Fillable Transfer On Death (Tod) And Beneficiary Designation printable pdf download

Vision

Transfer on Death (TOD) and Beneficiary Designation

Please complete, sign in the presence of a notary and retain a copy for your records.

Please note: This transfer may not be valid in all states and this document may not constitute a legal transfer of your assets upon

your death. Please consult with your independent tax or accounting professional to confirm the legality of this transfer as well as

to discuss any legal or tax consequences.

______________________________________________

_____________________________________________

Primary Account Holder Name

Additional Account Holder Name (if applicable)

______________________________________________

_____________________________________________

Social Security Number

Social Security Number of Additional Account Holder

______________________________________________

_____________________________________________

Date of Birth (MM/DD/YYYY)

Date of Birth (MM/DD/YYYY) of Additional Account Holder

______________________________________________

_____________________________________________

Vision Account Number

To Vision Financial Markets LLC (“Vision” or “you”):

I (We) wish to create a transfer on death (TOD) registration for the account listed above (the “Account”). I (We) hereby designate

the person(s) identified below as Beneficiary(ies) to receive all monies, securities and other assets held in the Account upon my

death, or the death of the last surviving Account owner

if the Account is owned by more than one

person. 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 form in your possession and no change in beneficiary shall be effective until actually received and

accepted by you.

I (We) understand that because of the complex legal and tax issues involved, you will not advise whether this TOD account des-

ignation 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, and where enacted not all such laws are the same. I (We)

understand that I (we) should consult my (our) own legal and tax advisers before electing or revoking this Transfer on Death and

Beneficiary Designation as I (we) deem appropriate.

An original TOD,

A change to an existing TOD Beneficiary Designation

This TOD Designation is:

Please consider this instrument my (our) express request and authorization to establish or change the Account as a Transfer on

Death (TOD) account, which shall supersede all prior like authorizations. I (we) understand that upon presentation of a certified

copy of my death certificate or death certificate of the last surviving Account owner (and any other documents required by Vision),

all assets held in the Account will be passed directly on to the individual(s) named as beneficiary(ies) below, pursuant to the per-

centages listed by each name. Should any beneficiary predecease me (us), their share of the Account assets shall be transferred

as follows:

Divided equally between the remaining beneficiary(ies),

Passed to the issues of the deceased beneficiary

I (We) hereby designate the person(s) named below as beneficiary(ies) to receive the assets remaining in the Account upon my

death, or upon the death of the last surviving Account owner if the Account is owned by more than one person. Named beneficia-

ries may only be U.S. Citizens or non-U.S. Citizens that have obtained a tax identification number or a social security number.

Transfer on Death (TOD) - Beneficiary Designation

Transfer On Death (Tod) And Beneficiary Designation

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