Reset Form

Beneficiary Individual
Retirement Account Return Options:

(IRA) Application
Electronically via Message Center:
Log in and go to Client Services >
Message Center to attach the file
Regular Mail:
PO Box 2760, Omaha, NE 68103-2760
Overnight Mail:
200 South 108th Avenue
Omaha, NE 68154-2631
Questions? Call a New Accounts representative at 800-276-8746.
Please visit us at www.tdameritrade.com for more information on opening an account. Fax: 866-468-6268

Work ID: 19912536

1 Type of Beneficiary IRA (KMM134727500V8042L0KM
Please select C Traditional Beneficiary IRA
✔

only one.
C Roth Beneficiary IRA
C Minor Traditional Beneficiary IRA*
C Minor Roth Beneficiary IRA*
Please complete for Minor Beneficiary IRAs:
This Minor Beneficiary IRA will be opened pursuant to state UTMA/UGMA statutes. Please indicate the age of termination of
custodianship and the state law under which this Minor Beneficiary IRA account will be governed:
(State)* Age of Termination* . (state of UTMA/UGMA establishment must be provided)
*If you do not indicate the age of termination, the account will be set up with the state’s default age of termination according
to the applicable state law. Certain states permit the age of termination to be extended beyond the default statutory age of
termination (usually up to 21 or 25 years of age). This election may be exercised only in those states that specifically provide
for it, and only insofar as the extension complies with any applicable requirements.
I understand that electing to extend the age of termination to age 25 may cause me to lose my annual exclusion from
federal gift tax and that I should consult with an attorney or tax advisor before making this election.

*TDA1586* Page 1 of 15 TDA 1586 A 11/22

 2A Beneficiary Options - Death before January 1, 2020** Complete Section 2B if the date
of death is 2020 or later.

**Complete only one section: 2A OR 2B. Please consult IRS Publication 590-B, your financial advisor, or your tax advisor to
select the best option.

A copy of the death certificate is required.

A Beneficiary IRA must be established unless the spousal option to treat the IRA as your own is chosen below.
If the decedent’s IRA is held at another firm, a Beneficiary IRA must be established at the other firm prior to transferring to TD Ameritrade.
You will also need to complete a TD Ameritrade Transfer Form.

Death before January 1, 2020

Beneficiary is: If the owner had NOT begun RMD2 If the owner had begun RMD2

Please C Spouse 1. Transfer your spouse's IRA assets into 1. Transfer your spouse's IRA assets into
select only (Please also select an IRA and treat it as your own an IRA and treat it as your own
one choice one of the following): 2. Transfer your spouse's IRA assets to 2. Transfer your spouse's IRA assets to a
and one a beneficiary IRA and elect either Life beneficiary IRA and elect either Life Expectancy
sub-choice
C Life Expectancy
Expectancy or Five Year Rule 1
or Five Year Rule
(where C Five Year Rule 1

applicable). C Treat as own (Enter account number to transfer to):

CN
 on-Spouse Natural Person
(Please also select
one of the following):
C Life Expectancy
The entire account balance may be required
to be distributed by the end of the 5th year
following the owner's death
OR
Elect in writing prior to 12/31 of the year
following the year in which the account owner
passed away to take distributions based on your
life expectancy or the owner's life expectancy

C Five Year Rule 1 Elect in writing prior to 12/31 of the year

following the year in which the account owner
passed away to take distributions based on
your life expectancy

C * *Trust (Qualified)
(Please also select
one of the following):
C Life Expectancy
The entire account balance may be required
to be distributed by the end of the 5th year
following the owner's death
OR
The beneficiaries of a qualified trust may use the
oldest beneficiary's date of birth to calculate Life
Expectancy Payments. Consult IRS Publication
590 and consult your tax advisor.

C Five Year Rule 1 The beneficiaries of a qualified trust may use the
oldest beneficiary's date of birth to calculate Life
Expectancy Payments. Consult IRS Publication
590 and consult your tax advisor.

C E state, Foundation, The entire account balance may be required IRS minimum required distributions are based on
**Trust (Non-Qualified) to be distributed by the end of the 5th year the remaining single life expectancy of the IRA
following the owner's death owner as if they were still alive

C 2 nd Generation Continue to use same payout method as first Continue to use same payout method as first
Beneficiary IRAs3 generation beneficiary generation beneficiary

**TD Ameritrade does not advise on whether a trust is qualified or not, please consult with a tax or legal advisor.
1 -Five Year Rule: the entire account balance of the Inherited IRA must be distributed by the end of the 5th year following the original
account owner's death.
2 -Begun RMD" means that the deceased owner reached their required beginning date (RBD) for required minimum distributions
(RMD's) REGARDLESS of whether they actually took any withdrawals. If the original IRA owner was born before July 1, 1949, they
reached their RBD on April 1 of the year following their 70 1/2 birthday. If the original IRA owner was born on or after July 1, 1949, their
RBD is April 1 of the year following the year the owner turns(ed) 72.
3 -These options are applicable only if BOTH the original account owner AND the 1st Generation Beneficiary died before 2020. If the 1st
Generation Beneficiary died on or after January 1, 2020, please complete section 2B below.

