EFTA01268366.pdf

Account Transfer Form
1D Ameritrade
Mall or Fax to:
PO Box 2760 • Omaha, NE 68103-2760
Fax: 866-468-6268 Receiving Firm DTC Clearing Number.
Please use the Direct Registration System (DRS) Transfer Form TOA 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 Ameritrade, 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.
*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 TO Amedtrade accounts, please use the Internal transfer form. Please note you cannot use this form
to 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 70% years or older at death, please attach a copy of your end of year statement fo enable us to calculate the required
minimum distribution for the account.
1. ACCOUNTLINFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE
DELIVERING ACCOUNT
Your TO Ameritrade Account
(The registration of the account being transferred should match your (As directed in Section I both registration and Tax (Os for the
TO Ameritrade account and account being transferred should match.)
TO Ammitrade account and the Tax ID for both the TO Ameritrade
account and account being transferred.)
Account Number (R ul : Account Number (R ul :
(Only one perform) (Dayon@ perform)
Account ReeistraUcoMat Account Registration/Mr
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
Social Seooty/Tax ID Number. Sochi Securlty/Tax ID Number:
Social Secunty/Tax ID Number: Sods Number.
(Secondary. If appacaele) (Secondary if appricable)
Contra/D•liutrIng Rim Name (Required):
Account Type (select one)
DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
— (Non IRA) OTraditional or Rollover IRA ContraiDetivertne Fm Address:
alcent O Roth IRA 345 PARK AVE 26TH FLOOR NY,NY10154
DTrust 08enenclary IRA COM e no cooked).
ElCorptBusIness O Beneficiary Roth IRA
OUGMAAJTMA O Qualified Plan (401k. 4038. PSP. etc.) Contra/Detwering Firm Emait
['Estate ❑SIMPLE IRA
O SEP IRA
Account Type (select one)
00ther.
- (Non IRA) El Traditional or Rollover IRA
aloint O Roth IRA
IDTrust O Beneficiary IRA
Corp/Business O Beneficiary Roth IRA
0
OUGMAIUTMA O Qualified Plan (401k, 4038, PSR etc.)
DEstale O SIMPLE IRA
O SEP IRA
DOlher
If the registrations do not match, you may either establish a now account online at www.tdomeritrado.com or you must supply additional
documentation and all delivering account owners must sign section 4. For unlike tillefrogistration transfer; please call the transfer department
at 888-723-8504, option 4 for additional requirements. 'Please note it there aro 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 AmonCredo Acct it 867-730320
A. BROKERAGE FIRM TRANSFER (Unless otherwise indicated, TO ATOtiffede will transfer in Fulg
OFull Transfer—To transfer entire account, check here and skip to Section 4.
aPartial Transfer—List specific security andfor cash amount below. If bonds are being transferred, please supply the CUSIP
Only whole shams can be 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
(Partial Transfers Only) (indicate trot whoa snares (Panial Transfers Only) (Indicate a ofwholesheres
or -ALL7 or *AU?)
1. 539439AG4 1,903,000 5.
2. AAPL 180,000 6.
3. APO 263,157 7.
G. 8
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 mall the Original form to complete the transfer request.
IRA Savings Accounts-Typically held with Bank/Creche Union.
OTotal Transfer (Transfer entire account) O Wire
(feestnay wry)
O Partial Transfer (Transfer part of account) Portion to transfer q Chock
Certificates of Deposit (CDs).
°Redeem my CD immediately.
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 21days 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
deadfine, maturity date, surrender charge period/window, etc., paperwork must be received by TO Amerifrade in good order three weeks
prior to the firm deadline to allow for proper processing times. To liquidate a CO held in a non-retirement account, contact the bank or
credit union at which the assets are being held.
Annuity Transfer
OTransfer my Annuity
OFUll ❑Partial OVVire
have an annuity policy that l wish to transfer. Please redeem and terminate on my behalf. (fees may apply)
I am aware of, and acknowledge, that lam responsible for any penalties that I may Incur from q Check
any early withdrawal.
Select only one: Liquidate annuity in full or partial liquidation. If partiali s selected, amount for partial must be included.
