Request To Remove Worthless Securities Form
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REQUEST TO REMOVE WORTHLESS SECURITIES
Scottrade
Account Information:
®
Account Number
Account Title
Securities to be removed from the above-listed account (a $7 fee will be applied for each security):
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
Quantity
CUSIP
Symbol
Security Name
By signing below, I/We affirm that the following conditions have been read, understood, and agreed to:
• I/We agree to sell each mentioned position for zero cents ($.00), which will generate a legal trade
confirmation and is irreversible.
• I/We understand and acknowledge that as of the date set forth below, there is no available bid/market to sell
these shares.
• I/We understand that Scottrade will be the buyer in this transaction, and makes no representation regarding
the value, if any, of the above-mentioned securities.
• I/We further agree to hold Scottrade, Inc., its directors, officers, employees, agents, subsidiaries, and
assigns, harmless from, including but not limited to any and all claims, demands, losses, liabilities,
attorneys’ fees or damages resulting from this sale.
X
Account Holder's Signature
Date
X
*SF8001*
Joint Account Holder's Signature
Date
Signature Verification via
Application
Signature Page
ID
SF8001/11-15
Associate Initials
Scottrade, Inc. - Member
FINRA
and
SIPC
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Parent category: Business