EFTA01268387.pdf

Account Transfer Form TO Ameritrade Mail or Fax to: PO Box 2760 . Omaha, NE 68103-2760 Far 866-4684268 Receiving Firm DTC Clearing Number: 0188 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 TO Ameritrade Attn: TO Amer'trade, PO Box 2760, Omaha, NE 68103.2760 or fax to 866468-6268. "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 7D Ameritrade accounts, please use the Internal transfer form. Please note you cannot use this form to transfer from a standard checking account andlor savings account from a banIdcrecht union. For IRAs, and Beneficiary 1RAs where the original owner was 7034 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 Your TO Ameritrado Account ACCOUNT TO BE TRANSFERRED (The registration of the account being transferred should match your (As dkectedIn Section 1both registration and Tax Ws for the TO Amerind° account and the Tax ID for both the TO Ameritrade 713 Ameafrede account and account being transferred should match.) account and account being transferred.) Account Number ( of : Account Number ( fred : (Only One per form) (Only one per :Om) Account Registreboraille: Account ResofrationfTlee: SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC Social Security/Ts* IO Number Social Seemly/Tax ID Number Social Seamy:Max IO Number: Social Seizinlyrrax ID Number (Secondary it applicable) (Secondatx If applicable) CormatOewering Form Name (Required): Account Type (select one) Deutsche Bank O Inclividual - (Non IRA) ['SIMPLE IRA ContraDefvering Arm Address: Joint ['SEP IRA 345 Park Ave, 26th Floor, NY, NY 10154 OTrust ['Traditional or Rollover IRA Contra0eINenno Firm Phone Number (Rewired): O Corp/Business ORoth IRA ❑ UGMAAJTMA ['Beneficiary IRA Account Type (select one) 04038 OBeneficiary Roth IRA 00ther: ['Estate Individual - (Non IRA) ['SIMPLE IRA atuablied Plan ("See above) ['Joint [PEP IRA 1:ITrust ['Traditional or Rollaier IRA Corp/Business ['Roth IRA OUGMAAJTMA ['Beneficiary IRA 04036 DBeneficiary Roth IRA ['Other: OEstate ['Qualified Plan ("See above) If fho registrations do not match, you may either establish a now account online at wwwfdamorlfradtcom or you must supply additional documentation and all delivering account owners must sign section 5. For unlike title/registration transfer; please call the trans for department at 888-7234504 for additional requirements. 'Please note if there are any issues with processing your transfer, wo will communicate that to you via your secure message center when you log In to your account. '75 11 lualcIpai spa 01 was skew-a ama)ai of upon Ja6uoi ou no). aquasqnsun Aetu no,14/ •wooepeusepouosku4DuosueAels-uaile Aq woomewl3Ouye>wepweqop of was sera flew-a situ IIIIVIIIVIIIhill III IIII CONFIDENTIAL SONY_GM_000W 130F 07116 EFTA_00122960 EFTA01268387  TD Amorivade MCI ft 3. TRANSFER INSTRUCTION Please review the following Instructions and complete the proper section(s) for your transfer request. Only one sub-section (such as. A, B. C, or D) can be selected per transfer. Check box for Full or Partial Transfer. Only whole shares can be requested, as fractional shares cannot be transferred. Please contact the delivering frm regarding your options. For Partial Transfers. list descriptions of assets and shares. Unless otherwise indicated. TO Ameritrade wil transfer in FIJI. 'Please note—TD Ameritrade cannot request Mutual Funds hold at Brokerage Firms to be liquidated. To place trades for liquidation, please contact the delivering firm prior to submitting the transfer request. Some money market funds are self-liquidating. To liquidate others, please contact the delivering firm. A. BROKERAGE FIRM TRANSFER O Full Transfer—To transfer entire account, check here and then skip to the Signature Section 4, and complete Section 5 and/or Section 8 (if applicable). Partial Transfer—List specific security and/or cash amount in the lines given below. If bonds are being transferred, crease supply the Bond CUSIP. Only whole shares can be requested as fractional shares cannot be transferred. Please contact the delivering firm eganfing your options. Asset Description (CUSIP or symbol) Quantity Asset Description (CUSIP or