UTMA/UGMA Account Conversion Application-TDA 0321

1 Page 1 of 11 TDA 2690 A 03/21 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 UTMA/UGMA Account Conversion Application*TDA2690*If you have additional questions, please visit our website at or call us at Type1 Please choose one of the options below:If wanting to maintain this Account number at TD Ameritrade: CC Convert UTMA/UGMA Account into an Individual Account . (Complete Sections 1, 2, 4, 5, 6, 7, 8, and 11) Please submit a copy of the former minor s government issued photo ID and Social Security Convert UTMA/UGMA Account into a Joint Account . (Complete Sections 1, 2, 3, 4, 5, 6, 7, 8, and 11) Note: Former minor must be primary Account owner listed in Section 2 State laws vary. You should consult with a tax or legal adviser to determine if the Account ownership you wish to select is available in your state.

2 Please choose a joint Account type. If you are establishing a joint Account and do not check a box, the Account will be registered as Joint Tenants with rights of survivorship . If the Account owners do not qualify for the joint Account type selected, then the joint Account type will default to Joint Tenants with rights of survivorship . C C Joint Tenants with rights of survivorship (JTWROS). If a Joint owner dies, his/her interest passes to the other Account Owner (not available to residents of Louisiana). C C Community Property. AZ, CA, ID, LA, NM, NV, PR, TX, WA, WI residents only (spouses only). C C Tenants in Common - _____% Owner _____% Co-Owner (50/50, unless otherwise noted). If a Joint owner dies, his/her interest passes to his/her estate. Please submit a copy of the former minor s government issued photo ID and Social Security wanting to transfer assets into a different TD Ameritrade Account :CC Total Transfer to existing TD Ameritrade non IRA Account .

3 (Complete Sections 1 and 11) Note: Former minor must be listed as Account owner or co-owner of receiving Account . Account will be closed after the transfer is this form to convert a TD Ameritrade brokerage Account with Custodial ( UTMA/UGMA ) registration to a TD Ameritrade brokerage Account once you have reached the age at which your custodial relationship ends according to your state law. (Age of Termination)Do not sign or date until you have reached the appropriate UTMA/UGMA Age of accounts using the TD Ameritrade Investment Management, LLC Portfolios advisory service: The Account modification privileges in the margin, options, and check writing sections are not applicable to TD Ameritrade Investing Accounts using the advisory service of TD Ameritrade Investment Management, LLC and any responses in these sections will not be applied to your Account . In addition to this form, you must also fill out the Personal and Financial Information Form to update your Account with any changes in your financial situation or investment Number: Account Title: Page 2 of 11 TDA 2690 A 03/21 Account Owner (Former Minor & Beneficiary of UTMA/UGMA Account )2 Number of Dependents:Mother s Maiden Social Security Number:Date of Birth:Home Address (no PO box or mail drop):Mailing Address (if different from above):City:City:Primary Phone number:C C Check here if this is not a phone numberFax number:Secondary Phone number:C C Check here if this is not a phone numberState:State:Zip Code:Zip Code:Country:Country:Employer Name (If Self-Employed, provide the name of your business):Please choose from the list provided on page 11 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.

4 Email (required for electronic delivery of your Account statement and trade confirmations):First Name:Middle Name:Last Name:Name Prefix (optional): CC Mr. CC Mrs. CC Ms. CC Dr. CC Status: CC Single CC Married CC Divorced C C WidowedPlease specify if you are:CC EmployedCC UnemployedCC RetiredCC HomemakerCC StudentCC Self-EmployedAnnual 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+Page 3 of 11 TDA 2690 A 03/21 Section 2, Account Owner continuedCountry of Citizenship:Country of Birth:CC Check here if you are NOT a of Dual/Secondary Citizenship (if applicable):* Nonresident aliens must submit a W-8 BEN form, a copy of a current passport, and a copy of a bank or brokerage statement. If a address is listed, then attach a Letter of Explanation for Mailing Address/Phone Number Attachment for Form W-8.

5 This form can be found on the TD Ameritrade Forms Library: citizens*: Do you hold a current immigration visa? CC Yes CC NoSpecify visa type:Visa Number:Expiration: Account Co-Owner (Only Complete this Section if Converting the Account into a Joint Account )3 Number of Dependents:Mother s Maiden Social Security Number:Date of Birth:Home Address (no PO box or mail drop):City:State:Zip Code:Country:First Name:Middle Name:Last Name:Are you the Account Owner s spouse? CC Yes CC NoApproximate 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+What best describes the initial 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):What best describes the ongoing source of funds for this Account ?