Page 2 of 15 TDA 1586 A 11/22

 2B Beneficiary Options - Death on or after January 1, 2020** Complete Section 2A if the date
of death is before 2020.

**Complete only one section: 2A OR 2B. Please consult the IRS website, your financial advisor, or your tax advisor to select the
best option.
Work ID: 19912536
A copy of the death certificate is required. (KMM134727500V8042L0KM
A Beneficiary IRA must be established unless the spousal option to treat the IRA as your own is chosen below.
If the decedent’s IRA is held at another firm, a Beneficiary IRA must be established at the other firm prior to transferring to
TD Ameritrade. You will also need to complete a TD Ameritrade Transfer Form.

Death on or after January 1, 2020

Please Beneficiary is: If the owner had NOT begun RMD3 If the owner had begun RMD3
select only
one choice C Spouse 1. Transfer your spouse's IRA assets into 1. Transfer your spouse's IRA assets into an
and one (Please also select one of the an IRA and treat it as your own IRA and treat it as your own
sub-choice following): 2. Transfer your spouse's IRA assets to 2. Transfer your spouse's IRA assets to
(where C Life Expectancy a beneficiary IRA and elect either Life a beneficiary IRA and elect either Life
applicable). Expectancy or Ten Year Rule Expectancy or Ten Year Rule
C Ten Year Rule 1

C Treat as own (Enter account number to transfer to):

C Non-Spouse Natural Person Ten Year Rule1 Ten Year Rule1&2
(See below for exceptions
for "eligible designated
beneficiaries"):

C *Eligible Designated Beneficiaries

✔ Life expectancy payments can occur Life expectancy payments can occur
(Please also select one of the OR OR
following):
Ten Year Rule1 Ten Year Rule1
C Life Expectancy exception met
C Ten Year Rule 1

C **Trust (Qualified) Ten Year Rule1 Ten Year Rule1

C Estate, Foundation, The entire account balance may be IRS minimum required distributions are
**Trust (Non-Qualified) required to be distributed by the end of based on the remaining life expectancy of
the 5th year following the owner's death the IRA owner as if they were still alive

C 2nd Generation Beneficiary IRAs Special Rules4 Special Rules4

*Upon death of the account owner, distributions to individual beneficiaries must generally be completed within 10 years. There
are exceptions for spouses, certain disabled or chronically ill individuals, and individuals not more than 10 years younger than the
account owner. If a minor child of the original IRA owner is named beneficiary, they also have a special exception to the 10 year
rule, but only until they reach age 21. To determine your eligibility for an exception, please review IRS Publication 590-B or speak
with your tax professional.
**TD Ameritrade does not advise on whether a trust is qualified or not, please consult with a tax or legal advisor.
1 -Ten Year Rule: The entire account balance must be withdrawn by the end of the 10th year following the original account
owner's death.
2 -Important Pending IRS Guidance for beneficiaries of IRA owners who died in 2020 or later:
While the IRS has yet to publish final regulations, currently proposed regulations would require certain beneficiaries to take
annual required minimum distributions from an Inherited IRA, while also being required to deplete the entire Inherited IRA
within 10 years following the original IRA owner’s year of death. This proposed rule would generally only impact beneficiaries of
deceased IRA owners who are NOT considered “Eligible Designated Beneficiaries” in situations where a Traditional IRA owner
passed away in 2020 or later, AND on/after the owner's required beginning date. Please consult with your tax advisor, if you have
questions about whether you should take a required distribution from your Inherited IRA before December 31, 2022 and annually
thereafter.
3 -"Begun RMD" means that the deceased owner reached their required beginning date (RBD) for required minimum distributions
(RMD's) REGARDLESS of whether they actually took any withdrawals. If the original IRA owner was born before July 1, 1949,
they reached their RBD on April 1 of the year following their 70 1/2 birthday. If the original IRA owner was born on or after July 1,
1949, their RBD is April 1 of the year following the year the owner turns(ed) 72.
4 -When the 1st Generation beneficiary died in 2020 or later, payment options may be dependent upon the choice made by the
1st Generation Beneficiary. While the Ten Year Rule will apply to the 2nd Generation Beneficiary, the actual 10 year period may
begin with death of the original account owner or the death of the 1st Generation Beneficiary. Annual life expectancy payments
are also often required during the 10 year period (or during the remaining period). Given the complexity, please consult your tax
advisor to determine your options and withdrawal requirements.

