Reset Form BROKERAGE ACCOUNT APPLICATION Select an Account: Joint - type: Partnership - type: Custodial Individual Trust Estate Print Form IRA - type: Corporate - type: Qualified Plan - type: Conservator/Guardianship Applicant Information about the primary account holder - depending on the account type, this may be the minor, protected person, or organization (trust, corporation, partnership, etc.). Name of Individual/Organization - if an individual, list first, middle & last names Mr. Mrs. Ms. Primary Physical Address no P.O. boxes or mail receiving/incorporation services State City ZIP plus 4 Coverdell ESA Investment Club Update Acct #: Non-Corporate Org Co-Applicant Information about the secondary account holder - depending on the account type, this may be a custodian, trustee, trading officer/partner, or other authorized representative. Name First Mr. Mrs. Ms. Middle Last Primary Physical Address no P.O. boxes or mail receiving/incorporation services State City (legal residence) Account Mailing Address How did you hear about us? Internet TV/Radio Ad Print Ad News Article Already a Client Refer/Promo Code: ZIP plus 4 (legal residence) if different from home address; P.O. boxes may be used Account Email Address Phone Home check preferred Cell Social Security/Tax ID # Date of Birth Citizenship Information Phone Work check preferred Are you a U.S. citizen? No - complete next section Yes - skip to employment Country of citizenship: Are you a permanent U.S. resident? Home Cell Work Social Security/Tax ID # Date of Birth Are you a U.S. citizen? No - complete next section Yes - skip to employment Citizenship Information Country of citizenship: Are you a permanent U.S. resident? Yes - Alien Registration Number: No*- Visa type: Yes - Alien Registration Number: No*- Visa type: *If you will be in the U.S. 183 days or less, contact our International Department for assistance. *If you will be in the U.S. 183 days or less, contact our International Department for assistance. Employment Employed - list occupation: Unemployed Self-employed Employment Homemaker Student Employed - list occupation: Unemployed Self-employed Retired Employer Employer Employer Address Employer Address list occupation if self-employed Homemaker Student Retired list occupation if self-employed Yes No Is any applicant employed by or affiliated with a securities firm, a securities exchange, or FINRA? Yes No Is any applicant a control person or affiliate of a public company as defined by the SEC? This would generally include If yes, provide organization name and compliance department address: 10% shareholders, members of the Board of Directors, and policy-making officers. If yes, provide company's trading symbol and name: Yes No Is any applicant, member of immediate family, or business associate a senior foreign political official? Is this an Online Trading Account? Yes - Trade confirmations and monthly account statements are posted electronically. To receive paper copies, log into your account and access the "My Account" tab to change your document delivery settings (fees may apply). Mail or Hold No - Non-Internet commissions apply. Trade confirmations and monthly account statements are mailed free of charge. Sales Proceeds: Mail or Dividends & Interest: Hold Margin - sign Margin section below. Not available for IRAs, Custodial accounts, Coverdell ESAs, Conservatorships, Guardianships or Estate accounts. Additional Services Options - complete an Options Application** check all that apply Account Transfer: complete an Account Transfer Form** **Go to the Scottrade.com Forms Center, or contact us to have the form sent to you. Under penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). 2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, (b) I have not been notified by the IRS that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. If you are subject to backup withholding, cross out item 2. The IRS does not require your consent to any provision of this document other than the certification required to avoid backup withholding. 