Ira Brokerage Account Application - Scottrade Form
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IRA BROKERAGE ACCOUNT APPLICATION
Select an Account:
Traditional
Roth
SEP
SIMPLE
Rollover
Custodial
Update Acct #:
Coverdell
SIMPLE Plan
The following account types require additional paperwork - please refer to the Advisor Services Forms Center.
Inherited Traditional
Inherited Roth
Inherited Trust
Other Inherited:
Investment Advisor Information (to be completed by the Investment Advisor ONLY)
Book of Business Name (if applicable)
Investment Advisor Firm Name
Investment Advisor Name
Investment Advisor Email Address
Master Account Number
Fee Collection Account Number
Applicant
Name
Are you a U.S. citizen?
Social Security/Tax ID # Date of Birth
Mr.
First
Middle
Last
Mrs.
Yes - skip to
No - provide
Ms.
employment
citizenship info
Dr.
Citizenship
Primary Physical Address
no P.O. boxes or mail/receiving incorporation services
Country:
acct mail will
Alien Registration Number:
Are you a permanent
Yes -
be sent here
U.S. resident?
City
State
ZIP
Visa Type:
No*-
(legal residence)
*If you will be in the U.S. 183 days or less, contact our International Department.
Mailing Address
Employment
(optional)
Status:
Employed
Self-employed
Unemployed
Student
acct mail will
Homemaker
Retired
Occupation:
be sent here
Phone
Home
Cell
Work
ext.
Employer:
check
preferred
Employer
Applicant Email
Address:
Address:
Per section VI-B, Notices, Email and Electronic Communications; Consent to Electronic Delivery, of the Brokerage Account Agreement, by providing your email address, you consent
to receive electronic account statements and trade confirmations, which will be sent to the primary email address unless you choose to have them sent to the mailing address of
Monthly Paper Statements ($2 per month)
Paper Trade Confirmations ($1 each)
record by checking:
If no email address is provided, or only your advisor's email address is provided, your account settings will default to monthly paper statements and paper trade confirmations and
your account may be charged respectively for each. You may change these elections at any time by logging into your Scottrade account and updating your preferences.
Affiliations:
Yes
No
Is any applicant employed by or affiliated with a securities firm, a securities exchange, or FINRA? If yes, provide organization name and compliance department
address in"Affiliation Details" below.
Yes
No
Is any applicant a control person or affiliate of a public company as defined by the SEC? This generally includes 10% shareholders, members of the Board of
Directors, and policy-making officers. If yes, provide company's name and CUSIP/trading symbol in "Affiliation Details" below.
Yes
No
Is any applicant, member of immediate family, or business associate a senior foreign political official?
Applicant Affiliation Details:
Co-Applicant Affiliation Details:
Custodian Information (to be completed for Coverdell/Custodial IRAs ONLY)
Are you a U.S. citizen?
Name
Social Security/Tax ID # Date of Birth
Mr.
First
Middle
Last
Mrs.
Yes - skip to
No - provide
Ms.
employment
citizenship info
Dr.
Citizenship
Primary Physical Address
no P.O. boxes or mail/receiving incorporation services
Country:
acct mail will
Alien Registration Number:
Yes -
Are you a permanent
be sent here
U.S. resident?
City
State
ZIP
Visa Type:
(legal residence)
No*-
*If you will be in the U.S. 183 days or less, contact our International Department.
Mailing Address
Employment
(optional)
Status:
Employed
Self-employed
Unemployed
Student
acct mail will
Homemaker
Retired
Occupation:
be sent here
Phone
Home
Cell
Work
ext.
Employer:
check
preferred
Applicant Email
Employer
Address:
Address:
SIMPLE IRA Information (to be completed for SIMPLE IRAs and SIMPLE Plans ONLY)
Employer's Plan Name
SIMPLE IRA 4-digit ID Number (if applicable)
Employer's Tax ID
Employer's Name, Complete Address and Phone Number
Inherited Trust/Entity Information (to be completed for Inherited Trusts/Entities ONLY)
Trust/Entity's Name and Entity Address
Trust/Entity's Tax ID
*SF1000*
Accepted by Principal
AA
Registered Principal
SF1000/12-16
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