Page 3 of 15 TDA 1586 A 11/22

3 Decedent Information Work ID: 19912536
Name of Decedent: (KMM134727500V8042L0KM
Elda Garza
U.S. Social Security Number: Date of Birth: Date of Death:

0 4 0 8 1 9 4 0 1 1 2 0 2 0 2 2
Account Number of Decedent's IRA (if applicable):

- - - - - 5 4 1 2
To calculate your Life Expectancy payments or RMDs, please refer to www.tdameritrade.com/beneficiaryrmd
An IRA beneficiary has until December 31 of the year following the IRA owner’s death to determine the appropriate beneficiary election
and take possession of the funds. IRA beneficiary options depend on the relationship to the deceased and if the deceased had begun
Required Minimum Distributions (RMDs). If the decedent had begun RMDs or was required to begin them but didn’t because of death, the
beneficiary must start or continue those distributions. Please consult a qualified tax advisor or IRS Publication 590-B should you have any
questions or concerns.
Had the decedent begun, or was the decedent required to begin RMDs? C Yes C No
✔

An IRA owner is required to begin RMDs on April 1 of the year following the calendar year in which the owner reached RMD Age. If the
IRA owner was born on or before June 30, 1949, RMD Age is 70 1/2. If the IRA owner was born after June 30, 1949, RMD Age is 72.

4 Funding your Account

C A transfer from the decedent's TD Ameritrade account listed above.
✔

CA direct transfer from another firm. Please submit an External Transfer Form and a copy of your most recent statement.
Firm name:

5 Account Owner Information

Name Prefix (optional): C Mr. C Mrs. C Ms. C Dr. C Rev.
✔

First Name: Middle Name: Last Name:

Sandra Olivia RIOS MENDOZA

Name of Entity (if applicable): Tax ID Number: RIMS540614LG1

Date of Birth: Number of Dependents: U.S. Social Security Number: Mother’s Maiden Name:

0 6 1 4 1 9 5 4 0 0 Mendoza Guardado
Home Address (no PO box or mail drop):

Lorenzo Rodriguez 77 - Col. San José Insurgentes

City: State: Zip Code: Country:

Del. Benito Juarez CDMX 0 3 9 0 0 Mexico

Mailing Address (if different from above):

City: State: Zip Code: Country:

Primary Phone number: Secondary Phone number:

C Check here if this is not a U.S. phone number
✔
C Check here if this is not a U.S. phone number
✔

5 2 - 5 5 - 5 5 9 8 2 9 2 8 5 2 - 5 5 - 1 3 2 0 6 6 3 4
Fax number: Email (required for electronic delivery of your account statement
and trade confirmations):
drasandrarios@gmail.com

Page 4 of 15 TDA 1586 A 11/22

 Work ID: 19912536
Section 5, Account Owner Information continued
(KMM134727500V8042L0KM
Please specify if you are:

C Employed C Unemployed C Retired

✔
C Homemaker C Student C Self-Employed

Employer Name (if Self-Employed, provide the name of your business):

Please choose from the list provided on page 15 the occupation code and industry of occupation code that most accurately describes your situation.
Occupation Code: Industry of Occupation Code:

Employer Address:

City: State: Zip Code: Country:

Mexico
Annual Income:
C $0-$24,999 C $25,000-$49,999
✔
C $50,000-$99,999 C $100,000-$249,999 C $250,000+

Approximate Net Worth: (not including primary residence)

C $0-$14,999 C $15,000-$49,999 C $50,000-$99,999

✔
C $100,000-$249,999
C $250,000-$499,999 C $500,000-$999,999 C $1,000,000-$1,999,999 C $2,000,000+

Approximate Liquid Net Worth: (cash, stocks, etc.)

C $0-$14,999 C $15,000-$49,999
✔
C $50,000-$99,999 C $100,000-$249,999
C $250,000-$499,999 C $500,000-$999,999 C $1,000,000-$1,999,999 C $2,000,000+

What best describes the initial source of funds for this account?

C Employment/Wages C Retirement Funds C Gift C Savings

C Inheritance/Trust
✔
C Investments C Unemployment/Disability C Legal Settlement
C Lottery/Gaming C Spousal/Parental Support C Other (describe source of funds):

What best describes the ongoing source of funds for this account?

C Employment/Wages C Retirement Funds

✔
C Gift C Savings
C Inheritance/Trust C Investments C Unemployment/Disability C Legal Settlement
C Lottery/Gaming C Spousal/Parental Support C Other (describe source of funds):

C Check here if you are NOT a U.S. citizen.

✔ Country of Citizenship:
Mexico
Country of Dual/Secondary Citizenship (if applicable): Country of Birth:

Mexico

Non-U.S. citizens*: Do you hold a current U.S. immigration visa? C Yes C No

✔

Specify visa type: Visa Number: Expiration:

B1/B2 3 4 5 2 1 2 4 6 0 8 0 3 2 0 2 7
*Nonresident aliens must submit a W-8BEN form, a copy of a current passport, and a copy of a bank or brokerage statement.
If a U.S. address is listed, then attach a Letter of Explanation for U.S. Mailing Address/Phone Number for Form W-8. This
form can be found on the TD Ameritrade Forms Library: https://www.tdameritrade.com/form-library.

