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M *TDAI2423* - TD Ameritrade

TDAI 2423 REV. 03/18 Page 1 of 4 ACCOUNT INFORMATIONName (First, Middle Initial, Last): | Social Security Number: Primary Telephone Number: | Date of Birth: Type of Account: M Traditional IRA M Roth IRA M SEP IRA M Beneficiary IRA M SIMPLE IRA* M Rollover IRA M Beneficiary Roth IRA*Has the SIMPLE IRA been funded for at least two years? M Yes M NoTYPE OF DISTRIBUTION I direct TD Ameritrade Clearing, Inc. to distribute the amount requested for the following reason (check only one box): This is a distribution due to:M Normal distribution (also applies to Required Minimum Distributions) I am over age 59.

Page 2 of 4 TDAI 141fi REV. 59/50 M E. Full Distribution in cash and securities. Please close my account M M F. Client On Demand Distribution Authority. Checking this box allows you to verbally request one-time disbursements in any amount at

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