Trust Account Application - TD Ameritrade

1 Page 1 of 12 TDA 4286 A 01/22 Questions? Call a New Accounts representative at 800-276-8746. Please visit us at for more information about opening an Account . Return Options:Electronically via Message Center: Log in and go to Client Services > Message Center to attach the fileRegular Mail: PO Box 2760, Omaha, NE 68103-2760 Overnight Mail: 200 South 108th Avenue Omaha, NE 68154-2631 Fax: 866-468-6268 Trust Account Application *TDA4286*1 Type of Account (Please select only one. Additional paperwork is required for some Account types.)QUALIFIED RETIREMENT PLANS (Please provide a signed plan document)Is this Account part of an existing plan at TD Ameritrade ?

2 CC Yes CC NoIf yes, please provide an Account number:CC Profit Sharing Plan (PSP)CC 401(k)CC Roth 401(k)CC 403(b)9CC Money Purchase Pension Plan (MPPP)CC Individual 401(k)CC 403(b)7CC Other:CC Defined Benefit/Cash Balance PlanCC Personal Trust CC Other:Funding Your Account2I will be funding withCC A check. Please make check payable to TD Ameritrade Clearing, A wire transfer to be initiated after Account opening . Please contact TD Ameritrade prior to initiating the wire A transfer of assets from an existing Account . Please complete and include an External Transfer Form and a copy of your most recent A transfer from an existing TD Ameritrade Account .

3 Please complete and include an Internal Transfer Stock certificates. Please contact TD Ameritrade prior to submitting 2 of 12 TDA 4286 A 01/22 Title of Trust :Grantor(s)/Settlor(s)/Trustor(s) of the Trust :Employee Participant: (where applicable)Name(s) of the Successor Trustee(s): (if applicable)Beneficiaries of the Trust :Home Address: (no PO Box or mail drop)City:State:Zip Code:Country:3 Trust InformationDate of Formation:Date of the Last Amendment to the Social Security Number:Tax ID Number:ORMailing Address: (if different from above)City:State:Zip Code:Country:Primary Phone number:C C Check here if this is not a phone numberSecondary Phone number.

4 C C Check here if this is not a phone numberEmail Address (required for electronic delivery of your Account statement and trade confirmations):Fax number:Please list the single Tax ID or Social Security Number under which your Trust reports Income:CC $0-$24,999CC $25,000-$49,999CC $50,000-$99,999CC $100,000-$249,999CC $250,000+Approximate Net Worth: (not including primary residence)CC $0-$14,999CC $15,000-$49,999C C $50,000-$99,999CC $100,000-$249,999CC $250,000-$499,999CC $500,000-$999,999CC $1,000,000-$1,999,999CC $2,000,000+Approximate Liquid Net Worth: (cash, stocks, etc.)CC $0-$14,999CC $15,000-$49,999C C $50,000-$99,999CC $100,000-$249,999CC $250,000-$499,999CC $500,000-$999,999CC $1,000,000-$1,999,999CC $2,000,000+Page 3 of 12 TDA 4286 A 01/22 Section 3, Trust Information continuedCC Check here if any Trustee, their spouse, any member of their immediate family living in the same household, 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.

5 Specify the name of the affiliated person/Trustee, the company name, ticker symbol, address, city, and state:CC Check here if any Trustee, their spouse, any member of their immediate family living in the same household, 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. If checked, please specify the name of the affiliated person/Trustee and affiliated entity below. If this entity requires its approval for you to open this Account , please provide a copy of the required authorization letter (with this Application ):CC Check here if any Trustee, their spouse, any member of their immediate family, including parents, in-laws, siblings, and dependents is, or is employed by, a federal or state registered Investment Advisor.

6 Specify the name of the person affiliated with the Trustee employed by the Registered Investment Advisor and Investment Advisor company name:CC Check here if any Trustee, their spouse, any member of their immediate family, including parents, in-laws, siblings, and dependents is using a license in a professional sale or trading capacity. Specify the name of the licensed professional, their relationship to the trustee, and if associated with an entity:4 Affiliations5 Authorized Agent CompensationCC Check here if any Authorized Agent (unaffiliated with the entity) is being compensated for providing investment advice, placing trades, or otherwise managing the best describes the initial source of funds for this Account ?

7 CC Employment/WagesCC Retirement FundsCC GiftCC SavingsCC Inheritance/TrustCC InvestmentsCC Unemployment/DisabilityCC Legal SettlementCC Lottery/GamingCC Spousal/Parental SupportCC Other (describe source of funds):What best describes the ongoing source of funds for this Account ?CC Employment/WagesCC Retirement FundsCC GiftCC SavingsCC Inheritance/TrustCC InvestmentsCC Unemployment/DisabilityCC Legal SettlementCC Lottery/GamingCC Spousal/Parental SupportCC Other (describe source of funds):Page 4 of 12 TDA 4286 A 01/226 Trustee InformationFull Legal Name:Date of Birth:Name Prefix (optional): CC Mr. CC Mrs. CC Ms. CC Dr.

8 CC of Dependents:Home Address: (no PO box or mail drop)Mailing Address: (if different from above)City:City:State:State:Zip Code:Zip Code:Country:Country:Country of Citizenship:Country of Birth:CC Check here if you are NOT a of Dual/Secondary Citizenship (if applicable) citizens*: Do you hold a current immigration visa? CC Yes CC NoSpecify visa type:Visa Number:Expiration:Primary Phone number:C C Check here if this is not a phone numberSecondary Phone number:C C Check here if this is not a phone numberEmail Address (required for electronic delivery of your Account statement and trade confirmations):Fax number:Tax ID Number:Employer Name (If Self-Employed, provide the name of your business):Please choose from the list provided on page 12 the occupation code and industry of occupation code that most accurately describes your Code:Industry of Occupation Code:Employer Address:City:State:Zip Code:Country.

9 * Nonresident aliens must submit a copy of a current passport and a copy of a bank or brokerage Social Security Number:ORPlease specify if you are:CC EmployedCC UnemployedCC RetiredCC HomemakerCC StudentCC Self-EmployedPage 5 of 12 TDA 4286 A 01/227Co-Trustee InformationFull Legal Name:Date of Birth:Name Prefix (optional): CC Mr. CC Mrs. CC Ms. CC Dr. CC of Dependents:Home Address: (no PO box or mail drop)Mailing Address: (if different from above)City:City:State:State:Zip Code:Zip Code:Country:Country:Country of Citizenship:Country of Birth:CC Check here if you are NOT a of Dual/Secondary Citizenship (if applicable) citizens*: Do you hold a current immigration visa?

10 CC Ye s CC NoSpecify visa type:Visa Number:Expiration:Primary Phone number:C C Check here if this is not a phone numberSecondary Phone number:C C Check here if this is not a phone numberEmail Address (required for electronic delivery of your Account statement and trade confirmations):Fax number:Tax ID Number:Employer Name (If Self-Employed, provide the name of your business):Please choose from the list provided on page 12 the occupation code and industry of occupation code that most accurately describes your Code:Industry of Occupation Code:Employer Address:City:State:Zip Code:Country:* Nonresident aliens must submit a copy of a current passport and a copy of a bank or brokerage Social Security Number:ORPlease specify if you are:CC EmployedCC UnemployedCC RetiredCC HomemakerCC StudentCC Self-EmployedPage 6 of 12 TDA 4286 A 01/228 Trade Confirmations and Account StatementsI understand that I will receive monthly Account statements and trade confirmations electronically, unless I make a selection below.