EFTA01381397.pdf

Account Transfer Form ID Ameritrade Mall or Fax to: PO Box 2760 • Omaha, NE 68103-2760 Fax: 866.468.6268 Receiving Firm DTC Clearing Number: OM 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 Ameritrade 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 two TO Ameritrade accounts, please use the Internal transfer form. Please note you cannot use this form to transfer from a standard checking account and for sayings account from a banklcredif union. For IRAs, and Beneficiary IRAs where the original owner was 7O45 years or older at death, please attach a copy of your end of year statement to enable us to calculate the required minimum distribution for the account. 1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT THE DELIVERING ACCOUNT Your TD Amoritrado Account (The registration of the account being transferred should match your (As directed in Section 1both registration and Tax IDs for the TO Ammitrade account and the Tax 10 for bolts the TO Ameritrade TD Amerifrado account and account being transferred should match.) account and account being transferred.) Account Number it trod . Account Number ( • (Only one per for (Only one per term) Account Registration/Tele Account Roglabalionaitle SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC Social Security/Tax 1O Number: Social Security/lex ID Number. Social Security/Tax ID Number: Social SecuritytTax ID Number (Secondaty, If applicable) (Secondary, a applicable) Contrat/Delhoting Firm Name (Recamd) Account Type (select one) DEUTSCHE BANK PRIVATE WEALTH MANAGMENT EiJoint Trust - (Non IRA) O Traditional or Rollover IRA O Roth IRA O Beneficiary IRA Contra/Deltveilog Firm Address 345 PARK AVE 26TH FLOOR NY,NY10154 ContraiDerwering Firm Phone Number (Required): CCorp/Business ❑Beneficiary Roth IRA DOGMA/111MA O Qualified Plan (401k, 403B, PSP, etc.) ContratDefivedng Firm Email: O Estale O SIMPLE IRA O SEP IRA Account Type (select one) o Otherr, O Indiyidual (Non IRA) El Traditional or Rollover IRA point El Roth IRA Trust O Beneficiary IRA ElOorpfElusiness O Beneficiary Roth IRA OUGMNUTMA ❑ Qualified Plan (401k, 403B, PSP, etc.) ['Estate OSIMPLE IRA O SEP IRA O 0ther 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 titlelregistration transfer, please call the transfer department at 888.723.8500, option 0 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. 111111111101 1111111111111111 No 1 at 3 IDA190 F C'S, CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0080343 CONFIDENTIAL SDNY_GM_00226527 EFTA01381397