Form 69448p-Utod - Transfer On Death Beneficiary Designation Form
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1
2Transfer on Death (TOD)
Beneficiary Designation Form
Please note that Transfer on Death Beneficiary Designations are not available to residents in all jurisdictions
Please also note that TOD Accounts are subject to receipt and acceptance by our clearing firm,
Apex Clearing Corporation
(“Apex”). No TOD designation will be effected until all required documentation is received and accepted.
Account Information
Primary Account Holder Name
Apex Account Number
Entity/Business/Trust Name
Social Security Number or Taxpayer ID Number
Date of Birth
Joint Account Holder/Trustee Name (if Any)
Social Security Number or Taxpayer ID Number
Date of Birth
Beneficiary Designation
To my Broker/Dealer (“You” or “Your”):
I (We) wish to create a transfer on death (“TOD”) registration for the account listed above. I (We) hereby designate the person(s)
identified below (“Beneficiary(ies)”) to receive all monies, securities and other assets held in the account listed above upon my (our)
death, or the death of the last surviving account owner in the case of a joint account. I (We) may change the designation of the
beneficiary(ies) only by completing a new Transfer on Death Beneficiary Designation Form. The Beneficiary Designation may not be
revoked or changed by will, codicil, trust document or other testamentary document. You may rely on the latest Beneficiary
Designation in your possession and no change in Beneficiary shall be effective until actually received and accepted by you.
I (We) understand that you have entered into an agreement with Apex with respect to the execution and clearance of
securities. I (We) also understand that because of the complex legal and tax issues involved, neither you nor Apex will advise
whether the TOD designation is appropriate for tax or estate planning. I (We) acknowledge that the ability to register a securities
account in TOD form is created by state law and not all states have enacted such laws. I (We) understand that I (we) should consult
my (our) own legal and tax advisers before electing or revoking the TOD account designation as I (we) deem appropriate.
This Beneficiary Designation is:
An Original TOD
A Beneficiary Designation Change to an Existing TOD
I (We) hereby designate the person(s) named below as beneficiary(ies) to receive the assets remaining in the account listed above upon
my (our) death, or the death of the surviving account owner if the account is owned by more than one person:
Beneficiaries
(If a trust, please provide trust name, names of all trustees and date established.)
1. Name: _____________________________________ % Share*:________________ Relationship:______________________
Address: __________________________________________________________Telephone:____________________________
Date of Birth: ______________________________ Social Security Number or Taxpayer ID Number:_____________________
2. Name: _____________________________________ % Share*:________________ Relationship:______________________
Address: __________________________________________________________Telephone:____________________________
Date of Birth: ______________________________ Social Security Number or Taxpayer ID Number:_____________________
3. Name: _________________________________
% Share*:________________ Relationship:______________________
Address: __________________________________________________________Telephone:____________________________
Date of Birth: ______________________________ Social Security Number or Taxpayer ID Number:_____________________
* Please note: Share totals must equal 100%. Do not use fractional percentages or dollar amounts.
69448P-UTOD 06/11/2012
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Parent category: Business