Transfer On Death Agreement Form Page 3
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4INSTRUCTIONS FOR SPOUSAL CONSENT - Only complete Section 6 if you meet all of the following criteria:
•
You reside in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI).
•
You are married.
•
You have listed someone other than your spouse as a sole (100%) primary beneficiary in Section 2.
•
This account is not jointly held with your spouse as Joint Tenants with Rights of Survivorship.
If Section 6 does not apply to you, proceed to the Signature section at the bottom of the page
6. SPOUSAL CONSENT
The undersigned hereby declares that he/she is the spouse of the account holder of the TOD Beneficiary Plan and consents to any
designation of beneficiaries made whatsoever and whensoever by the account holder for this Agreement. Unless Scottrade has
received actual written notice of the revocation of the undersigned's written consent, the undersigned also agrees not to make any
claim against the beneficiary(ies) or against Scottrade as a result of any distribution to said beneficiary(ies) pursuant to this Agreement.
This consent shall apply to all assets in the account upon the death of the account holder. The undersigned can revoke this consent by
executing a letter of authorization (signed by the account holder and the undersigned), which must be received by Scottrade prior to
the account holder's death.
Signature of Spouse
Date
Signature of Witness* (Required)
Date
Name of Spouse
Name of Witness (Please Type or Print)
Address
Address
City/State
ZIP
City/State
ZIP
Signature of Spouse**
Date
Signature of Witness* (Required)
Date
Name of Spouse
Name of Witness (Please Type or Print)
Address
Address
City/State
ZIP
City/State
ZIP
®
* This witness may not be the account holder, a Scottrade
employee or any designated beneficiary of these account assets.
** The signature of both spouses is only required when the account is jointly held with your spouse as Joint Tenants in Common and one
or both clients is not being named the sole (100%) primary beneficiary.
SIGNATURES - By signing this Agreement, I acknowledge that I have read and agree to the accompanying
Designated Beneficiary Plan Terms and Conditions.
X
Print Name
Signature
Date
X
Date
Print Name
Signature
Signature Page
ID
Signature Verification via
Application
Associate Initials
SF1026/11-15
Page 3 of 4
PLEASE CONTINUE
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