Page 5 of 15 TDA 1586 A 11/22

Section 5, Account Owner Information continued
Work ID: 19912536
(KMM134727500V8042L0KM
C Check here if you, your spouse, any member of your immediate families living in the same household, including parents, in-laws, siblings,
and dependents is a member of the board of directors, 10% shareholder, or policy-making officer of a publicly traded company. Specify
the company name, ticker symbol, address, city and state:

C Check here if you, your spouse, any member of your immediate families living in the same household, including parents, in-laws, siblings,
and dependents is licensed, employed by, or associated with, a broker-dealer firm, a financial services regulator, securities exchange,
or member of a securities exchange. If checked, please specify entity below. If this entity requires its approval for you to open this
account, please provide a copy of the required authorization letter (with this application):

6 Custodian Information (For Minor and Entity Beneficiary IRAs Only)

Relationship to Minor: C Parent C Legal Guardian** C Other:

** I f you are the Legal Guardian of the Minor, you must submit legal documentation with this application showing your appointment
as guardian.

Name Prefix (optional): C Mr. C Mrs. C Ms. C Dr. C Rev.

First Name: Middle Name: Last Name:

Date of Birth: Number of Dependents U.S. Social Security Number:

Home Address (if different from minor, no PO box or mail drop):

City: State: Zip Code: Country:

Mailing Address (if different than above):

City: State: Zip Code: Country:

Primary Phone Number: Secondary Phone Number:

C Check here if this is not a U.S. phone number C Check here if this is not a U.S. phone number

Fax Number: Email (required for electronic delivery of your account statement and
trade confirmations):

Please specify if you are:

C Employed C Unemployed C Retired C Homemaker C Student C Self-Employed

Employer Name (If Self-Employed, provide the name of your business):

Please choose from the list provided on page 15 the occupation code and industry of occupation code that most accurately describes your situation.
Occupation Code: Industry of Occupation Code:

Employer Address:

City: State: Zip Code: Country:

Page 6 of 15 TDA 1586 A 11/22

 Work ID: 19912536
Section 6, Custodian Information continued
(KMM134727500V8042L0KM
Annual Income:
C $0-$24,999 C $25,000-$49,999 C $50,000-$99,999 C $100,000-$249,999 C $250,000+

Approximate Net Worth: (not including primary residence)

C $0-$14,999 C $15,000-$49,999 C $50,000-$99,999 C $100,000-$249,999

C $250,000-$499,999 C $500,000-$999,999 C $1,000,000-$1,999,999 C $2,000,000+

Approximate Liquid Net Worth: (cash, stocks, etc.)

C $0-$14,999 C $15,000-$49,999 C $50,000-$99,999 C $100,000-$249,999

C $250,000-$499,999 C $500,000-$999,999 C $1,000,000-$1,999,999 C $2,000,000+

What best describes the initial source of funds for this account?

C Employment/Wages C Retirement Funds C Gift C Savings

C Inheritance/Trust C Investments C Unemployment/Disability C Legal Settlement
C Lottery/Gaming C Spousal/Parental Support C Other (describe source of funds):

What best describes the ongoing source of funds for this account?

C Employment/Wages C Retirement Funds C Gift C Savings

C Inheritance/Trust C Investments C Unemployment/Disability C Legal Settlement
C Lottery/Gaming C Spousal/Parental Support C Other (describe source of funds):

C Check here if you are NOT a U.S. citizen. Country of Citizenship:

Country of Dual/Secondary Citizenship (if applicable): Country of Birth:

Non-U.S. citizens*: Do you hold a current U.S. immigration visa? C Yes C No

Specify visa type: Visa Number: Expiration:

*Nonresident aliens must submit a W-8BEN form, a copy of a current passport, and a copy of a bank or brokerage statement.
If a U.S. address is listed, then attach a Letter of Explanation for U.S. Mailing Address/Phone Number for Form W-8. This
form can be found on the TD Ameritrade Forms Library: https://www.tdameritrade.com/form-library.

C Check here if you, your spouse, any member of your immediate families living in the same household, including parents, in-laws,
siblings, and dependents is a member of the board of directors, 10% shareholder, or policy-making officer of a publicly traded
company. Specify the company name, ticker symbol, address, city and state:

C Check here if you, your spouse, any member of your immediate families living in the same household, including parents, in-laws,
siblings, and dependents is licensed, employed by, or associated with, a broker-dealer firm, a financial services regulator, securities
exchange, or member of a securities exchange. If checked, please specify entity below. If this entity requires its approval for you to
open this account, please provide a copy of the required authorization letter (with this application):

Page 7 of 15 TDA 1586 A 11/22

 Work ID: 19912536
7 For
Investment Objectives
Select the degree of risk you are willing to take with the assets in this account:
(KMM134727500V8042L0KM
definitions
regarding
C Conservative C✔ Moderate C Aggressive C Speculative
investment
Select the primary investment objective for this account:
objectives,
please C Conservation C✔ Moderate C Moderate Growth C Growth C Aggressive Growth
see page
14 of the Select the secondary investment objectives for this account: (Check at least one or all that apply)
application. C Conservation C✔ Moderate C Moderate Growth C Growth C Aggressive Growth C None
Select the liquidity needs for this account: (Check only one that applies)
C Within 3 months C 4 - 6 months
✔
C 7 - 9 months C 10 - 12 months C More than 1 year
Select the investment time horizon for this account:
C Less than 1 year C 1 - 3 years C 4 - 6 years C 7 -9 years C 10-12 years C 13 years or more
✔

