Account Modification Form - Online Stock Trading ...
Account Modification Form
Account # Account # Account #
Return Options:
Electronically via Message Center:
Log in and go to Client Services > Message Center to attach the file
Regular Mail: PO Box 2760, Omaha, NE 68103-2760
Overnight Mail: 200 South 108th Avenue Omaha, NE 68154-2631
Fax: 866-468-6268
Individual Retirement Accounts (IRAs) are not eligible to add a Co-Owner. Nonresident Alien Account Owners are only eligible for Joint Tenants with Rights of Survivorship (JTWROS) accounts. If you have additional questions, please visit our website at or call us at 800-669-3900.
Note: If adding account owner(s), the new owner(s) agree to be bound by any agreements, privileges, and/or features already established on the account.
Any account modifications indicated on this form will be applied to all of the above-listed accounts. If you do not intend for a modification to be made to all of the accounts listed above, you must submit a separate form for each account.
For accounts using the TD Ameritrade Investment Management, LLC advisory service: The 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 objectives.
1
Account Modification
C Add a Co-Owner. (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.)
State laws vary. You should consult with a tax or legal advisor to determine if the account ownership you wish to select is available in your state.
For residents of Louisiana, if married the account type will default to Community Property, if not married account type will default to Tenants in Common.
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 Community Property. AZ, CA, ID, LA, NM, NV, PR, TX, WA, WI residents only (spouses only).
C Tenants in Common
% Owner
interest passes to his/her estate.
% Co-Owner (50/50, unless otherwise noted). If a Joint owner dies, his/her
C Remove Co-Owner. Please complete Section 2. Do not sign in Section 11, and please only sign in Section 12. If the account has margin
and/or options privileges, please complete Sections 6, and 7. This form must be Notarized or have a TD Ameritrade Branch Stamp. We can accept mailed or faxed copies. Note: The primary Account Owner cannot be removed from the account.
*TDA189*
Page 1 of 11
TDA 189 F 03/21
2
Account Owner/Current Account Information
Name Prefix (optional):C Mr.C Mrs.C Ms.C Dr.C Rev.
First Name:
Middle Name: Last Name:
Marital Status:
C SingleC MarriedC DivorcedC Widowed
Email (required for electronic delivery of your account statement and trade confirmations):
Please specify if you are:
C Employed C Unemployed
C Retired
C Homemaker
C Student
Employer Name (If Self-Employed, provide the name of your business):
C Self-Employed
Number of Dependents:
Please choose from the list provided on page 11 the occupation code and industry of occupation code that most accurately describes your situation.
Occupation Code:
Industry of Occupation Code:
Employer Address:
City:
State:
Zip Code:
Country:
Annual Income:
C $0-$24,999
C $25,000-$49,999
C $50,000-$99,999
C $100,000-$249,999
Approximate Net Worth: (not including primary residence)
C $0-$14,999
C $15,000-$49,999
C $250,000-$499,999
C $500,000-$999,999
C $50,000-$99,999 C $1,000,000-$1,999,999
Approximate Liquid Net Worth: (cash, stocks, etc.)
C $0-$14,999 C $250,000-$499,999
C $15,000-$49,999 C $500,000-$999,999
C $50,000-$99,999 C $1,000,000-$1,999,999
C $250,000+
C $100,000-$249,999 C $2,000,000+
C $100,000-$249,999 C $2,000,000+
What best describes the ongoing source of funds for this account?
C Employment/Wages
C Retirement Funds
C Gift
C Savings
C Inheritance/Trust
C Investments
C Unemployment/Disability
C Legal Settlement
C Lottery/Gaming
C Spousal/Parental Support C Other (describe source of funds):
Page 2 of 11
TDA 189 F 03/21
3
Account Co-Owner Information
Name Prefix (optional):C Mr.C Mrs.C Ms.C Dr.C Rev.
First Name:
Middle Name: Last Name:
Are you the Account
Owner's spouse? C YesC No
Date of Birth:
Number of Dependents:
U.S. Social Security Number:
Marital Status:
C SingleC MarriedC DivorcedC Widowed
Home Address: (no PO box or mail drop)
City:
State:
Zip Code:
Mailing Address: (if different from above)
City:
State:
Zip Code:
Country: Country:
Primary Phone number:
C Check here if this is not a U.S. phone number
Secondary Phone number:
C Check here if this is not a U.S. phone number
Fax number:
Email (required for electronic delivery of your account statement and trade confirmations):
Please specify if you are:
C Employed
C Unemployed
C Retired
C Homemaker
Employer Name (If Self-Employed, provide the name of your business):
C Student
C Self-Employed
Please choose from the list provided on page 11 the occupation code and industry of occupation code that most accurately describes your situation.
