Transfer On Death Agreement Form Page 2
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43. DISPOSITION OF DECEASED PRIMARY BENEFICIARY ASSETS (Please check one.)
If any beneficiary listed above is not living at the time of death of the account holder (or in the case of joint tenancy, the last surviving account holder) or
does not survive the (last surviving) account holder or tenant in common by 120 hours, that beneficiary's share shall pass:
to the remaining primary beneficiary(ies) pro rata (proportionate to the designated percentages)
to the contingent beneficiaries as listed below
(Please complete section 4; assets will be divided equally unless different percentages are indicated.)
to my estate and go through probate (This will be the default selection if no choice is indicated.)
4. CONTINGENT BENEFICIARY DESIGNATION (if applicable)
Contingent Beneficiary's Name
Date of Birth
Daytime Telephone Number
Designated Percentage
Address
Social Security or Tax ID Number
Relationship to Account Holder
City
State
ZIP
Name of Primary Beneficiary Received From
Country(ies) of Citizenship
Country of Legal Residence
Contingent Beneficiary's Name
Date of Birth
Daytime Telephone Number
Designated Percentage
Address
Social Security or Tax ID Number
Relationship to Account Holder
City
State
ZIP
Name of Primary Beneficiary Received From
Country(ies) of Citizenship
Country of Legal Residence
Contingent Beneficiary's Name
Date of Birth
Daytime Telephone Number
Designated Percentage
Social Security or Tax ID Number
Relationship to Account Holder
Address
Name of Primary Beneficiary Received From
City
State
ZIP
Country(ies) of Citizenship
Country of Legal Residence
To list additional contingent beneficiaries, attach an additional Page 2.
Should all designated primary and contingent beneficiary(ies) disclaim the assets, predecease the account holder or not survive the (last surviving)
account holder by 120 hours, the assets will be distributed to the (last surviving) account holder's estate.
5. DIRECTIONS FOR DISTRIBUTIONS OF ASSETS TO MINOR BENEFICIARIES
Please check one:
A.
None of my designated beneficiaries are minors.
Please transfer any minor's assets to a custodial account at Scottrade, managed by the custodian(s) designated below. In each instance that
the assets pass to the designated custodian for the designated minor, the assets shall be transferred under the Uniform Transfer to Minor's
B.
Act of the account holder's state of residency.
I did not check 5B above and understand that a court-appointed guardian may be appointed to manage the minor's assets under on-going
C.
court supervision, which is acceptable to me.
If you have checked 5B, please list the custodian for each minor beneficiary.
Name
As Custodian For (Name of Minor Beneficiary)
Name
As Custodian For (Name of Minor Beneficiary)
Name
As Custodian For (Name of Minor Beneficiary)
Name
As Custodian For (Name of Minor Beneficiary)
SF1026/11-15
Page 2 of 4
PLEASE CONTINUE
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