8 Margin Privileges
All qualified accounts are opened as margin eligible accounts unless you decline margin privileges in this section.
To learn more about the use of margin in a retirement account and the associated risks involved, read the Margin Account Handbook and
the Margin Disclosure Document located within the forms library: https://www.tdameritrade.com/form-library.
C Check this box if you want to decline margin privileges. If you do not check the box, your account will be opened as a margin
account if it qualifies. By submitting this Account Application without checking the box to decline margin privileges, you represent
that you understand and agree that margin features are subject to the terms and conditions of the Client Agreement, which you have
agreed to by submitting this Account Application. You understand and acknowledge that securities securing loans from
TD Ameritrade may be lent to TD Ameritrade and lent by TD Ameritrade to others. You also acknowledge that if you trade "on
margin" you are borrowing money from TD Ameritrade and that you understand the requirements and risks associated with margin as
summarized in the Margin Account Handbook and Margin Disclosure Document.

9 Cash Sweep Vehicle

My uninvested cash will be deposited in the TD Ameritrade FDIC Insured Deposit Account (IDA) as a part of the Cash Balance
programs. See the Client Agreement for a complete description of the Cash Sweep program. Other sweep choices are available for
clients with household values greater than $500,000 and cash balances of more than $100,000. I understand my account statement will
include sweep transactions involving bank deposits or money market funds in lieu of immediate trade confirmations.

10 Trade Confirmations and Account Statements

I understand that I will receive monthly account statements and trade confirmations electronically, unless I make a selection below. If I do
not provide a valid email address, I will receive a quarterly paper statement or a monthly paper statement. Certain types of accounts or
activity (such as options trading) require a monthly statement, either electronically or via U.S. mail. I will be responsible for any fees that
apply. Accounts with a total liquidation value of $10,000 or an average of five trades per month over a three-month period are eligible to
receive free paper statement and confirmation delivery.
If I elect to receive either electronic statements or electronic confirmations, I will receive shareholder information electronically
when available.

Account Statement:

C Electronic Monthly
✔
C Paper Monthly ($2 fee may apply each month) C Paper Quarterly ($2 fee may apply each quarter)
Trade Confirmation:
C Electronic
✔
C Paper

C Unless
✔
 I have checked this box, TD Ameritrade is required to share my name and address with the companies I invest in through your
services so they may contact me directly about my investment. If I direct you not to share, you will receive the information on my
behalf and will forward it to me. Shareholder information includes proxy material, prospectuses, annual reports, and other corporate
communications. In some cases, regulations may require sharing information with the companies in which I have invested despite
this election.

Page 8 of 15 TDA 1586 A 11/22

11 Designation of Beneficiary
You must designate at least one primary beneficiary. If you select coprimary beneficiaries, indicate the percentage of your account you
are designating to each. If a primary beneficiary dies prior to the Account Owner, the remaining portion shall be payable proportionately
to any surviving primary beneficiaries. You may also designate contingent beneficiaries in the event that your primary beneficiaries
do not outlive you. In the event that TD Ameritrade is unable to identify the beneficiaries from the documents provided, the Custodial
Agreement will control.
State trust law may vary as to the legality of IRA beneficiaries naming subsequent beneficiaries. Please consult a qualified tax advisor or
attorney regarding the applicable trust law for your state of residence. If you name a trust, entity or estate as your beneficiary, additional
documentation and certifications will be required to request distribution beyond the named trust, entity, or estate.
If this is a Minor Beneficiary IRA, notwithstanding Section 8.07 of the Custodial Agreement,* in the event of the death of the Minor
prior to the age of termination, the Account will be distributed to the Minor's estate.
*Individual Retirement Custodial Account Agreement
If you are married and live in a state with community property statutes and do not designate your spouse as the sole beneficiary, you
represent and warrant that your spouse has consented to such designation.
Percentages must total 100% for all primary beneficiaries and 100% for all contingent beneficiaries. If percentages are not indicated,
they will be deemed equal shares. If percentages indicate an attempt to distribute as equal shares, but do not add up to 100%, the first
named beneficiary will receive a slightly higher percentage (for instance, if you indicate 33%, 33.3%, or 33.33% for all three beneficiaries,
TD Ameritrade will round the first beneficiary’s percentage up to 33.34% and the other two beneficiaries will each receive 33.33% ).
Further, when securities cannot be evenly distributed, or there are unclaimed securities, the Account Owner requests that such securities
be liquidated and any proceeds from the liquidation be distributed in the percentages requested to the named Beneficiaries.
Subject to the condition(s) set forth in this section, I designate the following as the beneficiary(ies) of my IRA:
All Beneficiary information is required. Please complete all fields.

