Check Request Form

Robinhood Financial, LLC (RHF)

Robinhood Securities, LLC (RHS)
Robinhood Money, LLC (RHY)

1. Account Holder Information

Account Holder Name (First, Middle Last) Account Email Address (optional)

Successor/Authorized Representative Name (First, Middle, Last)

2. Distribution Amount and Account Details

Robinhood Brokerage Account Number:_______________________; if not known, Account Holder’s SSN#_____________________

$ or ☐All available cash or ☐ Percentage of cash_______________________

Robinhood Spending Account Number:_______________________; if not known, Account Holder’s SSN#______________________

$ or ☐ All available cash or ☐ Percentage of cash_____________________

Please note that if you have multiple accounts, separate checks will be sent.
3. Payment Instructions

Pay To

Receiver’s Address

City State Zip Code

Check Memo (if applicable)

4. Signature
In the Section below, “Robinhood,” “us,” and “we” refer to Robinhood Markets, LLC and its affiliates, and their employees, agents, and representatives,
as the context may require; “you” and “account owner” refer to the owner indicated on the account form; for any account with an authorized person
(such as an executor or power of attorney), “you” and “account owner” or “executor name” or “power of attorney” refer to all owners and authorized
persons, collectively and individually.

By signing below, you:

Direct Robinhood Markets, LLC and its affiliates to act on all instructions given on this form and agree to indemnify us (jointly and severally, for
accounts with more than one authorized person) from and hold us harmless for any and all losses, liabilities, claims, and costs (including reasonable
attorneys’ fees) resulting from our effecting any transaction or acting upon such instructions.

Signature Date

Print Name

March 2023

20230313-2785760-8921538