Fillable Transfer On Death (Tod) Application And Agreement (Page 4 of 6) in pdf

Transfer On Death (Tod) Application And Agreement Page 4

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Sub Firm:

211

Account #:

Certification

Please selection ONE:

☐ Original Application for Registration in Beneficiary Form

☐ Change for Registration in Beneficiary Form

IMPORTANT: Some of the assets shown on your account statement may not be eligible for TOD registration. Please refer to the Terms and

Conditions for more information. Assets not eligible for TOD registration will be distributed to your heirs through normal probate or estate

settlement procedures. Because of the complex legal and tax ramifications involved, we cannot advise whether a TOD registration is or is not

an appropriate component of an individual client’s tax and estate planning. The ability to register securities accounts in TOD form is created by

state law and not all states have enacted or recognize such laws. CLIENTS SHOULD ALWAYS CONSULT WITH THEIR OWN LEGAL AND TAX

ADVISORS BEFORE ELECTING OR REVOKING A TOD ACCOUNT REGISTRATION.

Note: To establish a Transfer of Death (TOD) agreement, all account holders must sign. A Power of Attorney (POA) signature will not be accepted

on behalf of a client.

Primary Account Holder Signature

Print Name

Date

Secondary Account Holder Signature

Print Name

Date

Spousal Consent –

IF APPLICABLE, ALSO SEE PAGE 1

If Account Owner lives in a community property jurisdiction, this section must be completed by the spouse of the Account Owner if the spouse

is not a joint tenant of this Account and is not named as the sole primary beneficiary of the Account assets. The undersigned hereby declares

that he/she is the spouse of the Account Owner noted above and consents to any designation of beneficiaries made whatsoever and whensoever

by the Account Owner for this TOD Registration and agrees not to make any claim against the Beneficiary(ies) or against us as a result of any

distribution to said Beneficiary(ies) pursuant to this Application. This consent shall apply to all TOD-Eligible assets in the Account at the Death of

the Account Owner.

Name of Spouse (Please type or print)

Address of Spouse

Signature of Spouse

Date

City, State

Zip Code

Required Notarization of Spouse’s Signature

State: ___________________ County: _________________________

Subscribed and sworn before me

This: _______________ Day of: _____________________ Year: _________________

__________________________________________________________