TD Ameritrade is not responsible for the timing or execution of iquidations processed by the delivering firm.
C. MUTUAL FUND COMPANY TRANSFER
Chock box for in-kind or Liquidation Transfer. Please list the Symbdor CUSIP for the Mutual Fund(s) you wish to move.
Unless otherwise Indicated, TD Ameritrade will transfer shares in-kind. This section pertains only to shares of Mutual Funds held direct y
with the fund company. for brokerage accounts containing Mutual Funds andfor 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 Handling Gains & Dividends
Fund Name or Symbol Mutual Fund Account if
(Indicate a of shares or ALL7 (Check one) (Check one tI In-lohd)
Din-Kind M Reinvest
°Liquidate • Cash
Olnaind °Reinvest
O Liquidate °Cash
OIn-Kind M Reinvest
°Liquidate OCash
if you are transferring more funds than will fit above, please include on attached list for the comp! le list of funds OWire
A statement MUST be included to ensure proper handfing and processing of your Mutual Fund transfer (foes may amp?)
• Unless otherwise indicated, I authorize the Transferor to liquidate any non-transferable proprietary money marker O Check
and mutual fund assets that are part of my account and to transfer the resulting credit bane.; to my account with
TO Ameritrade. If the fund is unable to be held by TD Amentrade, l (please initial here) authorize the Transferor
to liquidate and transfer as cash.
COMPIDENTIAL so194.119ficlittii2272
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TO Ameritrade Acct i 867-730320
Registration Difference
For unlike titled or type transfers, such as Individual to Jolt I authorize the transfer from account to aCO0unt.
Al parties on the delivering account must sign below. All TD Ameritrade parties must sign in section 6 for transfer authorization.
XGent Signature: Date:
XClient Signature: Date:
XClient Signature: Date:
5. ONE AND THESAME,LETITERPEAPPL(CABLE)..
If you we transferring an account, and the name(s) at TD Amoritrade do not exactly match but are still one and the same person, please complete
this scalar). This section should be utilized if your name has changed due to one or more of the folimidng: 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 driver's license,
passport, or government ID. (Please specity account types, such as Individual to Joint)
I (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.
)( Sirens.: XSignature:
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 incicated in the instructions above, please transfer, in-kind, all assets into my account with TD 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 credo balance, or If the credit balance In the account
Ls inSufficicmt to satisfy any outstanding fees. If certificates or other instruments in my account are in your physical possession, [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 sate, when and as directed by me. I understand that upon receiving a copy of this transfer instruction, rarebit account 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 crocR/debit cards and/or unused checks issued to me in connection with my account.
If this TD Nitwit:ado account' a qualified retirement account, I have amended the applicable plan to designate the successor custodian.
Alternatively, this TD Amedtra account is an Individual Retirement Account (IRA),
I have adopted an IRA plan so I t it names the successor custodian. (Medaition Signature Guarantee— For TO Amentrade Use Only)
XClient Signature: Date:
€7k5/201 r
XC-oOwners Signature: Date:
XCo-Owner's Signakart„...Z Date
XCo-Owes Signs Dale:
The undersign • organizationcifigrees to serve as successor custodian for the account of the above-named Individual. and as custodian. we agree to
acecpt the as els being trans erred.
XRoprosen five Signature: Date: (dedaion Signature Guarantee — Fee TD Arne:it/ado Use Oray)
2-25-2olf
Representative Print Ne
For TD Ameritrade C Laing, I (use only
Please be advised lh t M 'rade Clearing, Inc. is an Approved 403(b)(7)
Vendor anctior hes eriIwe into an Information Sharing Agreement with the Et netuyer
for the above-captioned 403(b)(7) account. The Employer/Agent Signature above
hereby authorizes TO Ameritrade Clearing. Inc. to accept this exchange.
Investment Products: Not FDIC Insured • No Bank Guarantee • May Lose Value
TD Ameritrade, Inc. and TD Arne:tirade Clearing, Inc., members FINRA/SIPC. TD Ameritrade is a trademark jointly owned by
TO Ameritrade IP Company, Inc. and The Toronto-Oomlnlon Bahr, CI 2018 TD Ameritrade.
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