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IRA account

Title: Return This Form - ********* - TD Ameritrade
TDA Form # OLA 186
Return This Form
Please follow the steps below:
  • Review the information listed on this form.
  • Make any necessary changes.
  • Sign the form.
  • Mail or fax this form to TD Ameritrade. (See last page for contact information.)
  • Include any additional paperwork.
Account information
Account type
Individual
Joint Tenants WROS (With Rights of Survivorship)
Joint Tenants in Common
Joint Community Property
Joint Tenants by the Entirety
Guardianship or Conservatorship
Traditional IRA
Roth IRA
Rollover IRA
Minor Roth IRA
Minor IRA
SEP IRA
SIMPLE IRA
529 College Savings Plan
Coverdell ESA
UGMA/UTMA
Trust
Limited Partnership
Partnership
Investment Club
Limited Liability Company
Sole Proprietorship
Corporate
Non-Incorporated Organization
Individual 401k, Pension or Profit Plan for Small Business
Foreign
Account number
I will primarily use my account to
New to investing false
Personal information
Full name ROBERT
Email address
Best daytime phone number ext.
Secondary phone number ext.
Citizenship status
Country of citizenship
Type of visa
Expiration date
Visa number
SSN/ITIN
Date of birth
Marital status
Mother's maiden name
Dependents
Home address
Mailing address
Employment information
Employment status
Business/employer name Edge_Spring
Occupation programmer
Employer address
Financial information
Approximate annual income
Approximate net worth
Approximate liquid net worth
Personal affiliations
Are you licensed or employed by a registered broker-dealer, securities exchange or member of a securities exchange? false
Employer name
Employer address
Are you or any member of your immediate family, or any of your personal or business associates a senior political figure? false
Senior political figure name
Political title
Country where title is held
Relationship to account owner
Are you a director, 10% shareholder, or policy-making officer of a publicly traded company? false
Company ticker
Company address
Client agreement
Please select your answer for each question.
Under penalty of perjury, I certify that:
  • 1.
    is my correct taxpayer identification number.
    Agree
    Disagree
  • 2.
    I am a U.S. person (including a resident alien); provided, however, if I am a nonresident alien as disclosed in this application, I do not certify that I am a U.S. person and I understand that I must submit a W-8BEN Form .
    Agree
    Disagree
If the Social Security number shown on this form is incorrect, please attach a completed and signed W-9 form when you send your application back to us.
Download W-9 form
I have received and read the "Client Agreement" and "Custodial Agreement" which are incorporated by this reference, that will govern my account. I agree to be bound by these agreements , as amended from time to time, and request an account to be opened in the name(s) set forth below.
The Client Agreement applicable to this brokerage account contains predispute arbitration clauses. By signing this agreement, the parties agree to be bound by the terms of the agreement including the arbitration agreement located in the Client Agreement.
I represent to you that:
  • I am the person identified in this account.
  • If I am a nonresident alien, I have "earned income" actually and actively earned within the United States.
  • I am accepting and agreeing to abide by all of the Client Agreement and "Custodial Agreement" .
The IRS does not require your consent to any provision of this document other than the certification required to avoid backup withholding.
_________________________________________________________________________
ROBERT 		_____________
Date
Account Number:
For Introducing Broker use only
_________________________________________________________________________
R.R. - Gen. Prin. 		_____________
Date
For TD Ameritrade Clearing, Inc. use only
_________________________________________________________________________
New Accounts Opened By(initial & date):
Mail or fax all the required paperwork to:
Fax: 1-866-468-6268 Questions?
Call us at 800-454-9272.
Regular:
TD Ameritrade, Inc
box 2760
Omaha, NE 68103-2760 		For additional information on how to fund your account, visit
www.tdameritrade.com/waystofund.html
Overnight:
TD Ameritrade, Inc
200 South 108th Ave
Omaha, NE 68154-2631
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