Designate your Primary Beneficiary(ies)

Primary Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.)
✔
C Per Stirpes
Beneficiary's Name: SSN/TIN: SAPJ520906BWA
100 Jorge Arturo Santana Portillo OR

Relationship: Date of Birth/UA Date/Date of Formation:

husband 0 9 0 6 1 9 5 2

Primary Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Primary Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Primary Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Primary Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Total: 0 100 % Total must add up to 100%

Page 9 of 15 TDA 1586 A 11/22
Section 11, Designation of Beneficiary continued

Designate your Contingent Beneficiary(ies)

Contingent Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Contingent Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Contingent Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Contingent Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Contingent Share %: Beneficiary is: C An individual C A trust C Other (custodianship, charity, corporation, etc.) C Per Stirpes
Beneficiary's Name: SSN/TIN:
OR

Relationship: Date of Birth/UA Date/Date of Formation:

Total: 0 % Total must add up to 100%

Page 10 of 15 TDA 1586 A 11/22

12 Offer Code (Optional)

By entering an offer code in this field, you represent and warrant that you have read and agree to the applicable Offer Terms & Conditions.
If the offer code you enter is invalid, no offer will be applied to your account. If you have questions regarding offer codes, please call
1-800-454-9272.

Offer Code: Work ID: 19912536

(KMM134727500V8042L0KM
13 Trusted Contact (Optional)
By completing this section, you authorize TD Ameritrade to contact the person(s) named below for the following reasons: if there are
questions or concerns about my whereabouts or health status; if TD Ameritrade suspects that I may be a victim of fraud or financial
exploitation; if TD Ameritrade suspects that I might no longer be able to handle my financial affairs; to confirm the identity of any legal
guardian, executor, trustee, authorized trader, or holder of a power of attorney; or if TD Ameritrade has any other concerns or is unable
to contact me about my account(s) held at TD Ameritrade. Please review the Client Agreement for the full terms and conditions
regarding how TD Ameritrade uses this information.
NOTE: Your Trusted Contact must be someone other than an account owner. You may provide more than two Trusted Contact
Persons by completing and signing additional Authorization Forms.

First Name: Middle Initial: Last Name:

Relationship:

Phone number: Email:

Mailing Address:

City: State: Zip Code: Country:

First Name: Middle Initial: Last Name:

Relationship:

Phone number: Email:

Mailing Address:

City: State: Zip Code: Country:

Page 11 of 15 TDA 1586 A 11/22

14 Options Account
Due to the risks involved in options, we are required to obtain the following information. The income information above must be completed
to be considered for options.
C Check this box to decline options privileges.
Options Objectives (Only required if applying for options.)
For Types of Transactions: (Check all that apply)
definitions
regarding C Stocks C Bonds C Options
options
objectives, What Are Your Options Investment Objectives: (Check all that apply)
please
Growth C Speculation C Income C Conservation of Capital
see page C
14 of the
application. What Type of Activity Do You Plan to Conduct in Your Options Account?

C Tier 1 - Covered C Tier 2 - Standard Cash C Tier 2 - Standard Margin

Write covered calls Purchase options Create spreads
Write cash-secured puts + Tier 1 - Covered Write covered puts
+ Tier 2 - Standard Cash

MARGIN REQUIRED
Tier 2 - Standard Margin requires a margin account. If you select
this tier, you will automatically be applying for options and margin
approval regardless of whether you checked the box to decline
margin privileges in Section 8.

Account Owner Options Objectives (Only required if applying for options.)

For Minor Years of Investment Experience:
Beneficiary
IRAs, C Less than 1 year C 1-2 years C 3-5 years C 6-9 years C 10+ years
please use
Custodian
Investment Knowledge or Education:
information
to complete C Limited C Good C Extensive C Professional Trader
this section.

15 Individual Retirement Account Agreement

I have received and read the Client Agreement that will govern my account. I understand that the Client Agreement contains predispute
arbitration clauses. I agree to be bound by this Client Agreement as amended from time to time. I hereby request an IRA to be opened in
the name set forth below.
I am establishing an Individual Retirement Account (IRA) Plan under the TD Ameritrade Clearing, Inc. (Custodian) Prototype Individual
Retirement Custodial Account Agreement for the account type specified in Section 1, above, which is incorporated herein by reference.
I understand that the account is subject to rules and regulations of the U.S. Internal Revenue Service, and that the funding of the account
may have significant tax and financial consequences. I accept responsibility for the information contained in this application and affirm
such information is true and correct. I agree to indemnify and hold harmless TD Ameritrade Clearing, Inc. from any and all liability and
claims for damages resulting from any action taken pursuant to this Agreement.
I designate TD Ameritrade Clearing, Inc. as Custodian and make the following declaration: Having received and read the Custodial
Agreement, I understand that the Custodian will invest and reinvest my account assets only with written direction from me or from
a properly appointed investment manager. This document constitutes my authority to execute all trades for my IRA. Confirmations
and statements will verify such instructions. All securities, dividends, and proceeds will be held at TD Ameritrade Clearing, Inc. unless
otherwise instructed.
For Beneficiary IRAs: I direct TD Ameritrade Clearing, Inc. to maintain my Beneficiary IRA.
For Minor Beneficiary IRAs: I understand that this account will be opened pursuant to state UTMA/UGMA statutes. I agree that the
owner of the assets in this account is the minor according to applicable state UTMA/UGMA statutes and that I will only use the assets for
the benefit of the minor. Upon the minor attaining age of termination as indicated above, I instruct TD Ameritrade, without further notice
or instruction, to restrict my access to the account and register the account in the name of the minor. I further agree to provide
TD Ameritrade, upon request, with the minor’s current address, phone number and other contact information. Notwithstanding Section
8.07 of the Custodial Agreement,* in the event of the death of the Minor prior to the age of termination, the Account will be
distributed to the Minor's estate.

