*TDAI4468* - TD Ameritrade

1 Account # _____Advisor Code _____Case # _____Page 1 of 8 tdai 4468 REV. 11/18 INVESTMENT ADVISOR: TO BE COMPLETED BY ADVISORI nvestment Advisor Firm (Agent) and Primary Contact:Firm Name: _____ Primary Contact: _____TYPE OF BENEFICIARY IRA (PLEASE SELECT ONLY ONE.)M Traditional Beneficiary IRAM Roth Beneficiary IRAM Minor Traditional Beneficiary IRA*M Minor Roth Beneficiary IRA*Please complete for Minor Beneficiary IRAs:This Minor Beneficiary IRA will be opened pursuant to state UTMA/UGMA statutes. Please indicate the age of termination of custodianship and the state law under which this Minor Beneficiary IRA account will be governed:(State)* _____ Age of Termination* _____.

2 (state of UGMA/UTMA establishment must be provided)*The age of termination varies by state, although most states set the age of termination at 21. If you do not indicate the governing state law or age of termination, the account will be set up under the laws of the custodian s state of residence and that state s default age of termination. Certain states permit the age of termination to be extended beyond the default statutory age of termination (usually up to 21 or 25 years of age). This election may be exercised only in those states that specifically provide for it, and only insofar as the extension complies with any applicable understand that electing to extend the age of termination to age 25 may cause me to lose my annual exclusion from federal gift tax and that I should consult with an attorney or tax advisor before making this S RETIREMENT ACCOUNT INFORMATIOND ecedent s First Name: | Middle Initial: | Last Name: Account Number of Decedent s IRA (if applicable): |Date of Decedent s Death (mm/dd/yyyy):Relationship to Decedent.

3 |Decedent s Date of Birth (mm/dd/yyyy): (ex., spouse or non-spouse)ACCOUNT OWNER: COMPLETE ALL INFORMATION BELOW FOR THE PRIMARY OR MINOR ACCOUNT OWNERF irst Name: | Middle Initial: | Last Name: Social Security Number or Estate Tax ID: | Date of Birth: Primary Telephone Number: M Check here if this is not a phone number. | Secondary Telephone Number: M Check here if this is not a phone Address (required for electronic delivery of your account statement and trade confirmations): Home Street Address (no PO boxes): City: | State: | ZIP Code: Mailing Address (if different from above): City: | State: | ZIP Code:Please specify if you are: M Employed M Self-employed M Unemployed M Retired M Homemaker M StudentEmployer Name (If self-employed, please provide the name of your business).

4 Please choose from the list provided on page 8 the occupation code and industry of occupation code that most accurately describes your situation. Occupation: Industry of Occupation:Employer Street Address:City: | State: | ZIP Code:123 BENEFICIARY IRA ACCOUNT APPLICATION *TDAI4468* Page 2 of 8 tdai 4468 REV. 11/18 Check here if you are a: | Country of Citizenship (For Citizens and Permanent Residents): M Citizen M Permanent Resident M Not a Citizen If a Permanent resident, please attach a copy of an unexpired permanent resident of Dual or Secondary Citizenship (if applicable): | Country of Birth (For Citizens and Permanent Residents) citizens: Do you hold a current immigration visa?

5 M Yes M No Specify Visa type: _____ Visa Number: _____ Expiration: _____(Nonresident aliens must submit Form W-8 BEN and a copy of a current passport. If a address is listed, then attach a signed Form TDAI 835 Letter of Explanation for Mailing Address Phone Number Attachment to Form W-8 .)M Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, is a member of the board of directors, 10% shareholder, or policy-making officer of a publicly traded company. Specify the company name, address, city, and state: _____M Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents is licensed, employed by, or associated with, a broker-dealer firm, a financial services regulator, securities exchange, or member of a securities exchange.

6 If checked, please specify entity below, and provide a copy of the required authorization letter (with this application): _____This section does not need to be completed for Minors in Minor AccountsAnnual income: M $0 - 24,999 M $25,000 - 49,999 M $50,000 - 99,999 M $100,000 - 249,999 M $250,000+Approximate net worth: M $0 - 14,999 M $15,000 - 49,999 M $50,000 - 99,999 M $100,000 - 249,999 (not including primary residence) M $250,000 - 499,999 M $500,000 - 999,999 M $1,000,000 - 1,999,999 M $2,000,000+CUSTODIAN INFORMATION (FOR MINOR BENEFICIARY IRAS ONLY)Custodian must be someone of legal age other than the Minor, and cannot be the Investment Advisor.

7 Relationship to Minor: M Parent/Legal Guardian M Grandparent M Other: _____First Name: | Middle Initial: | Last Name: Social Security Number or Estate Tax ID: | Date of Birth: Primary Telephone Number: M Check here if this is not a phone number. | Secondary Telephone Number: M Check here if this is not a phone Address (required for electronic delivery of your account statement and trade confirmations): Home Street Address (no PO boxes): City: | State: | ZIP Code: Mailing Address (if different from above): City: | State: | ZIP Code:Please specify if you are: M Employed M Self-employed M Unemployed M Retired M Homemaker M StudentEmployer Name (If self-employed, please provide the name of your business).

8 Please choose from the list provided on page 8 the occupation code and industry of occupation code that most accurately describes your situation. Occupation: Industry of Occupation:Employer Street Address:City: | State: | ZIP Code:Check here if you are a: | Country of Citizenship (For Citizens and Permanent Residents): M Citizen M Permanent Resident M Not a Citizen If a Permanent resident, please attach a copy of an unexpired permanent resident of Dual or Secondary Citizenship (if applicable): | Country of Birth (For Citizens and Permanent Residents) citizens.

9 Do you hold a current immigration visa? M Yes M No Specify Visa type: _____ Visa Number: _____ Expiration: _____(Nonresident aliens must submit Form W-8 BEN and a copy of a current passport. If a address is listed, then attach a signed Form TDAI 835 Letter of Explanation for Mailing Address Phone Number Attachment to Form W-8 .)M Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, is a member of the board of directors, 10% shareholder, or policy-making officer of a publicly traded company. Specify the company name, address, city, and state: _____M Check here if you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents is licensed, employed by, or associated with, a broker-dealer firm, a financial services regulator, securities exchange, or member of a securities exchange.

10 If checked, please specify entity below, and provide a copy of the required authorization letter (with this application): _____Annual income: M $0 - 24,999 M $25,000 - 49,999 M $50,000 - 99,999 M $100,000 - 249,999 M $250,000+Approximate net worth: M $0 - 14,999 M $15,000 - 49,999 M $50,000 - 99,999 M $100,000 - 249,999 (not including primary residence) M $250,000 - 499,999 M $500,000 - 999,999 M $1,000,000 - 1,999,999 M $2,000,000+4 Page 3 of 8 tdai 4468 REV. 11/18 BENEFICIARY ELECTIONSAn IRA owner is required to begin Required Minimum Distributions (RMDs) on April 1 of the year following the calendar year in which the owner reached age 70 ; this is known as the Required Beginning Date (RBD).