3) I am a U.S. person (including a U.S. resident alien). By signing this Application, I acknowledge that I have received, read and agree to abide by the terms of the accompanying Brokerage Account Agreement, which contains a pre-dispute arbitration clause on page 11, item VII-B. X Applicant/Authorized Person's Signature Date X Co-Applicant/Authorized Person's Signature Date Margin - sign below ONLY if you are applying for margin privileges *SF1000* SF1000/12-12 By signing this Application I acknowledge that I have received, read and agree to abide by the terms of the accompanying Brokerage Account Agreement, including the Margin Accounts provisions starting on page 8. X X Applicant/Authorized Person's Signature Date Co-Applicant/Authorized Person's Signature Date Page 1 of 2 For SAS Use Only Registered Principal *SF2361* P.O. Box 31759, St. Louis, MO 63131-0759 SF2361/6-11 TRADITIONAL INDIVIDUAL RETIREMENT ACCOUNT #100 (1/2009) ACCOUNTHOLDER INFORMATION DATE Type of IRA: Regular SEP Transfer Rollover NAME HOME ADDRESS STATE CITY (including a direct rollover from an employer’s plan) Recharacterization BUSINESS PHONE ( ZIP CODE HOME PHONE ( ) ) DATE OF BIRTH SOCIAL SECURITY NO. DESIGNATION OF BENEFICIARY(ies) The following individual(s) or entity(ies) shall be my primary and/or contingent beneficiary(ies). If neither primary nor contingent is indicated, the individual or entity will be deemed to be a primary beneficiary. If more than one primary beneficiary is designated and no distribution percentages are indicated, the beneficiaries will be deemed to own equal share percentages in the IRA. Multiple contingent beneficiaries with no share percentage indicated will also be deemed to share equally. If any primary or contingent beneficiary dies before I do, his or her interest and the interest of his or her heirs shall terminate completely, and the percentage share of any remaining beneficiary(ies) shall be increased on a pro rata basis. If no primary beneficiary(ies) survives me, the contingent beneficiary(ies) shall acquire the designated share of my IRA. No. Beneficiary’s Name and Address Date of Birth U.S. Social Security Number (required) Is this person a U.S. Citizen? 1. 2. 3. 4. 5. SPOUSAL CONSENT I am not married. Primary or Contingent Relationship Share % % Yes Primary No Contingent Yes Primary No Contingent Yes Primary No Contingent Yes Primary No Contingent Yes Primary No Contingent % % % % SIGNATURES Important: Please read before signing. I am married. This section should be reviewed if either the trust or the residence of the accountholder is located in a community or marital property state and the accountholder is married. Due to the important tax consequences of giving up one’s community property interest, individuals signing this section should consult with a competent tax or legal advisor. I am the spouse of the above-named accountholder. I acknowledge that I have received a fair and reasonable disclosure of my spouse’s property and financial obligations. Due to the important tax consequences of giving up my interest in this IRA, I have been advised to see a tax professional. I hereby give the accountholder any interest I have in the funds or property deposited in this IRA and consent to the beneficiary designation(s) indicated above. I assume full responsibility for any adverse consequences that may result. No tax or legal advice was given to me by the Custodian. I understand the eligibility requirements for the type of IRA deposit I am making and I state that I do qualify to make the deposit. I have received a copy of the Application, the 5305-A Plan Agreement, the Financial Disclosure and the Disclosure Statement. I understand that the terms and conditions which apply to this IRA are contained in this Application and the Plan Agreement. I agree to be bound by those terms and conditions. Within seven (7) days from the date I open this IRA I may revoke it without penalty by mailing or delivering a written notice to the Custodian. I assume complete responsibility for: 1. Determining that I am eligible for an IRA each year I make a contribution. 2. Ensuring that all contributions I make are within the limits set forth by the tax laws. 3. The tax consequences of any contribution (including rollover contributions) and distributions. I expressly certify that I take complete responsibility for the type of investment instrument(s) I choose to fund my IRA, and that the Custodian is released of any liability regarding the performance of any investment choice I make. X ___________________________________________ _________________ (Accountholder) (Date) ___________________________________________ _________________ (Authorized Signature of Custodian) _________________________________________ ___________________ (Signature of Spouse) (Date) (Date) Acceptance by Scottrade, Inc. ___________________________________________ _________________ The Plan shall be deemed to have been accepted by Scottrade, Inc. upon receipt of all necessary forms, properly completed. RETURN COPY WITH “SCOTTRADE BROKERAGE ACCOUNT APPLICATION” TO SCOTTRADE, INC. Page 2 of 2 (Date) ©2009 Ascensus, Inc., Brainerd, MN