Brokerage Account Application, Inherited Individual Retirement Account Forms
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4BROKERAGE ACCOUNT APPLICATION
Yes
Do you have any other accounts with Scottrade or
Account
Please view Page 3 for a list of account types.
its affiliates (Scottrade Bank / Boulevard Bank)?
No
Type:
Primary Applicant / Organization Information
Depending on account type, this may be the minor, protected person or organization (trust, corporation, partnership, etc.)
Phone Numbers - check preferred
Name of Individual/Organization
First
Middle
Last
Suffix
Mr.
Ms.
Home
Mrs.
Dr.
Email Address
Date of Birth / Effective Date
Social Security / Tax ID #
account notices will be sent here
Cell
Primary Physical Address
no P.O. Boxes or mail receiving / incorporation services
Work
ext.
Street
City
State
ZIP
Fax
Mailing Address
include city, state & ZIP - if a mailing address is not provided, account notices will be sent to the primary physical address
Individual, Joint, Retirement & Minor Account Applicants -
complete the rest of this page, then proceed to Page 2
All Other Account Types -
complete the Expected Account Activities section, then proceed to Page 2
Citizenship
If you will be in the U.S. 183 days or less, contact us at 866.246.1788.
Yes - proceed to question 2.
1. Are you a U.S. citizen?
Country:
No - complete section at right.
2. Are you a citizen of any other non-U.S. countries?
Yes - list below
Yes -
Permanent Resident Card Number:
Are you a permanent
Countries:
U.S. resident?
No -
Visa type:
Expiration Date (MM/DD/YYYY):
Employment
Employer Industry Code* Occupation Code*
Status:
Employed
Unemployed
Self-employed /
Retired
Homemaker
Student
business owner
Job Title
Job Description
Employer
Employer Address
*See p.3 for a code list or
contact us for assistance.
Please provide the following information to help us understand your financial status.
Scottrade will not use this information to supervise the suitability of any transaction
in your account.
1. What is your annual income?
$0 - $24,999
$25,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000+
2. What is your household net worth (excluding residence)?
$0 - $24,999
$25,000 - $49,999
$50,000 - $249,999
$250,000 - $499,999
$500,000+
Affiliations
This information is to comply with requirements mandated by the U.S. Government and other regulatory agencies, and to better understand your intentions for your brokerage account.
Yes
- Scottrade will inform the securities firm, exchange or FINRA of your intention to maintain this account and provide copies of
1. Are you employed by / affiliated with
confirms, statements & other requested information. Provide organization name & compliance address in the field below.
No
a securities firm, exchange or FINRA?
- provide company name & CUSIP / symbol in
2. Are you or a member of your household a control person / affiliate of a public company as defined by the SEC?
Yes
the "Required Information" space below.
This generally includes 10% shareholders, members of the Board of Directors and policy-making officers.
No
- select from the
Yes
U.S. Federal Gov't Official
U.S. City Mayor
3. Are you currently, or have you ever been, a
following:
No
U.S. State Governor
Senior Executive / Director of a Gov't-owned Non-U.S. Entity
high-level elected / appointed government official?
Non-U.S. Gov't Official - provide country & title here:
Yes
- provide name, country, relation-
4. Do you have an immediate family member or close associate who
ship & position in space below.
No
is or was a high-level elected / appointed government official?
Country:
Yes
5. Do you receive compensation, directly or indirectly, from a business related to or
No
engaged in the growth, sale or distribution of marijuana or products containing marijuana?
Title:
Required
Information
for "yes"
responses:
Expected Account Activities
Yes
No
1. Do you plan to trade low-priced, over-the-counter securities ("penny stocks")?
Yes
No
2. Do you plan to deposit or transfer-in low-priced, over-the-counter securities?
3. What best describes the initial
Employment Wages
Gift
Inheritance / Trust
Investments
Other - describe:
funding source for this account?
Legal Settlement
Lottery / Gaming
Retirement Funds
Savings
Spouse / Parent Support
Unemployment / Disability
Employment Wages
Gift
Inheritance / Trust
Investments
Legal Settlement
Lottery / Gaming
4. What best describes the ongoing
Retirement Funds
Savings
Spouse / Parent Support
Unemployment / Disability
Other -
source of funds for this account?
describe:
5. Do you anticipate initiating/receiving international ACH or wire transfers?
Yes - list non-U.S. countries to be
No - proceed
involved in these transfers (below):
to Page 2.
6. What is the expected frequency of these international transfers?
Once or twice per year
Once every few months
Once a month
Several times per month
7. What is the expected annual international transfer total?
$0 - $9,999
$10,000 - $49,999
$50,000 - $99,999
$100,000 - $249,999
$250,000 - 499,999
$500,000+
8. Indicate purpose(s) for these international transfers:
Charitable Payment
Personal Remittance
Vacation / Travel
Commission / Payroll
Investment / Real Estate Opportunity
Personal Purchase of International Goods
Non-U.S. Asset Management
*SF1000*
Business Expense / Income
Other - describe:
SF1000/11-15
Page 1 of 4
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