Occupation Code:
Industry of Occupation Code:
Employer Address:
City:
State:
Zip Code:
Country:
Page 3 of 11
TDA 189 F 03/21
Section 3, Account Co-Owner Information continued
Annual Income:
C $0-$24,999
C $25,000-$49,999
C $50,000-$99,999
C $100,000-$249,999
Approximate Net Worth: (not including primary residence)
C $0-$14,999
C $15,000-$49,999
C $250,000-$499,999
C $500,000-$999,999
C $50,000-$99,999 C $1,000,000-$1,999,999
Approximate Liquid Net Worth: (cash, stocks, etc.)
C $0-$14,999 C $250,000-$499,999
C $15,000-$49,999 C $500,000-$999,999
C $50,000-$99,999 C $1,000,000-$1,999,999
C $250,000+
C $100,000-$249,999 C $2,000,000+
C $100,000-$249,999 C $2,000,000+
What best describes the ongoing source of funds for this account?
C Employment/Wages C Inheritance/Trust C Lottery/Gaming
C Retirement Funds C Investments C Spousal/Parental Support
C Gift
C Savings
C Unemployment/Disability
C Legal Settlement
C Other (describe source of funds):
C Check here if you are NOT a U.S. citizen.
Country of Citizenship:
Country of Dual/Secondary Citizenship (if applicable):
Country of Birth:
Non-U.S. citizens*: Do you hold a current U.S. immigration visa? C Yes C No
Specify visa type:
Visa Number:
Expiration:
*Nonresident aliens must submit a W-8BEN form, a copy of a current passport, and a copy of a bank or brokerage statement. If a U.S. address is listed, then attach a Letter of Explanation for U.S. Mailing Address/Phone Number for Form W-8. This form can be found on the TD Ameritrade Forms Library: .
4
Affiliations
Check here if the C Account Owner or C 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:
Check here if the C Account Owner or C 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):
Page 4 of 11
TDA 189 F 03/21
5
Investment Objectives
For definitions regarding investment objectives, please see
page 10 of
the form.
Select the degree of risk you are willing to take with the assets in this account:
C Conservative
C Moderate
C Aggressive
C Speculative
Select the primary investment objective for the account:
C Conservation
C Moderate
C Moderate Growth
C Growth
C Aggressive Growth
Select the secondary investment objectives for the account: (Check at least one or all that apply)
C Conservation
C Moderate
C Moderate Growth C Growth
C Aggressive Growth
C None
Select the liquidity needs for this account: (Check only one that applies)
C Within 3 months C 4 - 6 months
C 7 - 9 months
C 10 - 12 months C More than 1 year
Select the investment time horizon for this account:
C Less than 1 year C 1 - 3 years
C 4 - 6 years
C 7 -9 years
C 10-12 years
C 13 years or more
6 7
Current Margin Trading Privileges
If you are adding a Co-Owner to an account that already has margin privileges, the account will need to be re-reviewed for margin privileges. Please complete all of the financial information above. If any of the fields are left blank, there may be a delay in processing your request. Note: Duplicate like-titled margin accounts are not permitted. All qualified accounts are opened as margin accounts unless you decline margin privileges in this section. A margin account allows you to borrow from TDAmeritrade against certain securities as your collateral. A decline in the value of your securities may require you to provide additional funds, or force the sale of securities in your account. Selling short can expose you to potentially unlimited risk. To learn more about the potential benefits of margin borrowing and the associated risks involved, read the Margin Account Handbook and the Margin Disclosure Document located within the forms library:
C Check this box if you want to decline margin privileges and/or to remove margin privileges from the account if it already has them.
If you do not check the box, your account will be opened as a margin account if it qualifies. By submitting this Account Application without checking the box to decline margin privileges, you represent that you understand and agree that margin features are subject to the terms and conditions of the Client Agreement, which you have agreed to by submitting this Account Application. You understand and acknowledge that securities securing loans from TD Ameritrade may be lent to TD Ameritrade and lent by TD Ameritrade to others. You also acknowledge that if you trade "on margin" you are borrowing money from TD Ameritrade and that you understand the requirements and risks associated with margin as summarized in the Margin Account Handbook and Margin Disclosure Document.
Options Account
If you are adding a Co-Owner to an account that already has options trading privileges, the account will need to be re-reviewed for options trading. Please complete all of the information below. If any of the fields are left blank, there may be a delay in processing your request.
C Check this box to decline options privileges. If the account currently has options privileges, then checking this box will remove
options from the account, additional information may be required.
Page 5 of 11
TDA 189 F 03/21
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