Page 12 of 15 TDA 1586 A 11/22

Section 15, Individual Retirement Account Agreement continued Work ID: 19912536
(KMM134727500V8042L0KM
*Individual Retirement Custodial Account Agreement
This application provides for the deposit of funds or securities into the account. I understand that the funding of this account is
subject to the rules and regulations of the U.S. Internal Revenue Service and that my failure to abide by such rules and regulations may
have important and possibly irrevocable tax and financial consequences. I attest that the funding information provided is true and correct,
authorize TD Ameritrade Clearing, Inc. to deposit the funds or securities according to the funding instructions, and assume full responsibility
for this funding transaction. I release and agree to indemnify and hold harmless TD Ameritrade Clearing, Inc. and its affiliates from any and
all liability and claims for damages from any adverse consequences that may result.
I understand that nondeposit investments purchased through TD Ameritrade are not insured by the Federal Deposit Insurance Corporation
(FDIC), are not obligations of or guaranteed by any financial institution, and are subject to investment risk and loss that may exceed the
principal invested. Unless I have declined the margin feature, I acknowledge that securities securing loans from TD Ameritrade may be
lent to TD Ameritrade and lent by TD Ameritrade to others. I also acknowledge that if I trade “on margin,” I am borrowing money from
TD Ameritrade and that I understand the requirements and risks associated with margin as summarized in the Margin Handbook and Margin
Disclosure Document.
Important information about procedures for opening a new account:
To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions
to obtain, verify, and record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will
allow us to identify you. We may also utilize a third-party information provider for verification purposes and/or ask for a copy of your
driver’s license or other identifying documents.
If you wish to trade options in your account, complete the Options Account section.
If an options account has been requested, I agree to abide by the rules of the listed options exchanges and the Options Clearing Corporation
and will not violate current position and exercise limits. I have received and read the Client Agreement that will govern my account, and agree to
be bound by it as currently in effect and as amended from time to time. I am aware of the risks involved in options trading and represent that I
am financially able to bear such risks and withstand options-trading losses.

If I am a U.S. person for tax purposes:

Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number; (2) I
am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the
Internal Revenue Services (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends,
or (c) the IRS has notified me that I am no longer subject to backup withholding; (3) I am a U.S. citizen or other U.S. person; and
(4) the FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
If I have been notified by the IRS that I am subject to backup withholding because I have failed to report all interest and
dividends on my tax return, I must cross out (2) in this certification.
If I am not a U.S. Person for tax purposes:
I am submitting the applicable Form W-8 with this form to certify my foreign status.

The IRS does not require your consent The Client Agreement applicable to this brokerage account contains a predispute
to any provision of this document arbitration clause. By signing this agreement, the parties agree to be bound by the terms
other than the certifications required of the Client Agreement, including the arbitration agreement located in Section 12 of the
to avoid backup withholding. Client Agreement on page 8.

Account Owner's/Custodian's Signature: Date:

Sign Here X
0 5 0 5 2 0 2 3
Original
signatures
are required;
electronic
signatures
and/or
signature
fonts are not
authorized.

Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value

TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members FINRA/SIPC, are subsidiaries of The Charles Schwab Corporation.
TD Ameritrade is a trademark jointly owned by TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank.
©2022 Charles Schwab & Co. Inc. All rights reserved.

Page 13 of 15 TDA 1586 A 11/22

Investment Objectives Definitions
Conservation: Reflects your desire to seek very low risk and minimize potential loss of principal. You may seek income from your
investments while understanding that returns may not keep pace with inflation. You may also intend to invest over a short period of time.
Moderate: Reflects your desire to seek lower risk and fluctuation in your portfolio, while striving to achieve more stable returns on your
investments. It may also mean that you plan to invest over a short period of time.
Moderate growth: Reflects your desire to seek growth in your portfolio by typically using a balance of growth and conservative
investment types. It may also mean that you are moderately tolerant of risk and plan to invest for a medium to long period of time.
Growth: Reflects your desire to seek the potential for investment growth, as well as your tolerance for more significant market
fluctuations and risk of loss. It may also mean that you plan to invest over a long period of time.
Aggressive Growth: Reflects your desire for potentially substantial investment growth, as well as your tolerance for large market
fluctuations and increased risk of loss. It may also mean that you plan to invest over a long period of time.