symbol) Quantity (Partial Transfers Only) (Indicate 0 of %note shares (Partial Transfers Only) (Indicate s of whde shares or -ALL7 or 'ALL') ASNA 70500 FMI 49830 SGMO 50000 B. MUTUAL FUND COMPANY TRANSFER ['Full Transfer—To transfer entire account, check here. ['Partial Transfer—List specific mutual funds In the lines given below Check box for In-kind or Liquidation Transfer. Please list the Symbol or CUSIP for the Mutual Fund s) you wish to move. Unless otherwise Indicated, TD Ameritrade wit transfer shares in-kind. This section pertains only to shares of Mutual Funds held (Wetly with the fund company, for brokerage accounts containing Mutual Funds and/or Stocks please corn* e the Brokerage Firm Transfer section (Section 3A. above). 'Proprietary Mutual Funds and all no-load Money Market funds cannot be transferred ki-kind andmust be liquidated. Quantity Handling Gains a Dividends Fund Name or Symbol Mutual Fund Account a (macaw a &shares or ALL) (Check one) (Check ow lin-keg° an -Kind OReinvest OUquidate • Cash • In-Kind • Reinvest M liquidate E Cash a imam • Reimest DIAL:date • Cash Eik,.•Gnd HRoinvosl Liquidate Cash arl-Kind ['Reinvest ['Liquidate OCash 'If you are transferring more funds than will fit above. please include an attached Mt for the complete list of funds. ElWire A statement MUST be included to ensure proper handing and processing of your Mutual Fund transfer. (fees may apply) • Unless otherwise Indicated, 1authorize the Transferor to liquidate any non-transferal* proprietary money market EICheCk and mutual fund assets that are part of my account and to transfer the restating crook balance to my account with TO Amentrade. If the fundis unable to be had by TD Ameritrade, I (please initial here) authorize the Transferor to liquidate and transfer as cash. SDNY_GkeDSMit CONM1DENTIAL EFTA_00122961 EFTA01268388  TD Amentrade Accl C. BANK/CREDIT UNION 8. ANNUITY/LIFE INSURANCE TRANSFER Transfer cash only. Unless otherwise indicated, all cash will be transferred. Banks, Insurance/Annuity, and Trust Companies require Original Client Signature. Please mail the Original form to complete the transfer request. 'Each section will hove additional Information. IRA Savings Accounts—Typically held with Bank/Credit Union. ❑ Total Transfer (Transfer entire account) DWIre (lees may apply) 0 Partial Transfer (Transfer part of account) Portion to transfer $ 0 Chock Certificates of Deposit (CDs). °Redeem my CD immediately. I am aware of, and acknowledge, that I am responsible for any penalties that I may Incur from any early withdrawal. °Redeem 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 et maturity. For any investment instruments that have a renewal deackne, maturity date, surrender charge period/window, etc., paperwork must be received by TD 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! Life Insurance Transfer o Transfer my Life Insurance I have a life insurance policy that I wish to transfer Please redeem and terminate on my behalf I am aware of, and acknowledge, that I am responsible for any penalties that I may incur from any early withdrawal. OTransfor my Annuity 0 Full 0 Partial $ 0 Wire I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf. gem may amply) I am aware of, and acknowledge, that I am responsible for any penalties that ! may Incur from 0 Chock any early withdrawal. Select only one: Liquidate annuity in full or partial liquidation. If partial is selected, amount for partial must be Included. Contact the insurance company to determine whether surrender forms are required before submitting the transfer form to TO Ameritrade. Attach surrender form if applicable. TD Amentrade is not responsible for the arcing or execution of liquidations processed by the delivering firm. D. TRANSFER AGENT Chock box for In-kind transfer from a Transfer Agent. This section is specifically for transfers from a Transfer Agent via the Direct Registration System or DRS transfer. DRS transfers must be between like-titled accounts. Please provide the MOST recent copy of your delivering account statement dated within 90 days. 