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alified Plan (401k. 4038. PSP. etc.) Contra/Detwering Firm Emait ['Estate ❑SIMPLE IRA O SEP IRA Account Type (select one) 00ther. - (Non IRA) El Traditional or Rollover IRA aloint O Roth IRA IDTrust O Beneficiary IRA 0 Corp/Business O Beneficiary Roth IRA OUGMAIUTMA O Qualified Plan (401k, 4038,
red. X Roprosen five Signature: Representative Print Ne Date: 2-25-2olf For TD Ameritrade C Laing, I (use only Please be advised lh t M 'rade Clearing, Inc. is an Approved 403(b)(7) Vendor anctior hes eriIwe into an Information Sharing Agreement with the Et netuyer for the above-captioned 403(b)(7) acco
Social Security/1ex 10 Number: (Secondorx makable) Account Type (select one) — (Non IRA) ❑Joint K Trust ECorp/BusIness ❑UGMM)TMA K Estate El Traditional or Reamer IRA 0 Roth IRA 0 Beneficiary IRA K Beneficiary Roth IRA K Qualified Plan (401k, 403B, PSR etc.) ❑SIMPLE IRA K SEP IRA ❑Other: 2. PL
d. X RiokroKseniaUve Signatwi Representative Minted-Nang!' LMW .7.125/20m For TO Ameritrade CI fling, tE. use only Please be advised the TD uade Clearing, Inc. Is an 'Approved 403(b)(7) Vendor and/or has ent d into an Information Sharing Agreement with the Employer for the above.capdoned 403(b)(7) account
.NY10154 Can Ccara/Delivaing Rrm Email Account Type (select one) O Incrrviduai — (Non IRA) O Joint OTrust OcOrp/Buslness OUGMA/UTMA ['Estate El Traditional or Rollover IRA O Roth IRA O Beneficiary IRA O Beneficiary Roth IRA O Qualified Plan (401k, 4038, PSR etc) O SIMPLE IRA O SEP IRA 00ther if t
being trans erred. X Roprosen Signature: Representative RAI Na i ex,/ For TD Ameritrade C Ling, I (use only Please be advised th t M 'trade Clearing, Inc. is an 'Approved 403(b)(7) Venda' andror hes eryere into an Information Sharing Agreement with the Einott.ryer for the above-captioned 403(b)(7) acc
Entities connected to both El Traditional and Clearing, Inc.

Omaha
LOCATION
TD Ameritrade
ORGANIZATIONTrust Companies
ORGANIZATIONTD Ameritrade Attn
ORGANIZATIONLiquidation Transfer
ORGANIZATIONThe Toronto-Dominion Bank
ORGANIZATIONIndividual to Joint
ORGANIZATIONthe Tax ID
ORGANIZATIONORedeem
PERSONAmeritrade IP Company, Inc.
ORGANIZATIONSignature Guarantee
ORGANIZATIONMutual Funds
ORGANIZATIONNo Bank Guarantee '
ORGANIZATIONAmeritrade Clearing.
ORGANIZATIONTD Ameritrade, Inc.
ORGANIZATIONTD Ameritrade Clearing, Inc.
ORGANIZATIONMedallion Signature Guarantee
ORGANIZATIONSocial Security/Tax
ORGANIZATIONTD Amoritrade
ORGANIZATION