6 CC Employment/WagesCC Retirement FundsCC GiftCC SavingsCC Inheritance/TrustCC InvestmentsCC Unemployment/DisabilityCC Legal SettlementCC Lottery/GamingCC Spousal/Parental SupportCC Other (describe source of funds):Name Prefix (optional): CC Mr. CC Mrs. CC Ms. CC Dr. CC Status: CC Single CC Married CC Divorced C C WidowedPage 4 of 11 TDA 2690 A 03/21 Section 3, Account Co-Owner continuedMailing Address (if different from above):City:Primary Phone number:C C Check here if this is not a phone numberFax number:Secondary Phone number:C C Check here if this is not a phone numberState:Zip Code:Country:Employer Name (If Self-Employed, provide the name of your business):Please choose from the list provided on page 11 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:Email (required for electronic delivery of your Account statement and trade confirmations):Please specify if you are:CC EmployedCC UnemployedCC RetiredCC HomemakerCC StudentCC Self-EmployedAnnual Income:CC $0-$24,999CC $25,000-$49,999CC $50,000-$99,999CC $100,000-$249,999CC $250,000+Approximate Net Worth.

7 (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+What best describes the initial 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):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 5 of 11 TDA 2690 A 03/21 Section 3, Account Co-Owner continuedCountry of Citizenship:Country of Birth:CC Check here if you are NOT a of Dual/Secondary Citizenship (if applicable):* Nonresident aliens must submit a W-8 BEN form, a copy of a current passport, and a copy of a bank or brokerage statement.

8 If a address is listed, then attach a Letter of Explanation for Mailing Address/Phone Number Attachment for Form W-8. This form can be found on the TD Ameritrade Forms Library: citizens*: Do you hold a current immigration visa? CC Yes CC NoSpecify visa type:Visa Number:Expiration:Affiliations4 Check here if the CC Account Owner or CC Co-Owner, their spouse, any member of their immediate families 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. Specify the company name, ticker symbol, address, city, and state:Trade Confirmations and Account Statements5I understand that I will receive monthly Account statements and trade confirmations electronically, unless I make a selection below. If I do not provide a valid email address, I will receive a quarterly paper statement or a monthly paper statement. Certain types of accounts or activity (such as options trading) require a monthly statement, either electronically or via mail.

9 I will be responsible for any fees that apply. Accounts with a total liquidation value of $10,000 or an average of five trades per month over a three-month period are eligible to receive free paper statement and confirmation I elect to receive either electronic statements or electronic confirmations, I will receive shareholder information electronically when here if the CC Account Owner or CC Co-Owner, their spouse, any member of their immediate families 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 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): Account Statement: CC Electronic MonthlyCC Paper Monthly ($2 fee may apply each month)CC Paper Quarterly ($2 fee may apply each quarter)Trade Confirmation:CC ElectronicCC PaperCC Unless I have checked this box, TD Ameritrade is required to share my name and address with the companies I invest in through your services so they may contact me directly about my investment.

10 If I direct you not to share, you will receive the information on my behalf and will forward it to me. Shareholder information includes proxy material, prospectuses, annual reports, and other corporate communications. In some cases, regulations may require sharing information with the companies in which I have invested despite this 6 of 11 TDA 2690 A 03/216 Investment ObjectivesFor definitions regarding investment objectives, please see page 10 of the the degree of risk you are willing to take with the assets in this Account :CC ConservativeCC ModerateCC AggressiveCC SpeculativeSelect the primary investment objective for the Account :CC ConservationCC ModerateCC Moderate GrowthCC GrowthCC Aggressive GrowthSelect the secondary investment objectives for the Account : (Check at least one or all that apply)CC ConservationCC ModerateCC Moderate GrowthCC GrowthCC Aggressive GrowthCC NoneSelect your liquidity needs for this Account : (Check only one that applies)CC Within 3 monthsCC 4 - 6 monthsCC 7 - 9 monthsCC 10 - 12 monthsCC More than 1 yearSelect the investment time horizon for this Account .