EFTA01268360.pdf

Account Transfer Form
10 Ameritrade
Mail or Fax to:
PO Box 2760 . Omaha, NE 68103-2760
Fax: 866-468-6268 Receiving Firm DTC Clearing Number: 0188
Please use the Direct Registration System (DRS) Transfer Form T0A 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 Ameritrado Attn:
TD AmerIkeda, 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 > Message Center to write us, and attach the scanned document(s) to your message.
yeti 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 Ameritrade accounts, please use the Infernal transfer form. Please note you cannot use this form
fo transfer from a standard checking account and/or savings account from a bank/credit union. For IRAs, and Beneficiary IRAs where the
original owner was 7034 years or older at death, please attach a copy of your end of year statement to enable us to calculate the required
rninimum distribution kr the account.
1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE
DELIVERING ACCOUNT
Your TO Ameritrado Account
(The registration of the account being transferred should match your (As deeded in Section 1 both registration and Tax Os for the
TD Amedtrade account and the Tax ID for both the TO Amer/trade TO Ameritrade account and &gownt being transferred should match.)
account and account being transferred.)
Account Number (Required): Account Number (Required):
(O* one per form (O* one Perform) N4G•023804
Account Reciatrati i Account Recielrationfrate:
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
SoriN Socutay/Tax ID Number: 4S.ocial0 S /Tax ID Number.
66-0799192
Social Security/Tax ID Number ax ID Number.
(Seceerrafx M applicable) (Secondary, a appricalse)
Contracmilivenng Farm Name (Required):
Account Type (select one)
DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
❑Individual — (Non IRA) OTraditional or Rollover IRA CceararDerwaing Fkm Adams:
Rohl q Roth IRA 345 PARK AVE 26TH FLOOR NY,NY10154
Trust q Beneficiary IRA ContrwDefwnn Firm Phone Number (Required):
0CorpfBusiness O Beneficiary Roth IRA
OUGMA/UTMA O Qualified Plan (401k, 4038, PSR etc) Contra/Delivesing Firm Email:
DEState
O SIMPLE IRA
O SEP IRA
Account Type (select one)
pother:
OIndividual - (Non IRA) O Traditional or Rollover IRA
OJoint O Roth IRA
O
EaClTorurpst/ Business Beneficiary IRA
O Beneficiary Roth IRA
OUGMAILITMA O Qualified Plan (401k, 4038, PSP, etc.)
OEstate
O SIMPLE IRA
q SEP IRA
00ther
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 account owners must sign section 4. For unlike title/registration transfer, please call the transfer department
at 888-723-8504, option 4 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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TD Ameritrade Acct a 867-730320
3. TRANSFER INSTRUCTIONS-PLEASE COMPLETE ONLY ONE OF THE FOLLOWING SECTIONS (A,B, OR C)
A. BROKERAGE FiRM TRANSFER (Unless otherwise Indicated, TO Ameritrade will transfer in Full)
['Full Transfer—To transfer entire account, check here arid skip to Section 4.
['Partial Transfer—List specific security and/or cash amount below. If bonds are being transferred, please supply the CUSIP.
Only whole shares can be requested as fractional shams cannot be transferred. Please contact the delivering firm regarding your options.
Asset Description (CUSIP or symbol) Quantity Asset Description (CUSIP or symbol) Quantity
(Partial Transfers Only) (Indicate Sof whole shams (Partial Transfers Only) findcata 0 of whole shares
WALL) orALL 7
1. 539439AG4 1,903,O00 5.
2. AAPL 180600 6.
3. APO 263,157 7.
4. 8.
B. BANK/CREDIT UNION 8 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 fonn to complete the transfer request.
IRA Savings Accounts—Typicallyheld with Bank/Credit Union.
['Total Transfer (Transfer entire account) O Wire
(fees may *PAW
O Partial Transfer (Transfer part of account) Portion to transfer S q Check
Certificates of Deposit (CDs).
['Redeem my CD immediately.