Options Objectives Definitions

Growth: Investors are seeking the potential for investment growth and have a tolerance for more significant market fluctuations and
risk of loss.
Speculation: Investors are seeking short-term market gains that generally have above average, maximum risk, but offer the potential for
short-term, maximum gains. These strategies also have the potential for significant losses and investors understand they could lose most,
or all, of the money they have invested.
Income: Investors are seeking income with a modest degree of risk. These investors are typically willing to accept lower potential returns
in exchange for lower risk and volatility, and understand their returns may not keep pace with inflation.
Conservation of Capital: Investors are seeking to avoid risk and minimize potential loss of principal.

Page 14 of 15 TDA 1586 A 11/22

Occupation Codes
A42 Accountant/Auditor/Bookkeeper C82 Compliance/Regulatory Professional N21 Nurse
A62 Adjuster C92 Consultant O11 Office Associate
A82 Advertiser/Marketer/PR Professional C43 Counselor/Therapist O21 Other; If Other, include a description
A33 Air Traffic Controller C53 Customer Service Representative in the Occupation box.
A43 Ambassador/Consulate Professional D11 Dealer P81 Pharmacist
A53 Analyst D61 Dentist P91 Physical Therapist
A63 Appraiser D31 Distributor P22 Pilot
A73 Architect/Designer D41 Doctor/Surgeon/Physician P32 Police Officer/Firefighter/
A83 Artist/Performer/Actor/Dancer D51 Driver Law Enforcement Professional
A93 Assistant/Executive Assistant E51 Engineer P42 Politician
A44 Athlete E71 Exterminator P52 Project Manager
A64 Attorney/Judge/Legal Professional F71 Factory/Warehouse Worker R81 Real Estate Professional
A74 Auctioneer F81 Farmer/Rancher R71 Researcher
L51 Banker/Lending Professional F91 Financial Planner/Advisor S41 Salesperson
B21 Barber/Beautician/Hairstylist F22 Flight Attendant S51 Scientist
B31 Broker/Registered Rep F32 Human Resources Professional S61 Seamstress/Tailor
B41 Business Executive (VP, Director, etc.) I41 Importer/Exporter S71 Security Guard
B51 Business Owner I51 Inspector/Investigator S81 Social Worker
C81 Caregiver I81 Investor T41 Teacher/Professor
C91 Carpenter/Construction Worker/ I91 IT Professional/IT Associate T51 Technician
Contractor J31 Janitor T61 Teller
C22 Cashier J41 Jeweler T71 Tradesperson/Craftsperson
C32 Chef/Cook L31 Laborer T81 Trainer/Instructor
C42 Chiropractor L41 Landscaper U21 Underwriter
C52 Civil Servant M91 Mechanic V11 Veterinarian
C62 Clergy M22 Military, Officer or Associated W21 Writer/Journalist/Editor
C72 Clerk M32 Mortician/Funeral Director

Industry of Occupation Codes

A11 Accounting F11 Fashion/Clothing O31 Other; If Other, include a description
A21 Advertising/Marketing F21 Financial Services in the Industry of Occupation box
A31 Aerospace/Defense F51 Firearms and Explosives P11 Parking and Car Washes
A41 Agriculture/Forestry G11 Gaming/Casino/Card Club P21 Pawn Shops/Brokers
A51 Amusement and Recreation G21 Government/Public Administration P31 Personal Care/Hygiene (Beauty,
A61 Animal Services and Veterinary G31 Grocery/Supermarket Salon, Cosmetics, Massage, etc.)
A71 Architecture/Design H11 Healthcare/Medical Services P41 Pharmaceuticals
A81 Arts/Antiques H21 Hotel/Hospitality P51 Printing/Publishing
A91 Athletics/Fitness I11 Import/Export P71 Professional/Civic Organizations
A32 Automotive I21 Information Technology (IT) (Non-Retail)
B11 Aviation I31 Insurance R11 Real Estate
C11 Bar/Nightclub/Adult Entertainment Club J11 Jewelry, Gems, and Precious Metals R21 Religious Organization
C21 Childcare L11 Legal Services/Public Safety R31 Repair Services - Home, Auto,
C31 Cleaning/Janitorial/Housekeeping L21 Logistics/Supply Chain and Other
C41 Communications/Telecommunications M11 Manufacturing R41 Restaurant/Food Service
C51 Construction/Carpentry/Landscaping M21 Maritime R51 Retail Sales/Retail Trade
C61 Convenience Store/Liquor Store/ M31 Media/Entertainment S11 Science and Biotechnology
Gas Station M41 Mining, Oil, and Gas S21 Security
C71 Customer Service and Support M51 Money Services Businesses (Check T11 Transportation
E11 Education Cashing, Money Transmitting, Payday T31 Travel
E21 Embassy/Consulate Loans, Currency Exchange) U11 Utilities (Public)
E31 Energy N11 Non-Profit/NGO (Non-Government W11 Wholesale Sales/Trade
E41 Engineering Agency)/Charity

Page 15 of 15 TDA 1586 A 11/22