquidate E Cash
• In-Kind OReinvest
MI Liqtidate OCash
B
leaGnd EIReinvest
Liquidate Cash
Elln-Kind OReinvest
['Liquidate OCash
11 you are transferring more funds than will fit above, please include an attached list for the complete list of funds.
['Wire
A statement MUST be included to ensure proper handling and processing of your Mutual Fund transfer. (fees nay apply)
' Unless otherwise Indicated, I authorize the Transferor to liquidate any non-Uansferebes proprietary money market °Check
and mutual fund assets that are part of my account and to transfer the resulting credit balance to my account with
ID Amantrade. If the lunch's unable to be held by TO Amentrade, I (please initial here) authorize the Transferor
to liquidate and transfer as cash.
CONrilDENTIAL SD NY_Grtp6k1G(Ifilt
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TD Amerilrade Accl
C. BANK/CREDIT UNION it ANNUITY/LIFE INSURANCE TRANSFER
Transfer cash only. Unless otherwise indicated, all cash will be transferred. Banks, Insurance/Annuity, and Trust Companies require
Original Client Signature. Please mail the Original form to complete the transfer request.
'Each section will hove additional Information.
IRA Savings Accounts—Typically held with Bank/Credit
q Total Transfer (Transfer entire account) ['Wire
floes may apply)
q Partial Transfer (Transfer part of account) Portion to transfer $ ❑Check
Certificates of Deposit (CDs).
❑Redeem my CD immediately.
I am aware of, and acknowledge, that I am responsible for any penalties that I may incur from any early withdrawal.
❑Redeem my CD at maturity. Maturity Date:
Submit request at least 21 days prior to maturity. Please advise your bank not to roll over your CD to a new term.
Indicate in this section whether you wish to liquidate the CD immediately or at maturity. For any investment instruments that have a renewal
deadline, maturity date, surrender charge period/window, etc., paperwork must be received by TD Ameritrade In good order three weeks
prior to the firm deadline to allow for proper processing times- To liquidate a CD held in a non-retirement account, contact the bank or
credit union at which the assets are being held.
Annuity! Life Insurance Transfer
q Transfer my Life Insurance
I have a life insurance policy that I wish to transfer Please redeem and terminate on my behalf
I am aware of, and acknowledge, that lam responsible for any penalties that I may incur from
any early withdrawal.
q Transfer my Annuity
q Full q Partial $ q Wire
I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf. (fees may apply)
I ant aware of, and acknowledge, that I am responsible for any penalties that I may Incur from q Check
any early withdrawal.
Select only one: Liquidate annuity in full or partial liquidation. II partial is selected, amount for partial must be Included. Contact the
insurance company to determine whether surrender forms are required before submitting the transfer form to TO Ameritrade. Attach
surrender form if applicable. TD Arneiltrade is not responsible for the timing or execution of liquidations processed by the delivering firm.
D. TRANSFER AGENT
Chock box for In-kind transfer from a Transfer Agent This section is specifically for transfers from a Transfer Agent via the Direct
Registration System or DRS transfer. DRS transfers must be between like-titled accounts. Please provide the MOST recent copy of
your delivering account statement dated within 90 days.
*Note: All shares MUST be held in Book-Entry form at the Transfer Agent, prior to initialing the transfer.
q Transfer all of my WHOLE shares to my TD Ameritrade account and liquidate any fractional shares.
understand the cash proceeds of any liquidation will be mailed directly to the address on file for my account This option will leave
your account open at the Transfer Agent.
q Transfer all of my WHOLE shares to my TD Ameritrade account and liquidate any fractional shares.
I understand the cash proceeds of any liquidation will be mailed directly to the address on file for my account and close my account at
the delivery firm.
q Transfer all of my WHOLE shares to my TD Ameritrade account. Do not liquidate any fractional shares in my account.
understand my account at Me deivery firm will remain open and! will continue to accrue shares if lam enrolled in a DRIP program.
q Transfer only Part of the assets listed (below).
understand my account of the dethiery firm will remain open and I will continue to accrue shares if I am enrolled in a DRIP program.
Share Amount
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TO Ameritrade Accra if
4. TDAMERITRADE CLIENT AUTHORIZATION
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 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 if the credit balance in the
account is insufficient to satisfy any outstanding fees. If certificates or other instruments 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 receiving a copy of this transfer instruction. for a
full aLLount transfer. Transferor will freeze my account and cancel all open orders. I also understand that no new orders may/will be taken. I affirm
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 TD Ameritrade account is a nt account. I have amended the applicable plan to designate the successor custodian.
Alternatively, if this T e account is aryl dividual Retirement Account (IRA) I have adopted an IRA plan so that it names the
successor custodian.
XClient Signature: La? b_47 a r
, Dale:0 —
X C-oOwners Signature: Deli:
—
XC-oOwner's Signature: Dale:
XCoOnners Signakre: Date:
—
5. EGIST • II 9 9 - • • • . ' ES
'Note: this section is not applicable to transfers requested in Section 3.0, requests to transfer from a Transfer Agent, which must be eke-wiled.
Registration Difference
For unlike tilled or type transfers. I authorize the transfer from account to account.
Al parties on the deLvering account must sign below.
XClient Signature: Dale:
XClient Signature: Dale:
XClient Signature: Dale:
6. ONE AND THE SAME LETTER
II you are transferring an account. and the name(s) 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 more of the following: Marriage. Divorce. Name Speeng Error.
Of any type of Name Change odudIng Jr., Sc, etc. It last name difference, must supply legal documentation: that is, state issued drivers license.
passport, or government 10.
•
(please print name), am One and the Same as
(please print name) as shown on the deli ering firm account.
Please sign name BOTH ways.
XSignature: Signature:
7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONLY)
The undersigned organization agrees to serve as successor custodian for the account of the above-named individual, and as custodian, we
agree to accept the assets being transferred.
Representative Signature: Date:
Representative Printed Name:
For TD Ameritrade Clearing. Inc. use only
Please be advised that TO Ameritrade Clearing. Inc. is an Approved 403(b)(7) Vendor andror has entered into an Information Sharing
Agreement with the Employer for the above-captioned 403(b)(7) account. The Employer/Agent Signature above hereby authorizes
TD Amentrade Clearing. Inc. to accept this exchange.
Investment Products: Not FDIC Insured ' No Bank Guarantee ' May Lose Value
TD Ameritrade, Inc. and TD Amedtrade Clearing, Inc., members FINFtAISIPC. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company. Inc. and The Toronto-Dominion Bank. 0 2016 TD Ameritrade IP Company. Inc.
CONFM4ENTIAL
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