I am aware of, and acknowledge, that lam responsible for any penalties that 1m ay incur from any early withdrawal.
['Redeem my CD at maturity. Maturity Date:
Submit request at least 21 days prior to matting( Please advise your bank not b 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 haw a renown)
deadline, maturity dela 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 em being held.
Annuity Transfer
OTransfer my Annuity
❑Full D Partial $ El Wks
I have an annuity policy that I wish to transfer Please redeem and terminate on my behalf. him may app,')
l am aware of, and acknowledge, that I am responsible for any penalties that I may incur from O 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 Ameritrade is not responsible for the timing or execution of liquidations processed by the delivering firm.
C. MUTUAL FUND COMPANY TRANSFER
Cheek 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 comple e the Brokerage Firm Transfer section
(Section 3A, above).
Proprietary Mutual Funds and alI no-bad Money Market funds cannot be transferred in-kind and must be liquidated.
Quantity Handling Gains & Dividends
Fund Name or Symbol Mutual Fund Account 0
(Indicate Not shares or -ALL) (Check one) (Check one if ln-kind)
• In-Kind • Reinvest
• Liquidate • Cash
Oln-Kind O Reimest
OLiquidaM III Cash
BM-Kind • Ftelmest
Liquidate oCash
If you are transferring more funds than will fit above, please include an attached list for the cowrie e list of funds. ID Wire
*A statement MUST be included to ensure proper handling and processing of your Mutual Fund transfer. (fees may apply)
• Unless otherwise indicated, I authorize the Transferor to liquidate any non-transferable proprietary money market O Check
and mutual fund assets that are part of my account and to transfer the resulting credit balance to my account with
TO Amentrade. If the fund is unable to be held by TO Ameritrade. I (please initialh ere) authorize the Transferor
fo liquidate and transfer as cash.
C0 EN T IA L soNY_Obtigebt$394
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TO Amcritrade Acct rs 867-730320
Registration Difference
For unlike titled or type transfers, such as Individual to Joint. I authorize the transfer from account to account.
AN parties on the delivering account must sign below. All TD Ameritrade parties must sign in section 6 for transfer authorization.
XClient Signature: Date:
XClient Signature: Date:
XClient Signature: Date:
5. ONE AND THE SAME LETTER (IF APPLICABLE)
If you are trans:ening an account, and the name(s) at TD Ameritrade do not exactly match but are sill 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 Spelling Error,
or any type of Name Change including Jr.. Sc. etc. If last name difference. must supply legal documentation: that is, state issued drivers license.
passport, or government ID. (Please specify account types, such as Individual to Joint)
(please print name), am One and the Same as
(please print name) as shown on the delivering Inn account. Please speciy account type.% such as Individual to Joint)
Please sign name BOTH ways.
XSignature: XSignature:
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 via 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 fug account transfer.
Transferor wilt 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 qualified retirement account. I have amended the applicable plan to designate the successor custodian.
Alternatively, if this TO Ameritrodo account is an Individual Retirement Account (IRA),
I have adopted an IRA plan so that it names the successor custodian. (Medallion Signature Guarantee - For TO Amentrade Use Oily)
41,(' Caere Signature: Dale:
XCo-Owner's Signature: Dale:
XCo-Owner's Signature- Dale:
X Date:
Coawners
7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONL
The undersign • organizatioint agr oes to serve as ssuucccceessssoorrcustodian for the account of the above-named individual, and as custodian. we agree to
accept the as s being trans red.
XRepresen alive Signature'. Date: (Medallion Signature Guarantee — For TO Ameriviale Use Only)
-7.5-209
Representative RIAtettlarnir_.---'
For TD Ameritrade Caring, use only
Please be advised t t TD eritrade Clearing, Inc. is an Approved 403(b)(7)
Vendor' andlor has into an Information Sharing Agreement with the Employer
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 FINFtA/SIPC. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. 2018 TD Ameritrade.
CONFIDENTIAL SONY_GM_OOltgaggS ortng
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