'Note: All shares MUST be held in Book-Entry form at the Transfer Agent, prior to initialing the transfer 0 Transfer all of my WHOLE shares to my TD Ameritrade account and liquidate any fractional shares. understand the cash proceeds of any liquidation will be mailed directly to the address on file for my account This option will leave your account open at the Transfer Agent. ❑ Transfer all of my WHOLE shares to my TO Ameritrade account and liquidate any fractional shares. I understand the cash proceeds of any fiquidation will be mailed directly to the address on file for my account and close my account at the delhery firm. 0 Transfer all of my WHOLE shares to my TD Ameritrade account. Do not liquidate any fractional shares in my account. I understand my account at the dekvery firm will remain open and!will continue to accrue shares if lam enrolled in a DRIP program. O Transfer only Part of the assets listed (below). understand my account of the dekvery firm will remain open and I will continue to accrue shares if I am enrolledin a DRIP program. Share Amount SDNY—Gm—00011,11110F 07116 CONFIDENTIAL EFTA_00122962 EFTA01268389  TO Ameritrade Acct ft 4. TDAMERITRADE CLIENT AUTHORIZATION 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, in-kind, all assets into my account with TO Arneritrade. 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 wit 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 credit balance, or if the credit balance in the account is insufficient to satisfy any outstanding fees. If certificates or other instruments in my account are in your physical possession. I instruct Transferor to transfer them in good deWverabte form, including affixing any necessary tax waivers, 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 full cn.....uunt 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 credit/debit cards and/or unused checks Issued to me in connection with my account. If this TD Ameritrade account is a nt account, I have amended the applicable plan to designate the successor custodian. Alternatively, if this T dividual Retirement Account (IRA). I have adopted an IRA plan so that it names the successor custodian. X Client Signature: "I: Oliti_Ro 1 X Co-owners Signature: Darn: — — Dale: X X Co-Owners Signature: Co-Owner's Signalise. Dale: — _ • II 9 9 - • • • . ' 5. EGIST - 'Note: this section is riot applicable to transfers requested in Section 3.D, requests to transfer from a Transfer Agent, which must be Ike-Wed. Registration Difference For unlike tilled or type transfers, I authorize the transfer from account to account. Al parties on the delivering account must sign below. Dale: X Client Signature: Dale: X Client Signalise: Dale: -------- X Client Signature: 6. ONE AND THE SAME LETTER If you are transferring an account. and the name(s) at TO Amentrade 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 Speling Erroc or any type of Name Change ncludkig Jr.. St, etc. If last name difference, must supply legal documentation: that is. state issued drivers license, passport• or government la • (please print name), am One and the Same as (please print name) as storm on the delivering firm account. Please sign name BOTH ways. Signature: X Signalise: 7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONLY) The undersigned organization agrees to serve as successor custodian for the account of the above-named individual, and as custodian. we agree to accept the assets being transferred. )( Representative Signature: Davit Representative Printed Name: For TO Ameritrade Clearing, Inc. use only Please be advised that TO Arneritrade Clearing. Inc. is an Approved 403(b)(7) Vendor anchor has entered into an Information Sharing Agreement with the Employer for the above-captioned 403(b)(7) account. The Employer/Agent Signature above hereby authorizes TD Anieritrade Clearing. Inc. to accept this exchange. Investment Products: Not FDIC Insured ' No flank Guarantee ' May Lose Value TD Amentrade, Inc. and TD Arne:tirade Clearing, Inc.. members FINFtAISIPC. TD Ameritrade is a trademark jointly owned by TD Amentrade IP Company. Inc. and The Toronto-Dominion Bank. 0 2018 TD Arneritrade P Company. Inc. SONYGliti0.0001E07116 CONFM4ENTIAL EFTA_0O122963 EFTA01268390