Fillable Co-Applicant Page For Brokerage Account Application Form printable pdf download

BROKERAGE ACCOUNT APPLICATION

Co-Applicant Page

Co-Applicant / Authorized Person Information

For additional co-applicants: make additional copies of this page to complete for each co-applicant; all pages must be submitted together with the rest of this Application.

Name of Individual/Organization

First

Middle

Last

Suffix

Phone Numbers - check preferred

Mr.

Ms.

Home

Mrs.

Dr.

Email Address

Date of Birth / Effective Date Social Security / Tax ID #

Cell

Primary Physical Address

no P.O. Boxes or mail receiving / incorporation services

Street

Work

ext.

City

State

ZIP

Mailing Address

optional

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

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.

a securities firm, exchange or FINRA?

Yes

- 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?

the "Required Information" space below.

This generally includes 10% shareholders, members of the Board of Directors and policy-making officers.

Yes

- select from the

U.S. Federal Gov't Official

U.S. City Mayor

3. Are you currently, or have you ever been, a

following:

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:

- provide name, country,

Yes

4. Do you have an immediate family member or close associate who

relationship & position below.

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

engaged in the growth, sale or distribution of marijuana or products containing marijuana?

Title:

Required

Information for

"yes" Responses:

Margin -

Sign below ONLY if you are applying for margin privileges (not available to all account types).

By signing below, I acknowledge that I have received, read and agree to abide by the Margin provisions (Section IV) of Scottrade's Brokerage Account Agreement.

Co-Applicant/Authorized Person's Signature

Date

Signatures -

The following certifications and acknowledgements apply to all persons signing this application.

Under penalties of perjury,

1) The taxpayer identification number entered above is correct and belongs to me.

2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not

I certify that:

been notified by the IRS that I am subject to backup withholding as a result of failure to report all interest

If you are subject to backup

or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.

withholding, check here:

3) I am a U.S. person (including a U.S. resident alien).

By checking this box, I understand

4) Any FATCA code(s) entered on this form indicating that I am exempt from FATCA reporting

that Item 2 does not apply to me.

is correct. (Applies to foreign organizations only. Not applicable to Scottrade accounts.)

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE RECEIVED, READ AND AGREE TO THE TERMS OF THE

SCOTTRADE BROKERAGE ACCOUNT AGREEMENT, WHICH CONTAINS A PRE-DISPUTE ARBITRATION PROVISION ON

PAGE 11, SECTION VII-B, WHICH MAY BE ENFORCED BY THE PARTIES. I FURTHER AGREE THAT MY UNINVESTED

CASH BALANCES MAY BE SWEPT INTO THE SCOTTRADE SWEEP PROGRAM AS DESCRIBED IN THE AGREEMENT.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

*SF1000*

Co-Applicant/Authorized Person's Signature

Date

SF1000/9-15

Co-Applicant Page For Brokerage Account Application Form

Related Articles

Related forms

Related Categories