EFTA01268448.pdf

I 1
ID Account Transfer Form
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 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 Amentrade Attn:
TD 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.
"It 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 Iwo TD 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 banklcredit 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 to enable us fo calculate the required
minimum distribution !or the account.
1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE
DELIVERING ACCOUNT
Your TD Ameritrade Account
(As directed in Section 1b oth registration and Tax IDs forthe
(The registration of the account being transferred should match your
TO Amended° account and account being transferred should match.)
TO Ameritrade account and the Tax ID for both the TO Amentrade
account and account being transferred.)
Account Number (Required): Account Number (Required):
one per form) 867-730320 (OrlYcane Penerrn) N4G-023804
Account RegIstratIonfrdle: Account Regalrellonnet
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
Social Securityfrax ID Number Social Secuty/Tax ID Number:
66-0799192 86.0799192
Salsa Securltyrrax ID Number Social Searkyffax ID Number.
(Secondenc /I applicable) (Secondary. If applicable)
ContraVellwering Firm Name (Rerwirectp.
Account Type (select one)
DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
01nOMOual El
- (Non IRA) Traditional or Rollover IRA CordrarDelbeting Firm Address:
aoint EI Roth IRA 345 PARK AVE 26TH FLOOR NY.N1110154
OTrust
q Beneficiary IRA CoMmeeinwing Fern Phone Number (Required):
212-4mii-o953
['Corp/Business q Beneficiary Roth IRA
O UGMANTMA q Qualified Plan (401k, 403B, PSI? etc.) ConIraiDeNweng Firm Email:
ElEstate O
SIMPLE IRA
q SEP IRA
Account Type (select one)
pother:
DIncfrvidual — (Non IRA) q Traditional or Rollover IRA
abint ID Roth IRA
EITRISt O Beneficiary IRA
o
Elonsissiness Beneficiary Roth IRA
Duckwurtm El Qualified Plan (401,403B, PSP etc.)
['Estate O SIMPLE IRA
CI
SEP IRA
['Other:
N the registrations do not match, you may either establish a new account online at www.tdamoritrade.cont or you must supply additional
documentation and all delivering account owners must sign section 4. For unlike titlelregistration transfer; pleas* call the transfer department
at 888.72343504, 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
11111II1II1IIII1III1II1 III III
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3. TRANSFER INSTRUCTIONS-PLEASE COMPLETE ONLY ONE OF THE FOLLOWING SECTIONS (A,B, OR C)
A. BROKERAGE FIRM TRANSFER (Unless otherwise Indicated, ID Ameritrade will transfer in Fut)
['Full Transfer—To transfer entire account, check here and skip to Section 4.
OParlial 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 shares cannot be transferred. Please contact the delivering firm regarding your options.
Asset Description (CUSIP or symbol) Quantity Asset Description (CUSIP or symbol) Quantity
(Persil Transfers Only) (Indicate I of male shores (Penal Transfers Only) (Indicate ll of whole shares
or ALL') or ALL!
1. 04621XAK4 2,000,000 5. 30162RAA9 3,000,000
2. 172967.25 3,000,000 6. 361860208 80,000
3. 172967341 79,000 7. A29866A85 2,000,000
4. 17453BAW1 1,000,000 8. 46625HHA1 5,780,000
B. BANK/CREDIT UNION & ANNUITY TRANSFER
Transfer cash only. Unless otherwise Indicated, all cash will bo transferred. Banks, Annuity, and Trust Companies require Original
Client Signature. Please mall the Original fonn to complete the transfer request.
IRA Savings Accounts—Typically held with Bank/Credit Union.
OTotal Transfer (Transfer entire account) q Wire
(Fees may apply)
OPartial Transfer (Transfer part of account) Portion to transfer $ O Check
Certificates of Deposit (CDs).
ORedeem my CD immediately.
I am aware of, and acknowledge, that I am 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 crier your CD to a new term.
Indicate in this section whether you wish to liquidate the CO 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 TO 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 Transfer
OTransfer my Annuity
OFull ❑Partial $ • O Wire
I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf. (lees mef WOO
l am aware of, and acknowledge, that lam 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
Chock box for in-kind or Liquidation Transfer. Please list the Symbol or CUSIP for the Mutual Funti(s) you wish to move.
Unless otherwise Indicated. TO Ameritrade will transfer shares in-kind. This section pertains oNy 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 Handling Gains & Dividends
Fund Name or Symbol Mutual Fund Account a
(indicate U of shares or ALL') (Check one) (Check me ilb.kind)
OIMOnd ■ Reinvest
['Liquidate ■ RCaeshi nvest
II n-lCind
G Liquidate Cash
Oln.KInd OReinvest
°Liquidate O Cash
II you are transferring more funds than will fit above, please include an attached list for the corneas e list of funds O 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 iquidate any non4ransferable proprietary money market O Check
and mutual fund assets that am part of my account and to transfer the resulting credit balance to my account with
TO Ameritrade. If the fund is unable to be held by TD Ameribade, I (please initial here) authorize The Transferor
to liquidate and transfer as cash.
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TO Ameritrade Accl a 867730320
4. REGISTRATION DIFFERENCES AND DELIVERY ACCOUNT OWNERS' SIGNATURES (IF APPLICABLE)
Registration Difference
For unlice titled or type transfers, such as Individual toJoint. I authorize the transfer from amount to account.
All 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:
l(P Client Signature: Date:
5. ONE AND THE SAME LETTER (IF APPLICABLE)
If you are 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 more of the following: Marriage, Divorce, Name Spelling Error,
or any type of Name Change including Jr, Sr., 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 firm account. (Please Specify account types, such as Indaficlual to Joint)
Please sign name BOTH ways.
XSignature: 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 indicated in the instructions above. please transfer. inikind, all 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 be transferred wthin 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
transferabfe. 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. II 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 wailers, 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 lull account transfer.
Transferor will freeze my account and cancel al open orders. I also understand that no new orders maylvalil 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 TO Ameritrade account is a qualified retirement account, I have amended the applicable plan to designate the successor custodian.
Alternatively, if this TD Ameritrade account is an Individual Retirement Account (IRA).
I have adopted an IRA plan so that it names the successor custodian. (Medallion Signature Guarantee - For TD Ameritrade Use Only)
XClient Signature: Date:
XCo-Owners Signature: Date:
XCo-Owner's Signature: Date:
XCo-Owner's Signature: Dale:
7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONLY)
The undVsigned organizatior agrees to serve as successor custodian for the account of the above-named individual, and as custodian, wo agree to
accept yie assets being tranSierred.
XRe7ntative Signe Date: (Medallion Signature Guarantee — For TO Ameritrade Use Only)
V25/20/ cf
Representative Printerttiarir
For TO Ameritrade CI ring, . use only
Please be advised the TD -'trade Clearing. Inc. is an 'Approved 4O3(b)(7)
Vendor" and/or has eel- into an Information Sharing Agreement with the Employer
for the abovedaptioned 4O3(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 TO Arneritrade Clearing, Inc., members FINRNSIPC. TD Ameritrade is a trademark jointly owned by
TD Amoritrade IP Company, Inc. and The Toronto-Dominion Bank. 0 2018 TO Ameritrade.
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